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National Immunisation Programme

Volume 835: debated on Thursday 18 January 2024

Question for Short Debate

Asked by

To ask His Majesty’s Government what plans they have to accelerate the adoption of new innovative vaccines by the National Immunisation Programme.

My Lords, I was delighted to secure this debate as it is a subject of significant importance and one in which I have a close interest. Noble Lords will be aware of my particular interest in RSV, on which I had a Question only yesterday. But this is more about the global issue of which vaccines can get accelerated on to the national immunisation programme.

Undoubtedly, vaccines have contributed significantly to health and prosperity around the world ever since the pioneering work of Edward Jenner, who developed the world’s first vaccines for smallpox. The World Health Organization has said that vaccinations are

“one of the best health investments money can buy”.

Vaccines are critical to the prevention and control of infectious disease outbreaks, and they underpin global health security.

The Covid-19 pandemic imposed enormous pressure in 2020 and 2021, and it showed the importance of having robust plans and systems in place to address emergencies. Despite some setbacks, what both the UK and other countries achieved was remarkable. The pace at which vaccines were developed, manufactured and rolled out to patients was excellent. It was good that government, industry and the NHS came together to collaborate in order to accelerate existing timetables, taking months rather than years to get the job done.

I welcome the recently published NHS Vaccination Strategy and its emphasis on improving uptake rates and optimising the quality of the delivery of clinical trials. However, the strategy focuses on the better rollout of existing vaccines but does not include what more can be done to ensure that the UK has in place the right infrastructure for approvals and delivery, in order to enable new vaccines to reach patients as quickly as possible. I believe this is a mistake: we should focus on both. Put simply, we must improve the delivery of existing vaccines and spend existing money more effectively and efficiently in order to get new vaccines to patients more quickly and effectively. In fact, I received briefings this week from the Royal Pharmaceutical Society about the value of community pharmacies—their work had already been seen in the rollout during Covid-19—and how they can be used in this new deployment.

I was delighted recently to chair a round-table discussion with key stakeholders, hosted by GSK in your Lordships’ House on 19 October. It looked at this issue, lessons learned from Covid and how they could be applied to the national immunisation programme as we move forward. That discussion was very timely, following the Health and Social Care Committee’s report on vaccination, in which it said:

“It would be incredibly disappointing to reach a point where the vaccines themselves were ready but the infrastructure to approve and deliver them was still some time away”.

Our round table concluded many things, such as that quicker availability and increased uptake of vaccines would lead to a healthier nation, which in turn would have direct and immediate benefits for our economy.

Rather than looking at vaccines as a cost, we should see them as an investment. Recent studies have shown that the return on investment for vaccines can be as high as 14:1. Slow and low uptake of vaccines can cost the NHS money and soak up valuable resource. Each month that vaccine rollout is delayed means more patients attending general practice and A&E, and being there for hours on end, as well as more patients being admitted to hospital.

Working together, the Government, the NHS and industry can deliver a first-class national immunisation programme that gets new vaccines to patients as quickly as possible and delivers significant financial, operational and economic benefits. At a time when the Prime Minister has said that reducing waiting lists is a key priority for his Government, we must not forget the role that vaccines can play in helping to deliver this. I hope the Government are listening and will act. I am happy to share the round table’s report and its key recommendations with Members of your Lordships’ House, but we must turn words into action. We should be ambitious for patients, because we want to deal with all the health implications. We also want to address the new diseases that have not been subject to vaccines and could be readily dealt with.

We need a clear commitment from the Government to accelerate the NIP, and a clear and timetabled plan to achieve that. We need a commitment to work with industry and other stakeholders to deliver that plan. We must not let capacity or capability determine the speed at which vaccines enter the programme. That will mean a commitment to resourcing the JCVI adequately, and we need to improve JCVI horizon scanning and the liaison with industry. As we did during Covid-19, we should also establish a single front door to help industry navigate across government on routine vaccines.

I have some questions for the Minister. Will he give concrete commitments today to ensure the acceleration of the NIP, with a clear and timetabled plan to achieve it, and to work with industry and other stakeholders to develop that plan? If such commitments are given, can the Minister provide us with the timetabled plan, including an indication of the resources—staff and money—to deliver it? I know that there are many competing priorities for the Government, but there are also many for the National Health Service, not least the need to keep people well. However, these recommendations are all based on valuable lessons learned during Covid. I therefore seek your Lordships’ support for delivering them, as they will benefit patients, the NHS and the economy.

The UK built a world-leading vaccine development and deployment system during Covid-19 that enabled it to be at the forefront of global pandemic efforts. It is vital that the lessons learned during the pandemic are built on, to ensure that the UK has the right infrastructure in place for the approval and delivery of new vaccines on to the NIP, reaching patients as quickly as possible. We have the proven wherewithal to do it through the NHS and all the associated bodies.

Finally, when will the acceleration and accompanying works for NIP take place, and when will the funding be in place? I look forward to the Minister’s response and the contributions of other noble Lords on this very important issue, which impacts right across the UK. It relates specifically to NHS England, but I come from Northern Ireland, where this is a devolved matter. I am sure Scotland, Wales and Northern Ireland would like to do the same and see these approvals on to the national immunisation programme. It is vital for our health, our economy and our society.

My Lords, I thank my noble friend Lady Ritchie for securing this debate. I declare an interest as the chair of the London Resilience Forum and vice-president of the Encephalitis Society, a charity that advocates the use of vaccines for prevention of encephalitis.

Like my noble friend, I feel very strongly about vaccination and access to it. I would not normally use my own life story to back up a point in a debate but it feels appropriate to do so on today’s subject. As a teenager, I got mumps. It was very mild and nobody was particularly concerned. In those days it was treated as another childhood sickness that it was helpful for children to pick up at some point. The routine vaccine was introduced just a few years later as part of the MMR suite of vaccines, but it was not available at that time. Over the course of the few weeks after my mild dose of mumps, I became increasingly ill, and after several weeks of acute illness I was diagnosed with viral encephalitis, an inflammation of the brain. I am one of the lucky people who has contracted encephalitis but had a good recovery, with very few lasting effects. In the worst-case scenario, encephalitis can kill or cause brain damage or severe long-term disabilities.

Had MMR been available to me as a child, I would not have had this serious illness, which severely impacted my health throughout my teenage years and into my early 20s. Childhood vaccines save lives, limit disabling side-effects and prevent serious illness, but we do not yet have all the vaccines available that could do this.

We know that chickenpox can also lead to viral encephalitis or other complications, including death. I am delighted that the JCVI now recognises the life-saving potential of the varicella vaccine. I pay tribute to all those who have been campaigning on this issue over many years, including Professor Benedict Michael from Liverpool University, to whom I had the pleasure of speaking about this issue earlier this week. As noble Lords are probably aware, the varicella vaccine is routinely used in other countries, such as the USA, where it has been part of a suite of childhood vaccines since the 1990s. Other developed countries use it, including Italy and Israel. As the chair of the JCVI, Professor Sir Andrew Pollard, has said:

“Adding the varicella vaccine to the childhood immunisation programme will dramatically reduce the number of chickenpox cases in the community, leading to far fewer of those tragic, more serious cases”.

I understand that one of the arguments used previously against the introduction of the varicella vaccine has been a general belief in the UK that having some chickenpox circulating in the population provides greater immunity to older people at risk of shingles or shingles encephalitis from the virus. We should have evidence-based medical interventions. There is no evidence of higher rates of shingles or shingles encephalitis in older people as a result of childhood vaccination against varicella over the past 30-plus years in the States. Now that older and more vulnerable people are routinely offered a vaccine against shingles, which I welcome, this herd immunity argument should be discarded as the outdated argument that it is and confined to the past. Does the Minister agree with this position, and that chickenpox parties, which, shockingly, still take place, belong to the Victorian era and should also be confined to the past?

Can the Minister tell us whether and when the Government are planning to introduce the varicella vaccine? If he cannot, can he say when the Government are likely to take a decision on this issue? If the vaccine is added to the suite of childhood diseases that parents and guardians are encouraged to take up on behalf of children, how will the Government increase public health messaging to ensure that they understand exactly why this is needed?

Tragically, it is not just new vaccines that require public health messaging. In recent days we have heard of measles outbreaks in the West Midlands. We know that vaccine take-up is not uniform across social demographic groups. Can the Minister say how the department is addressing this and making sure that the current outbreak does not disproportionately impact specific groups?

Regrettably, the false claims about MMR are still causing vaccine hesitancy among some parents, and a whole generation of children, who are now young people, are undervaccinated. I raised the low take-up of MMR in London with the Minister last year and am grateful for his response at the time. I was pleased to hear from the UKHSA in London about work that is being done to ensure that MMR vaccines are available to students.

I appreciate that the Minister may not have this information to hand, but will he commit to looking into this work to ensure that this type of initiative is taking place across the country? Are there similar initiatives for other groups of adults who may have missed out? Will he commit to making sure that every effort is made to push back on the continued false claims or rumours about the MMR vaccine?

My noble friend mentioned the RSV vaccine. As noble Lords will be aware, this virus is the major cause of babies and young children having to be admitted to hospital, with more than 33,000 admissions every year, including 20 to 30 avoidable and tragic deaths of otherwise healthy children. Can the Minister commit to a timeline for introducing the vaccine for this age group? We know that RSV affects older people too and leads to an estimated 175,000 GP visits, 14,000 hospital admissions and 8,000 deaths among people aged over 60 in the UK every year. These are not insignificant numbers.

The House of Lords Library Note helpfully outlines the range of vaccines currently available. Missing from this list is the Covid vaccine, which over the past few years has saved innumerable lives and reduced the already frightening number of people suffering from long Covid. We know from recent reports that by June 2022 only 44% of the population had taken up their recommended number of jabs and boosters. In the early stages of the vaccine programme, a huge amount of cross-sectoral effort went into tackling disproportionate uptake in the face of considerable organised disinformation about the vaccine. What learning have the department and the NHS taken from that effort during the pandemic? How can and will that be applied to ensure that take-up improves to prevent future serious impacts of Covid, where possible, including preventing avoidable deaths? Will the Minister tell us when we will know what the long-term plans are for continuing to offer Covid vaccinations as part of a suite of vaccines offered to older and vulnerable people? Are the Government planning to include vaccines against RSV for these groups? Returning to the Covid vaccine, I ask: will the Government allow and perhaps encourage the commercial provision of Covid vaccines in future, as is the case with the flu vaccine, which is readily available in pharmacies?

My final point is on investment in science and technology. I think we are all proud of the ground-breaking work of British scientists in the fight against Covid. It was an unprecedented achievement in terms of the speed of the development and delivery of a new vaccine, as my noble friend Lady Ritchie stated. Can the Minister say what planning the department is undertaking to ensure that we use this generation’s success to inspire the next generation of epidemiologists and what investment it is planning to do this? How is he working with colleagues in other relevant departments to ensure this is possible? As I am sure noble Lords have gathered, this is an issue I feel very passionately about. I look forward to hearing the Minister’s response to this debate.

My Lords, I am extremely grateful to the noble Baroness, Lady Ritchie, for both the opportunities she has provided us with to debate vaccination this week. The bulk of my remarks will follow closely the comments made by the noble Baroness, Lady Twycross, but first I want to follow up on the RSV Question yesterday. The Minister’s Answer made me rather more nervous than reassured. I asked who was going to be responsible for the RSV vaccination programme and he described a landscape in which there are different teams dealing with infants, children, old people and so on. I do not want to be mean to the Minister because I know he is struggling through a cold while turning up to debate these issues and I am hesitant to correct him, but I wonder whether the correct answer actually is that Steve Russell, the chief delivery officer of NHS England and the person responsible for vaccination screening, is the person whom we should praise if the RSV programme is rolled out well or hold accountable if it is not. It seemed to me as I looked at it that Steve Russell may be the name I was looking for as the single responsible owner for that programme.

In terms of my broader comments, there are three areas that I want to touch on. The first is access to vaccination and immunisation records where any individual wants to understand what they or their children have had and where the gaps are. This still leaves a huge amount to be desired. Again, we saw an example during Covid of how this can work well. Everybody had an immediate interest, not least related to travel and access to facilities, in getting hold of those records; we produced them in double-quick time, and they are still there today. However, if you go beyond that and try to find your broader vaccination and immunisation records, it is a mess. I went online to look for it and found Connected Nottinghamshire, which helpfully offered some advice. That advice is multiple screenshots saying go into the NHS app and click on “consultations and events” or “medicines” and various other routes through, and they all basically end up telling you to go back and ask your GP. That is a super inefficient use of a GP’s time.

We have done all this work with the NHS app—take-up was boosted dramatically though the Covid vaccination certificate programme, we have invested a huge amount in it, and we now have medical records accessible through it—but, unless the Minister can correct me, it seems that, in most of the country, if an individual says, “I want to see what vaccinations I have had and what is missing”, they will not be able to do that. There is no simple, straightforward way to do it. I hope that the Minister can talk about whether the Government have a programme to enable that to happen, as it seems a very basic and fundamental thing. Knowing that information can help to boost take-up rates, which is what we are looking for. If people can see the gaps, they are much more likely to try to fill them.

The other part of that is integration with other sources of vaccination and immunisation. Obviously, there are travel vaccines, most of which are, correctly, not offered by the NHS; they are seen as a voluntary thing that individuals should pay for. However, if they have paid for a travel vaccine, there is an interest for the individual and a broader public health interest to make sure that that is integrated into their medical records. That is not the case today. There may also be workplace vaccinations. A lot of workplaces offer flu programmes. Other noble Lords may have had this experience: I took up the flu vaccine here, at our workplace, and was then pinged every few weeks by a reminder from my GP practice to come in for a flu vaccine, and I would go back to it saying, “I’ve had it”, and it would say “We don’t know that you’ve had it”. There is clearly a lack of joined-up connection there. This year, I went to have it done by the GP just to make sure I did not get those reminders every week. If workplaces have gone to the trouble of putting in place vaccination programmes, the least that we could do is to integrate those into NHS records. There are models, such as Patients Know Best, that allow you to integrate your own personal health data, and I hope that the Minister can indicate that there is some work going on in government to make sure that we follow that kind of model and bring this all together.

The second area that I am interested in is around invitations to participate in programmes and how those information flows work. Again, Covid was a model of clarity: you knew what you were getting and why you were getting it. The invitations went out to people using lots of modern channels, which made it very easy. People learned the language of Covid vaccination—“Are you getting a Spikevax or a Pfizer?”—but it was a very rare and exceptional situation. If you look back at the norm, the norm is that it is very confusing. The NHS produces a nice chart of all the vaccinations that you will get, but it uses jargon and abbreviations. I understand why—those are the accurate terms—but, for an ordinary person coming across this, they really are not very clear about what they are getting, why they are getting it and why it is important for them.

Again, I do not think that this is just in the area of vaccinations. I cite my personal experience: I got a text message from my practice asking if I wanted to come in for AF screening. As I am a health spokesperson in this place, I thought “I should know what AF is”. I looked it up and it stands for atrial fibrillation. If it had sent me a message that said, “We want to check that your heart is ticking over as it should; please pop in”, it would have been a lot more attractive than one asking if I wanted to come in for AF screening. I think most people will not have bothered to look it up and decide whether they should have it. I hope that the Minister can say who is looking at both the language of and the distribution channels for all these invitations for vaccinations and immunisations to make sure that they are optimised. To people working in the tech sector, this is known as UX—user experience—and they understand that changing the language on something changes the click-through rate dramatically. Similar discipline is needed here to make sure that all the invitations to vaccinations and immunisations are optimised for the target audiences and make them as likely as possible to click and to go and get that vaccination.

There is a generalised problem with distribution channels in the NHS that each screening programme has its own systems for call and recall, and they are not co-ordinated or joined up. If we want take-up of screening, vaccination and immunisation, the least we can do is to join up those programmes, have consistency around language and channels and some kind of pattern and schedule so that people understand what they are being invited for and when. I hope the Minister comments on consistency and co-ordination.

The final area on which I will touch is that of risk. This again follows the comments of the noble Baroness, Lady Twycross, and this is critical to take-up. MMR showed us how this can go off course. People weighed a risk that turned out to be false against a genuine and much more significant risk of suffering from a real disease. The noble Baroness’s personal comments showed us just how important it is that people take up these kinds of vaccinations. The result was a situation in which children have been harmed and not benefitted, which is still ongoing today. There will be children catching measles now, some of whom will, sadly, have very serious complications, essentially because of a false assessment of risk: the risk of MMR against the so-called, supposed risk that people presented on the other side. In some ways, this is comparable to people switching to driving every time there is a train crash. The data is clear: the train is safer than the car at all times. People often react to a single incidence of a problem. With a vaccine, as we saw with Covid, there will be somebody who has a heart attack following a vaccination, but that does not mean that the risk of not having the vaccination is better than the risk of having it. It just means that one person, sadly, had a heart attack.

There is a lot to be done on communicating risk. We need continually to help people to understand the rationale for each vaccination programme, not just the new ones but existing ones, as MMR has shown. I would be interested in understanding what the Government are doing to address this challenge, particularly considering the different levels of trust that different messengers have. We all understand that doctors, for example, are far more trusted than politicians like us. Pharmacists have a very trusted role within the community. We need to think carefully about how we communicate risk and use the most trusted sources.

I again thank the noble Baroness, Lady Ritchie, for this opportunity, and I hope that the Minister will refer to the points I have raised, perhaps in writing, to spare his voice, if he cannot respond to everything verbally today.

My Lords, I add my congratulations to my noble friend Lady Ritchie, who is as we all agree a great champion for better health through greater take-up and availability of vaccines and immunisation programmes. She rightly described them as a sound investment by the NHS, and I certainly agree.

There are two main issues at play: first, the failure of already approved and recommended drugs to be included in the national immunisation programme and, secondly, the number of factors that have slowed down how long the whole process takes. It potentially takes around a decade to pass through every stage of trial and approval and two years or more for a new vaccine to reach patients post regulatory authorisation.

I am sure that we all want vaccines to be available to patients quicker and to see full account taken of patient safety and cost effectiveness. It seems to me that the way forward is to emphasise systemic options to improve availability without sacrificing the necessary safeguards.

Like other noble Lords, I am grateful to the many stakeholders who have conveyed their views to me on how to accelerate the adoption of new innovative vaccines by the national immunisation programme. Their main suggestions for tackling these damaging delays focus on ensuring that the overall system works better while adapting to additional risk, perhaps in extraordinary circumstances, such as those we saw in the Covid pandemic.

But it bears pointing out that this is against the backdrop of a step in the wrong direction, which we have heard about, such that, due to a decade of declining rates of uptake of the MMR vaccination among preschool children, for example, the UK no longer has the status of having eradicated measles, according to the World Health Organization. This is borne out by Steve Russell, whom the noble Lord, Lord Allan, referred to; he is the chief delivery officer and national director for vaccinations and screening at NHS England. He highlights a decline in vaccination-programme uptake, particularly for childhood vaccinations, in the foreword to the NHS England strategy.

I thank my noble friend Lady Twycross for bringing before us the importance of childhood vaccination. She brought it into focus by sharing her own story, for which I am sure we all thank her, but her call for evidence-based intervention and for ensuring coverage by immunisation programmes surely must be heeded. It would be helpful to hear what discussions continue to take place across government about tackling misinformation and disinformation about MMR and other vaccines, which we obviously still see proliferating on social media.

I will put a few points to the Minister about the much-needed improvement of the UK’s performance in immunisation development and delivery. We heard from my noble friend Lady Ritchie about the GSK-hosted round table, which she kindly chaired. I noticed that she described the response during the Covid-19 pandemic as “remarkable” and I endorse her comments. That response magnified the value of vaccines to individuals, health systems, society and the economy, and it is absolutely vital to embed the lessons that were learned before they are lost, as she said. So I amplify the points made by my noble friend, because it would help to hear from the Minister about what lessons the Government have learned from the pandemic, what assessment they have made of the potential value of each of those lessons and what steps are being taken, at the very least, to assess the potential benefits from continuing in that manner, but ideally to take action to embed in the system all the good practice from which we have learned.

Within this, I echo the call for pharmacies to be complimented for rising to the challenge during the pandemic. They continue to play an increasingly key role in providing advice and healthcare, including convenient and accessible vaccination services. Does the Minister consider that community pharmacies can play an even larger role in immunisation programmes by expanding the range of vaccines that they can offer, including those for shingles, RSV and pneumonia? What steps are being taken to marshal the forces of community pharmacies and expand their potential as community well-being hubs?

The second point is a predictable issue with a bearing not on safety but on bureaucracy. I am aware of the potential complexities, but what steps are the Government taking to explore the adaptation of funding mechanisms to expected new programmes in order to avoid delays and issues because of the constraints of rigid envelopes and complex approval processes? What are the general steps in the areas of improving resourcing, co-ordination and process across regulators and health-technology assessment bodies?

There is an increasing focus on the role of vaccination in fighting AMR. The JCVI has shown some willingness to consider its impact in its value-assessment criteria. I suggest to the Minister that this could be an interesting development. Given that it is newer science, it would be interesting to hear from the Government what assessment they have made of the AMR-reduction benefit from vaccines and whether they are taking any steps to explore how it can be harnessed further.

With further reference to the JCVI, I want to raise the suggestion of evolving its work to better enable the adoption of innovative vaccines. Broadly, it is important that the JCVI is continuously looking ahead. Can the Minister indicate how the Government are working with JCVI to ensure this mode of travel?

I was very interested in the argument put forward by Policy Exchange that a busy pipeline of new vaccine technologies in the coming years, including a growing number of therapeutic as well as preventative candidates, coupled with a concerning decline—as we have discussed —in the uptake of key programmes such as MMR, necessitates a fresh look at the architecture and delivery model for vaccine development and deployment. Policy Exchange’s key recommendations on delivery include boosting ministerial oversight—I am sure the Minister will have a view on that; expanding the role for community pharmacy, which we have talked about many times in our Chamber; creating a new workforce model; and piloting a local delivery model called a “vaccine collaborative”. The positive and overarching principle behind those suggestions is that of extending care further into the community. It would be helpful to get a sense of the Government’s ambition in this area and the steps they are taking to move beyond traditional delivery mechanisms to make this improvement.

As I said at the beginning, we all want an improvement in the UK’s performance in immunisation development and delivery. I look forward to hearing the Minister’s response.

I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.

As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.

The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.

As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.

The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.

As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.

The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.

As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.

I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.

The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.

The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—

I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?

Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.

In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.

Sitting suspended.