MPs in the UK have warned that the country risks losing its place as a global leader in vaccination after the Health and Social Care Committee report on vaccination highlighted declining rates among children. A key concern within the report is that England did not meet the 95% target for any routine childhood immunisations in 2021/2022, the only nation within the UK to fall below target. The Committee suggests a more flexible delivery model for vaccination delivery to overcome practical challenges.
A major inquiry
The report from the Committee states that a “major inquiry” is underway to investigate prevention in health and social care. The inquiry comprises ten workstreams, of which vaccination is one.
“Vaccination is one of the most successful and cost-effective interventions to save lives and improve health. If the health and care system is to adapt to take a more preventative approach, vaccination is fundamental to that.”
WHO’s estimate that immunisation prevents up to 5 million deaths every year highlights the importance of maintaining high rates of vaccination. Although Minister for Mental Health and Women’s Health, Maria Caulfield MP, commented that the UK has “one of the most extensive immunisation programmes in the world”, there is uncertainty about whether the UK can sustain its leading role. From a perspective of vaccine uptake and vaccine development, this pole position is under pressure.
“If challenges around uptake and bureaucratic processes in clinical trial set-up are not addressed, there is a very real risk that the UK’s position as a global leader could be lost.”
Thus, the report outlines some steps to combat this risk.
Vaccine deployment and coverage
The report states that the UK’s routine immunisation schedule provides protection against 15 vaccine-preventable infections. The schedule begins at 8 weeks old and continues beyond 70 years of age. The Department of Health and Social Care (DHSC) has accepted WHO’s recommendation to strive for 95% of children immunised against vaccine-preventable diseases. However, NHS Digital data show that the target was not met in England during 2021/2022 across any of the vaccination programmes. The lowest level of coverage was for the DTaP/IPV booster at 5 years, with 84.2% coverage.
Furthermore, the report states concern at the RESULTS UK findings that “recent NHS data show that vaccine coverage fell in 13 out of the 14 routine programmes for children up to five-years-old in 2021-2022, and immunisation rates have been consistently dropping in recent years”. Readers may recall that days ago the UKHSA warned that, unless MMR vaccination rates improve, London could see a measles outbreak.
In June 2022, NHS England announced an “integrated vaccination and immunisation strategy” intended to design a future model to “maximise uptake, reduce unwarranted variation, and help people protect themselves and their families”. Within the strategy, the report identifies factors that will need to be addressed.
- Access and workforce
- Community groups and “trusted voices”
- Local delivery
Innovation and development
The report considers the UK’s clinical research environment, raising concerns about the risk to the UK international reputation. It quotes Moderna’s demand that “if the UK is to be a world-leading developer of the medicines of the future, the clinical trials system must be urgently reformed”. The Association of the British Pharmaceutical Industry (ABPI) found in October 2022 that “industrial clinical trial activity in the UK is at its lowest point to date”. The number of industry clinical trials initiated in the UK every year fell 41% between 2017 and 2021, with the strongest decline being in Phase III trials.
Ben Lucas, board member of ABPI, told the Committee that Spain currently appears a more attractive option for trials.
“For Spain it is about turnaround times and having legislation in place that allows and ensures your ability to execute a programme once you start it.”
To emphasise this, the Committee refers to Lord O’Shaughnessy’s review of commercial clinical trials in the UK, published in May 2023. This provided additional details on the experience of companies trying to establish clinical trials in the UK.
“We have heard from industry that the UK is viewed as an unreliable and unpredictable partner. Our approvals processes are theoretically competitive but inconsistent because of backlogs at the MHRA and unnecessary site-level approvals processes, which create delays.”
The review quoted a major global pharmaceutical company as complaining that of the 18 European countries in which it carries out its work, the UK was the second slowest for setting up clinical trials.
‘This is clearly unacceptable for a country with our resources and ambitions.”
Responding to this review, the Government committed £3 million to “rebuild capacity” and reduce turnaround time for all approvals, with a 60-day turnaround time goal. However, for the Committee, this will require a “watching brief” to encourage “swift” implementation.
Acknowledging a “great deal of development and innovation” in the area, with the potential to “transform prevention”, the report highlights the need to “futureproof” this space. It identifies the pipeline of vaccines as “exciting”, ranging from infections to AMR to cancer. For example, the partnerships with Moderna and BioNTech will encourage local research within the UK.
Speed of decision making
Moderna is quoted again, suggesting that “to support the shift to increasingly personalised therapeutics” it will be “vital” to “understand the regulatory requirements that will be needed to enable swift and safe approvals”. Not only the NHS, but regulatory and advisory bodies, will need specific focus on prevention. Moderna’s Stuart Carroll explained this in relation to the MHRA:
“The MHRA has great expertise, but it has some capacity problems…We need to keep investing in the MHRA…[it] has world-leading experts, but as we move into a more personalised healthcare space, we will need to add to that pool of expertise to ensure that we can approach that regulatory model in the best possible way.”
The JCVI also comes under scrutiny in the report, with a call to improve its modelling capacity. Professor Sir Andrew Pollard, Chair of JCVI, told the Committee that “very complex mathematical modelling” will be needed to provide the cost-effectiveness data that they need to show when understanding the effects of a vaccination programme in the NHS. He implied that the resource “has not been adequate” to date, describing it as a “major area” to accelerate innovation.
Delivery of innovations
As we see a shift to personalised healthcare, such as personalised cancer vaccines, delivery methods will need to adapt. Stuart Carroll is quoted again:
“We need to be in a position where we could do the diagnostic quickly in the healthcare setting…and send it to the manufacturer who can then sequence the genetic code…and then the manufacturer can quickly, almost Amazon style, in real time, with safety first always in mind of course, return it to the physician so that it can be administered to the patient.”
This will be a “different model” to “embrace”, suggests Carroll. With so many innovations emerging, future planning is required from NHS England, the MHRA, and JCVI, who should be ready to “play their part” in bringing these innovations to patients as quickly as possible.
Conclusions and recommendations
The report concludes with a repeated reflection on the importance of vaccination and the UK’s history as a world leader in this sphere. To achieve the “incredible success” of the COVID-19 vaccine rollout, the Committee witnessed a “mission-based attitude from Government”. One key element of this success was the “wide range of people” involved in delivering vaccination.
“To ensure that nobody misses out on vital vaccine protection because of practical challenges such as convenient times or locations, a more flexible delivery model, that makes the most of the wide range of healthcare professionals, is needed.”
For example, the report recommends a consultation on whether to allow medical and nursing students or recent retirees a “greater role” in delivery. Another important factor in the COVID-19 programme was national oversight, yet going forward with routine programmes, the role of Government and NHS England “must be limited to the more strategic, national level”.
“Local ICS leaders, public health directors, and health and care professionals have the best knowledge of the factors driving lower uptakes and the interventions needed to try and tackle that.”
The Committee welcomes NHS intention to establish an integrated vaccination and immunisation strategy, but calls for a “strong focus” on “practical challenges that limit access to vaccination”, an understanding of how to utilise a “wide range” of healthcare professionals, empowerment of local leaders, and “guidance and examples of best practice” to “voices other than NHS England can be used to communicate”.
MP Steve Brine is Chair of the Health and Social Committee and recognises that “vaccination is one of the greatest success stories when it comes to preventing infection”.
“However, unless the Government addresses challenges around declining rates among childhood immunisations and implements reform on clinical trials, the UK’s position as a global leader on vaccination risks being lost.”
“When it comes to developing the medicines of the future, it’s alarming to hear that industrial clinical trial activity in the UK is at the lowest point to date. One of the challenges is the slowness of bureaucratic processes to set up trials. This and other challenges must be fixed if we are to make the most of our world-leading academic and research expertise.”
What do you make of the report and areas explored; do you think the UK is on the brink of falling behind, or will it be able to restore its place as a “world leader”? Don’t forget to subscribe for more like this.