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MMR Vaccine

Volume 831: debated on Thursday 20 July 2023


Asked by

To ask His Majesty’s Government what further steps they will take to work with schools to encourage greater take up of the MMR vaccine among pupils.

The UK Health Security Agency is closely engaging with the Department for Education to boost uptake of the MMR vaccine, especially in areas with lower uptake. Earlier this month a messaging campaign to the education sector encouraged uptake among pupils, and an NHS England national MMR call/recall campaign between September 2022 and February 2023 reached approximately 940,000 parents and guardians and resulted in the delivery of over 160,000 vaccinations.

My Lords, I declare an interest as chair of the London Resilience Forum and as someone who contracted viral encephalitis as a child, albeit from mumps, not measles. Measles in children can cause death or serious disability. The increase in measles breakouts comes as research finds that the number of nurses in schools has dropped by 35%, with some local authorities scrapping the role altogether. Does the Minister believe that the decline in school nurses has contributed to falling MMR take-up in schools? Have the Department for Education and the Department of Health and Social Care set a joint target to achieve an uplift in the take-up of MMR, and what is it?

I do not necessarily believe that that is the reason for the reduction. What we saw during Covid, as with so many things, was a couple of years when people were not attending school so much and were not attending GP surgeries for their vaccinations. That is why we have had a series of catch-up campaigns, which are working. We are getting there, but clearly there is a long way to go.

My Lords, we learned from Covid that high-uptake vaccine programmes can be effectively delivered only with a firm foundation of high-quality data and surveillance. The UK measles and rubella elimination strategy set out by UKHSA commits to a target of rigorous case investigation and the testing of over 80% of suspected cases with an oral fluid test. Can the Minister update the House on our performance on surveillance so that we can get on top of falling vaccination rates?

I thank my noble friend. I was speaking to the senior epidemiologist at UKHSA just this morning about this. My noble friend is right to point out the concerns in this area. On exactly where we are on oral fluid testing, I will need to write to her.

My Lords, the NHS says that susceptibility is not just among the under-twos; it is particularly high among 19 to 25 year-olds whose parents were affected by the unfounded Wakefield stories two decades ago, and many may still not be vaccinated. What is the NHS doing to reach this cohort, including at further education colleges and universities, to ensure that they are fully vaccinated before they start their own families? Catching measles when pregnant can cause miscarriage, stillbirth, premature birth and low birth weight.

The noble Baroness is correct. The unfortunate Wakefield effect had quite an impact on that cohort of people, so the campaigns have been targeted particularly at specific communities in particular areas. Outreach campaigns are being done as part of that, looking at every area where it can be done. Sometimes that involves looking at colleges and sometimes it involves going specifically to community centres themselves.

My Lords, the Minister referred to outreach campaigns in relation to the take-up of MMR. Will that extend to children who are disabled and who are forced to be off school for certain periods of time to ensure that they are able to access their MMR vaccines?

Yes. This whole campaign is looking particularly at hard-to-reach communities. The concern is particularly in London. Whereas we have about 85% take-up across England as a whole, in London it is around 75%, so that is where the particular outreach is. That also involves looking at children who are not able to go to school or who are home-schooled.

My Lords, I welcome the catch-up campaigns that the Government are running. They are very welcome. I particularly note the campaign in London. As the Minister will know, there is variation across the country. The WHO stipulates that 95% is the target reach, yet we are at 89%. So how are those hard-to-reach communities, particularly the ethnic-minority communities, being targeted? The uptake is slightly lower in those particular areas.

There are two main approaches. If a child is under 11, we would prefer to have a parent present, for obvious reasons—because it involves a vaccination—so that is normally done through the primary care system, through nurses. Post 11, because you do not need the parent there, that is where schools really come into effect. In particular, there is a school-age assisted immunisation providers programme that goes into every school in a particular area, targets it and speaks to every child to see whether they have had their vaccination—and they can give it on the spot if they have not.

My Lords, does the Minister agree that the experience of both the MMR and Covid vaccination programmes shows that vaccine hesitancy is actually a very complex problem with multiple factors? Given the importance of high vaccination rates for public health, are the Government commissioning any research from academic experts in misinformation and disinformation so that we can understand what kinds of government campaigns will work and which ones will not and will only reinforce vaccine hesitancy?

The noble Lord is correct about trying to make sure that we learn the lessons from all these areas. The approach that they have been responding to so far is very much “horses for courses”. In the last six months alone, they have had four different types of campaign. We do not have the results from those campaigns yet, but the point is a very good one and I will make sure that we get those results from the research and share them.

My Lords, as my noble friend has referred to, it is very important that young people, children, get vaccinations when they are due, but the current government campaign to encourage adults to have a shingles jab, and indeed other areas, seems to point out—I have heard this from GPs—that the fact that adults are not now taking boosters for things such as tetanus, and other areas where vaccination is so important, means that there is a gap. Does my noble friend not think that we ought to do more to encourage adults to take up vaccinations, renewals and boosters where appropriate to safeguard their health?

Yes. That is where we really see UKHSA coming into its own in terms of taking an intelligence-led approach. The concern came from its modelling: its epidemiologists brought this up as a concern, which led to the alert going out on 14 July. Likewise, it is looking into other categories and, where there are those concerns, it will come out and suggest such outreach programmes.

My Lords, I refer to the question asked earlier by the noble Lord, Lord Young, about the high level of absence of children from school at the moment; I believe the present figure is in the order of 24%. What special steps are being taken there, where the appeal to the school will not make any difference yet we have to try to get to the homes of the individual parents?

As mentioned, there are outreach programmes, particularly for home-schooled children or children who are not there. There are also programmes in community centres, with the idea of trying to pick them up in as many places as possible. Obviously, there is concern about certain communities that are harder to reach than others. That is particularly the case in London, as I mentioned earlier. That is where we are trying to specifically target those community centres with outreach work.

My Lords, in April the UK Health Security Agency’s director of public health told the Health and Social Care Committee in the other place that the workload for delivering vaccines now falls disproportionately on general practices—particularly after the 2012 NHS reforms—and that this is one of the weaknesses we are trying to put back together.

In that context, the Minister may be aware of the issue around the quality and outcomes framework payment to GPs. GP practices in deprived areas are missing out on payments for delivering vaccines that could help them deliver more vaccines because it is extremely difficult for them to register the patients whom they have tried to contact multiple times when those patients do not respond. So, the GPs are missing out on payments they need to be able to reach those difficult-to-reach patients.

I am sorry, I am not quite sure what the question was there. Clearly, we need to make sure that the system is working in terms of making sure that the payments are there so the doctors can follow up. If the noble Baroness would like to follow up with me, so that I can fully understand it, I will get her a response.