Intended for healthcare professionals

Rapid response to:


Haemophilus influenzae type b vaccine—booster campaign

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1158

Rapid Response:

Catch-up campaigns are a nightmare in practice

Heath and Ramsay raise the possible scenarios of regular "catch-
up"campaigns for vaccine-preventable diseases. Such campaigns have been
relatively successful but do result in considerable stress in primary
care. Regrettably those who decide on campaigns seem unable to talk to
those of us who have to administer the campaign and rely on the effects of
bribery to try and encourage compliance.
A Catch-up campaign requires a plentiful supply of vaccine, storage
facilities at the site of administration, an accurate database of cohort,
an understanding of the need for the vaccine, software developments to
allow the data to be entered on the vaccinee's clinical record and the
ability to chase-up defaulters. Time is also required to adminster the
call-up, educate the parent/vaccinee, administer the vaccine and undertake
the necessary administration
Not one of these essential requirements has been pre-planned in the
current campaign. Vaccine is being despatched to practices in pre-defined
inaccurate quantities on a weekly basis over four months. No additional
storage facilities have been planned. Child health record systems are not
integrated with practice databases resulting in inaccurate mail-shots.
There has been no obvious marketing of the vaccine and practitioners have
been suspicious of the need for an additional vaccination (particularly on
the back of the continuing lay-press led anti-vaccination lobby). Clinical
computer software firms were not pre-warned about the additional vaccine
and clinical systems have not been updated with the necessary Read Codes
which inihibits the data entry requirements of any new vaccine dose.
At a time of stress in primary care with inadequate practitioner numbers
and daily demands for change, other things have to "give" in order to find
time for additional work - money apart.
Yes, I fully agree that catch-up campaigns CAN be successful. However the
Department of Health needs to take Primary Care planning into
consideration before instituting such campaigns - it also needs to
consider the benefits and disadvantages of central vaccine supplies which
introduce an additional and significant inefficiency into the system.

Competing interests:  
None declared

Competing interests: No competing interests

30 May 2003
Nigel Higson
General Practitioner & Chairman Primary Care Virology Group
Brighton BN3 3DX