New ILC report, commissioned by MSD, on routine vaccination in clinical risk groups in the UK.
This event will be chaired by Professor Emeritus David Blane, Imperial College London.
Speakers include:
Andrew Lane, Chair, National Pharmacy Association
Christina Marriott, CEO, Royal Society for Public Health
David Green, Nurse consultant for immunisations, Public Health England
Doug Brown, Chief Executive, British Society for Immunology
Jenny Lippiatt, Professionals and Practice Programme Manager, Age UK
Orin Lewis OBE, Co-Founder & Chief Executive, African Caribbean Leukaemia Trust
Patrick Swain, Research and Projects Officer at ILC and report author
While current guidance states that individuals with underlying health conditions should receive routine immunisations against vaccine-preventable diseases such as influenza (flu), pneumococcal disease and hepatitis B, uptake remains low. For example, only around half (53%) of people in a clinical risk group in England received the flu vaccine during the 2020/21 flu season. This is significantly lower than the WHO Regional Office for Europe target of 75%, with around 3.75 million at-risk people remaining unvaccinated against flu last winter.
As such, finding solutions to increase uptake in clinical risk groups and preventing potential excess morbidity and mortality is crucial. Through conversations with people in risk groups, condition-focused charities and medical experts, our latest findings highlight the current practices, barriers and potential solutions associated with immunisation. These discussions have informed our best practice guide aimed at equipping charities – who are seen as trustworthy and reliant by risk groups – with ideas on how to encourage routine vaccine uptake.
4. About ILC
• We are the UK’s specialist
think tank on the impact of
longevity on society, and
what happens next.
• We are one of the founding
members of the ILC Global
Alliance, an international
network on longevity with
members across 16
countries.
5. Summary
• Background – at-risk groups and vaccine uptake
• Barriers to routine vaccination in at-risk groups
• Recommendations to improve uptake
6. Research focus
• Research looks at 8 at-risk groups: asthma, CHD, CKD,
COPD, diabetes, HIV, leukaemia and myeloma
• Review of the literature and data on vaccine uptake in at-risk
groups
• Interviews with individuals from these 8 groups
• Conversations with 20 health-focused organisations
10. Has COVID-19 shifted attitudes?
46.7%
47.5%
56.7%
0%
20%
40%
60%
80%
100%
England NorthernIreland Scotland Wales UK average
Fluvaccinationuptakeforat-riskpeopleagedunder65acrosstheUK
2018/19 2019/20 2020/21
11. However, we are still way off target
56.7%
75.0%
0%
20%
40%
60%
80%
100%
England NorthernIreland Scotland Wales UK average
Fluvaccinationuptakeforat-riskpeopleagedunder65acrosstheUK
2018/19 2019/20 2020/21 WHOtarget
12. Barriers
What are the key challenges facing at-risk groups when it comes to
routine vaccination?
13. Research focus
• Our research found four key barriers associated with low
uptake for vaccination among at-risk people:
• Communication barriers
• Structural barriers
• Personal factors
• Accessibility issues
14. Communication barriers
• Vaccine misinformation
• Inaccessible information and poor communication
• Inconsistent messaging from some HCPs
15. Misinformation
“There’s an enormous amount of misinformation being shared, often on
WhatsApp…We wouldn’t necessarily see it directly, but you can see the impact
of it in refusal in some places.” (Kidney Care UK)
“There’ll be lots of patients out there who maybe are unsure [about
vaccines]…especially around COVID and the conspiracies…it will be
because the Government’s got a microchip in there.” (Person with CHD)
“I do think is that people's negative views are primarily based on
misinformation.” (Person with leukaemia)
16. Inaccessible information
“Whilst we are providing supportive information, it’s not necessarily
accessible…we are not reaching the whole of the blood cancer
community…people from different marginalised communities; who are less
digitally literate; who have less effective and supportive relationships with
their treating team.” (Blood Cancer UK)
“Information is available but the main issue, of course, is we only reach
those who reach out to us. There are many people that we don’t have
contact with, maybe underprivileged people – some socioeconomic and
religious groups – we simply don’t reach them.” (Leukaemia UK)
17. Inconsistent messaging
“Patients have told us when they go back to their GP, they’re saying, ‘Why
would we want to revaccinate you?’ Patients explain that their immune
system is very naïve; they’re starting from scratch. GPs are quite rightly
nervous about revaccination, because they might not 100% understand the
complexity…they’ve been through.” (Anthony Nolan)
“It’s a bit confusing when they’re like ‘Well, what’s your child’s name?’ ‘No,
I’m not booking in for a baby. I’m booking in for myself.’ The last one I had,
which was the pneumococcal jab, I had to talk the nurse through. She’s like,
‘But you’re 37?’ ‘Yeah, but I’ve had this treatment, so I need to have it. If you
look on my records, it says.’” (Person with myeloma)
18. Structural barriers
• Mistrust from historical structural racism
• Fear of stigma and discrimination
• Ethnic minorities and people living with HIV most affected
19. Low ethnic minority vaccine uptake
32.4%
39.7%
41.9%
58.5%
BlackCaribbean BlackAfrican Pakistani White British
Fluvaccineuptakeforat-riskpeople(16-64) byethnicity,England2020/21
20. Historical structural racism
“The structural racism and the mistrust element of [vaccine hesitancy]…is
huge, partly because nobody’s made any attempt to understand where
those sentiments come from.” (Asian Resource Centre Croydon)
“There’s lots of anxiety around not having enough diversity in clinical
trials…the majority of medical research is done on white…less diverse
backgrounds. This feeds into the scepticism.” (Diabetes UK)
“Given that HIV disproportionately affects people from BME groups,
perhaps a bigger issue is around trust in taking vaccines…levels of trust in
authority is lower in certain communities.” (Terrence Higgins Trust)
21. Stigma and discrimination
“Not all people will have told their GP about their status and that’s all to
do with stigma and discrimination. This has really come up recently with
COVID vaccines, that people have not been getting in the right category
because they haven’t declared their status.” (National AIDS Trust)
“We were concerned that people would miss out on the opportunity to have
a vaccine for purely the reason that they didn’t want to disclose their [HIV]
status, perhaps because of the stigma and discrimination they might feel
they would face if they did that.” (Terrence Higgins Trust)
22. Personal factors
• Needle phobias
• Time constraints and medical pressures
• Conflicts with personal beliefs
• Age
• A loss of body confidence
23. Needle phobias
“I suppose some people just don’t like the idea of taking stuff into their
body if they don’t have to…there’s that whole thing about needles; I don’t
find it frightening but I know some people don’t like needles.” (Person with
COPD)
“You’ve got that whole childhood fear of a jab: ‘I just don’t want that, I
don’t like needles, I’m not going, full stop.’” (Person with leukaemia)
24. Time constraints
“I think we’re all busy, aren’t we? If I’ve ever been guilty of not having my
flu jab straight away, it’s been because…something’s got in the way.”
(Person with asthma)
“You’ve got people who might be just getting on with their life, and they’re
just too busy, and they just don’t get it.” (Person with leukaemia)
25. Medical pressures
“Many patients have a complicated and difficult post-transplant
experience. They’re busy trying to…stay alive, as opposed to worrying
about when they should have their revaccination.” (Anthony Nolan)
“I was just exhausted [post-transplant]. If I think about how I felt, my
energy levels then, if someone had said, ‘You’ve got to go and have all
these jabs.’ I’d be like, ‘Do I?’” (Person with myeloma)
“When you’re in the clinic, you’re being told a million things; being told
about immunisation and you being expected to actually make that happen,
it’s probably the last thing on your list.” (National AIDS Trust)
26. Conflicts with personal beliefs
“Things like the ingredients of vaccines…if they’ve got animal protein, if
they’ve been tested on animals, also for religious beliefs…I think things like
that perhaps are a factor in why people wouldn’t [take vaccines].” (Person
with asthma)
“I think there have been questions around whether vaccines contain animal
products…for people of faith or people who have particular dietary
restrictions or needs.” (Terrence Higgins Trust)
27. Age
“I’d say 16 to 35’s will say ‘I don’t need that [vaccine], I know about diabetes,
I’m under control, I won’t have it.’ But when you start getting older…and it’s
[diabetes] not as in control, you get wiser. And you say ‘Well, what I’ll do is
I’ll have some safety net.’ So maybe that’s why [uptake is low].” (Person with
diabetes)
“Particularly younger adults who are in a risk group – they’re not believing
themselves to be at high risk.” (Asthma UK and the British Lung Foundation)
28. A loss of body confidence
“Leukaemia did come as a massive blow, and what that has
meant for me is a total loss of confidence in my own body.
Therefore, when you’re unsure and unclear about what’s
happening internally to yourself, why would you add something
else alien to that mix, because you actually then don’t know how
your body would respond anymore?” (Person with leukaemia)
30. Mobility barriers
“I never worried about physical accessibility with any of my
other jabs, but I did with COVID…I can’t stand for very long. I
can’t stand in a queue…like an hour-long queue, I literally
wouldn’t be able to, I’d have to sit on the floor.” (Person with
myeloma)
31. Appointment inflexibility
“It probably comes down to accessibility issues…about being
able to get an appointment at a time that works for you and
there’s not always a lot of flexibility in it.” (Asthma UK and the
British Lung Foundation)
32. Supply issues
“I always have the [flu] vaccine. I always attempt to get one – and I say
attempt – because they’re hard to get…I have to wait until the doctors have
got sufficient supply. I remember last year trying for weeks on end to get a
vaccine because the supply was so slow.” (Person with asthma)
“Some of them don’t get it because every single year, we run out of
vaccines. Therefore, they’ve had an appointment, there’s no vaccine, and
then they just don’t get round to rescheduling.” (Person with leukaemia)
34. Why charities?
• Trusted by at-risk groups
• Independent
• Specialist knowledge
• Tailored advice
• Key changemakers
35. Key opportunities
1. Improvedvaccination communications and information: targeted communications and
personalised messaging which speaks to at-risk individuals and their conditions
2. Closer community collaborations and partnerships: charities, community leaders, public
health groups and pharmacies working together to encourage vaccination
3. Easier access to vaccination for at-risk people: innovative solutions to make the process
better and more inclusive
45. The challenges
Need to empower the individual Need to engage with different concerns
of different communities
Need to remove barriers to access
46. The solutions – lessons from the pandemic
Need to empower the individual
Need to engage with different concerns
of different communities
Need to remove barriers to access
#CelebrateVaccines
#ExploreVaccines
Thanks Arun for that introduction and thanks to everyone for joining us today.
I’m going to start by introducing ILC, in case this is the first ILC webinar for some of our audience.
The International Longevity Centre-UK (or ILC) is the UK’s specialist think tank on the impact of longevity on society.
We’re focused on making society work for everyone, regardless of their age.
We are also one of the founding members of the ILC Global Alliance, which is an international network across 16 countries all focused on longevity.
So in my presentation today I’m going to start by talking about the context that lead to this project and some of the background data on routine vaccination in at-risk groups.
Then, I’m going to talk through some of the content of the report – namely the barriers to routine vaccination in clinical risk groups and our recommendations for improving uptake.
Before we get started, a bit of context about our research.
Our report focuses on eight at-risk groups: asthma, CHD, CKD, COPD, diabetes, HIV, leukaemia and myeloma.
Why these? Because people with these conditions are recommended routine vaccinations in the Government’s Green Book of Immunisation.
Firstly, we looked at the data and literature on uptake to build a picture of the current vaccine levels and people’s attitudes towards vaccines.
Then, to further understand the barriers and opportunities associated with routine vaccination, we interviewed eight at-risk people; one person from each group.
We also spoke to 20 organisations – mainly charities – to understand their perspectives about uptake in clinical risk groups.
So what does routine vaccination look like in those with underlying health conditions?
Current COVID-19 vaccine data shows that there has been very positive uptake among clinical risk groups.
The NHS England data on the screen is split into “at-risk or carers”, and “clinically extremely vulnerable” (people who have been told to shield during the pandemic).
Even though “at-risk” uptake is lower than the UK average, it is still incredibly high – around 4 in 5 at-risk people.
CEV uptake is 3% higher than the UK average, indicating strong awareness and willingness amongst this group to get vaccinated.
But despite this, uptake for other routine vaccines like flu and pneumococcal is much lower in clinical risk groups.
With the exception of diabetes, vaccine uptake remains around or below 50% for flu and below 20% for pneumococcal – average uptake figures in England are 53% and 17% respectively.
But has COVID-19 shifted attitudes?
When looking at UK flu vaccine data from the past 3 flu seasons, it seems like the pandemic has had a positive impact on uptake, with a 9.1% increase between 2019/20 to 2020/21.
Despite these increases, however, the UK is still almost 20% off the WHO flu vaccine target of 75% uptake.
While this target was reached last year in over-65s (with 82% uptake), the same cannot be said for clinical risk groups.
With the exception of Northern Ireland at 67.8%, England, Scotland and Wales were more than 20% below the WHO target.
As such, there’s still a long way to go with improving vaccine uptake in clinical risk groups, and understanding the barriers behind low uptake is crucial in order to change this.
So given that there’s a relatively low uptake in routine vaccinations among at-risk groups, what are the main barriers behind these figures?
Our research identified four key barriers associated with low uptake. These included:
Communication barriers
Structural barriers
Personal factors
Accessibility issues
Communication barriers can be broken down into three areas:
Misinformation
Inaccessible information and messages not being communicated effectively
Inconsistent messaging from some healthcare professionals
Charities and at-risk groups acknowledged that vaccine misinformation exists and could harm uptake – misconceptions about vaccination can cause some at-risk groups and communities to become more hesitant of taking vaccines
For charities, they expressed concerns that misinformation was being shared through channels that can be hard to monitor, such as social media platforms and forums.
While the at-risk people we spoke to were not “anti-vax” per se, they did state that misinformation could deter other at-risk people from getting vaccinated.
Charities acknowledged that although they are there to provide information, sometimes it isn’t reaching everyone.
This is particularly the case for marginalised and underserved communities, who aren’t always reached out to, represented in the comms, or made aware of the information that is available to them.
As such, some charities accept that not everyone is fully informed about vaccination.
Poor communication can also come in the form of inconsistent messaging.
While this was not the case for all groups, it was a particular issue for some cancer patients who had undergone a stem cell transplant.
We found that some medical professionals are hesitant to administer vaccines, given the compromised nature of their immune systems, as suggested by Anthony Nolan.
One individual with multiple myeloma who had undergone a SCT spoke about the difficulties booking their post-transplant reimmunisations due to these inconsistencies.
The medical professional they spoke to misunderstood their request and assumed they were booking vaccines for a child, reaffirming the misconception that vaccines are only for children.
In this instance, the lack of awareness and hesitancy made the process of routine vaccination harder for the patient, which could have been rectified with more consistent information.
Structural barriers can prevent some at-risk groups from accessing routine vaccination, especially ethnic minority groups and people living with HIV.
People from ethnic minorities are more likely to distrust the organisations who advise on and administer vaccination, due to historical structural racism, a lack of transparency and fears of discrimination.
Similarly, people living with HIV face stigmatisation and so may choose not to disclose their status, reducing their ability to access vaccination.
Uptake among certain ethnic minority communities is low, despite being disproportionately affected by underlying health conditions.
Flu vaccine uptake is significantly lower in some ethnic minority communities than White British people.
The graph on screen identifies 3 of the lowest ethnic minorities versus White British uptake.
Often, this low uptake is associated with a lack of trust and misgivings in the institutions who administer and advise on vaccines, due to historical structural racism towards ethnic minorities.
Hesitancy may also stem from scepticism in vaccine trials, which may not be representational – this feeds mistrust and a belief that vaccines are not effective or necessary in ethnic minority at-risk groups.
Other at-risk groups, such as those living with HIV, may be less likely to take vaccines because of a fear of stigma and discrimination.
Around 1 in 5 people living with HIV do not disclose their status to their GP because of these fears.
The HIV charities we spoke to expressed concerns that people living with HIV would miss out on the COVID-19 vaccine – and other vaccines – because of this.
Needle phobias, time constraints, conflicts with personal beliefs, someone’s age and a loss of body confidence can all undermine take-up of routine vaccination in at-risk groups.
One of the more common personal barriers to vaccination is fear of needles.
While the at-risk people we spoke to didn’t suggest that this would prevent them, they speculated that needle phobias may discourage others.
This barrier is not unique to at-risk groups, but it is still one which might affect some.
Secondly, not having enough time to book or attend vaccine appointments could impact uptake.
Time constraints were more often associated with having too many ongoing medical pressures.
This is especially the case for at-risk individuals with weakened immune systems.
Added medical pressures can sometimes become too much for people, meaning routine vaccination isn’t always prioritised.
Conflicts with lifestyle choices and faith beliefs were also mentioned as a potential barrier in some at-risk groups.
Vaccines may contain products that contradict these.
Someone’s age was also regarded as a potential barrier, especially younger people who might disregard vaccines as something which is unnecessary.
In fact, flu vaccine uptake is 13% higher in at-risk individuals aged 50-64 compared to the average uptake level for at-risk people aged 16-64.
Finally, one person with leukaemia suggested a loss in body confidence acted as a barrier.
They cited that they had lost faith in their ability to remain healthy, and as such, they thought vaccination wouldn’t have much effect.
Nonetheless, they did get the COVID-19 vaccine – again highlighting how the pandemic has changed some people’s attitudes on vaccination.
Finally, accessibility issues were seen as a potential barrier.
Physical barriers, such as mobility issues, prevented some respondents from reaching appointments.
Some charities also cited inflexibility of appointment times as a potential barrier to access.
We also found that supply issues prevented some from receiving seasonal vaccinations too.
Our findings suggested that accessibility issues sometimes stem from mobility barriers.
This was the case for someone with myeloma and their COVID-19 vaccine. Fortunately, they were able to get an appointment more locally, but this is not always the case for everyone.
Appointment inflexibilities could prevent people from getting vaccinated or could even put them off the process in the first place, as highlighted by one charity.
Finally, some at-risk groups mentioned how a lack of supplies caused them or others to be unable to receive routine vaccination.
With an increase in the number of people getting flu jabs since COVID-19, supply chain issues could become more common – something which has come up in the news recently.
Thus, ensuring demand is met for at-risk groups in the future is crucial.
So given these barriers, what are the opportunities to help increase uptake?
In particular, what can charities do to encourage and sustain uptake?
So, why charities?
Our research found that at-risk people regard charities as trustworthy and reliable.
Given their independence and specialist knowledge of health issues, at-risk people suggested charities were more approachable.
As such, we see charities as the key changemakers who are best suited to encourage at-risk people to seek routine vaccination.
We identified 3 potential opportunities to improve routine vaccination in at-risk groups. These included:
Improved vaccination communications and information, including tailored messaging to suit specific risk groups, encouraging peer-to-peer communication, and more signposting between charities and public health bodies
Closer community collaborations and partnerships, by working with community and faith leaders to disseminate information, and more cross-sector partnerships between the third and public sectors such as using joint social media campaigns
Finally, improving access can be achieved through innovative solutions, such as potentially collaborating with ride-hailing apps and lift services to get at-risk people to appointments and signposting to all the possible vaccine locations.
All of these recommendations have helped form part of our good practice guide, designed to equip charities with the tools to encourage and promote routine vaccination within the risk groups they cater to.
This can be downloaded for free from our website.
That brings a close to my presentation.
We welcome any additional thoughts and ideas, so if you would like to discuss any of this further or want to get in involved, please don’t hesitate to drop me an email using the address on screen.
Thanks very much.
