Intended for healthcare professionals

News News Analysis

Vaccination uptake: access is still biggest barrier, experts warn

BMJ 2019; 366 doi: (Published 17 September 2019) Cite this as: BMJ 2019;366:l5576
  1. Elisabeth Mahase
  1. The BMJ

Lack of access is still the main factor hindering vaccine coverage and must not be overlooked in the fight to increase uptake. This was the message delivered at the first ever global vaccine summit, co-hosted by the European Commission and World Health Organization.

Speaking at the conference in Brussels on 12 September, WHO’s director general, Tedros Adhanom Ghebreyesus, said that although there was a “serious problem of misinformation” and increasing vaccine hesitancy, especially in rich countries, access to vaccines remained the world’s “main problem.”

“Even in Europe children are dying from measles,” said Tedros in his speech calling for action. “This is a wake-up call. We were fighting it [measles], it was declining, but now it’s coming back and it could be with a vengeance.”

How much is access an issue in the UK?

In England in 2017-18 coverage of nine of the 12 routine childhood vaccinations, as measured at ages 12 months, 24 months, or five years, fell from the previous year.1 In 2018 the number of confirmed cases of measles rose to 991 in England and Wales, up from 284 cases in 2017. And in the first three months of 2019 more than 230 cases of measles were reported in the UK.2

This marked increase in reported cases led to the UK losing its measles-free status with the WHO, three years after it the virus was declared eliminated in the country.3

But surveys of vaccine attitudes have found that confidence is still high, with around nine in 10 people (89.9%) surveyed in the UK agreeing that vaccines were important for children, and 92% agreeing that vaccines were effective.4

Peter English, chair of the BMA’s public health committee and a consultant in communicable disease control for Public Health England South East, said that because vaccine confidence in the UK was still high, lack of access must be part of the issue. Nevertheless, much of the focus is on vaccine hesitancy, especially in media coverage.5

English said, “It’s very easy to point to antivaccine messages on social media and blame them for poor uptake. It saves having to invest in better systems to make it easier for parents to get to appointments with their children in tow, to ensure everybody gets an appointment at a time and place that works for them, that people who miss appointments are followed up, and that data systems reliably record all vaccinations given.”

He shared anecdotal evidence with The BMJ regarding situations where parents had to be persistent to get their children vaccinated, in the face of small barriers such as administration errors. Not everyone would be so persistent, he said.

“People certainly should not have to make an effort to get their children vaccinated, and a more proactive follow-up of those who miss a vaccination can make a big difference. Often, 90% or so of children are vaccinated, leaving only about 10% to chase up. It’s an effort but can be very rewarding,” English said.

What is being done to increase coverage?

A joint approach to tackle access and hesitancy is needed, experts have concurred. At the global vaccine summit the EU Commission and WHO unveiled 10 “actions towards vaccination for all.” Several focus on overcoming barriers to access, including ensuring that all countries have financially sustainable national immunisation strategies and that risks of vaccine shortages are mitigated through “improved vaccine availability monitoring, forecasting, purchasing, delivery, and stockpiling systems.”

The summit also recognised the importance of countering misinformation. It called for the root causes of vaccine hesitancy to be tackled and for all healthcare professionals and the media to provide “effective, transparent, and objective information to the public and fight false and misleading information, including by engaging with social media platforms and technological companies.”

Meanwhile, in the UK, recent concerns over a decline in coverage of the measles, mumps, and rubella vaccine led the prime minister to urge health leaders to try to increase uptake of both doses of the vaccine.6 As part of this effort NHS England has written to GPs urging them to promote catch-up MMR vaccination programmes for 10 to 11 year olds, as well as all those aged between 5 and 25 who have not had two doses.

Boris Johnson also said that the role of local immunisation coordinators would be strengthened, as they were effective at promoting vaccines to hard to reach families, although details on what this meant in practice were lacking.

Additionally, Johnson said that parents’ concerns about vaccines should be dealt with by updated NHS website advice that specifically countered misleading information about the dangers of vaccines. He also called for a summit of social media companies to discuss how they could play their part in promoting accurate information about vaccination.

Facebook already has an initiative to counter misinformation in many countries, including the UK, where Full Fact, an independent fact checking organisation, has been working to correct Facebook posts on vaccination and other health issues.7


View Abstract