Memorandum by UK Vaccine Industry Group
(WP 92)
Vaccines and their use in national immunisation
programmes continue to rank among the most important contributions
to public health in the UK. Indeed the World Health Organisation
has commented recently that vaccination is as good at delivering
benefits in public health as providing clean drinking water. The
previously immense burden of morbidity and mortality associated
with "common" childhood diseases such as diphtheria
and pertussis is now rare. Further opportunity to reduce the impact
of infectious diseases through prevention is still present. Taking
preventative measures when managing public health has benefits
for the individual, the population as a whole, and for the NHS
through efficient use of health care resources.
With reference through the White Paper to the
health promoting NHS, local communities leading on health,
and health as a way of life it is disappointing to read
little or no reference to vaccines and vaccination policy. Further
more, given the emphasis on "Choosing Health" it seems
peculiar to overlook an area where individuals can choose to prevent
ill health by vaccination.
The UK Vaccine Industry Group (UVIG) believes
that by extending the use of existing vaccines, planning thoroughly
for the introduction of new vaccines, targeting previously unmanageable
infectious diseases (such as meningitis B, Human Papilloma virus
and rotavirus), and undertaking effective dialogue with stakeholders,
more can be achieved as part of an overall programme to fight
infectious disease.
If vaccination policy with clear plans should
be in place to maximise the benefits of vaccination to decrease
the health burden as a direct result of infectious diseases.
Immediate opportunities to bring about further
improvements in public health via vaccines and vaccination policy
present themselves by lowering the age to 55s and over for flu;
offering flu vaccine for children; investing to improve uptake
of vaccines such as hepatitis B in at risk groups; and preparing
the way for the introduction of new vaccines such as those against
the human papilloma virus which is known to be linked to cervical
cancer.
The development and implementation of vaccination
policies and the resultant success, is driven by a number of important
factors—surveillance of disease, monitoring of uptake of
vaccines, targeting of vaccines to specific population groups,
structures and processes in the NHS to deliver policy and the
support of individuals and communities.
Effective implementation of all vaccination
policy should be promoted at a local level, including those policy
recommendations that are supported nationally such as childhood
and influenza vaccination. This should include policy recommendations
targeted to the population included clinical risk groups.
Despite the introduction of disease registers
the NHS struggles to target effectively groups by criteria other
than age. Reports from the Department of Health on the 2004 influenza
programme have indicated as much and evidence is available in
other areas such as hepatitis B and pneumococcal. Whilst, it has
now become a cliché, people at risk from certain infectious
diseases are subject to a postcode lottery.
Other factors add to the challenge faced by
local health care providers—competition with other health
priorities for health resources at a national and local level.
Parents and people have a greater access to information through
the internet and the media as a rule report negatively in vaccination
the Government should be providing health care professionals,
who are responsible for delivering policy, with continuing education
about vaccines and vaccination. This would equip them to implement
policy, to promote vaccination as a safe and effective means to
prevent ill health, and to answer questions posed by patients
on all aspects of vaccination.
Vaccines are niched within public health with
little recognition as part of the wider health agenda. Vaccines
and implementation of vaccination policy do not enjoy the priority
that their benefits to public health would otherwise suggest.
Clinical and NHS structural priorities focus on disease management
in the main, with prevention being targeted at heart disease,
cancer and obesity rather than infectious disease. Greater recognition
of the benefits of vaccines is needed raising awareness, restoring
public confidence and supporting public health.
There was the opportunity with the White Paper
to send a clear signal to the public and the NHS of the benefits
of vaccination and underline the critical role vaccines have as
part of the wider public health agenda.
Timely to this enquiry is the recent announcement
by the WHO that a pandemic influenza episode is likely to be sooner
than perhaps originally thought. On average pandemics occur every
25 years, and although Europe has not seen a pandemic year in
over 30 years (1968) experts believe that a future pandemic is
inevitable and may be imminent.
In a usual non-pandemic year, death rates from
influenza infection or its complication average 3,000-4,000. In
epidemic years such as 1993 the death rate reached 13,000 and
in 1989-90 some 29,000 deaths were attributed to influenza infection.
The death rate in an individual pandemic year is hard to predict,
but it will be significantly greater than in inter-pandemic years.
Of critical importance, however, is that without adequate preparation
and timely access to large volumes of an effective vaccine, the
effect of pandemic will be significant. The UK and fellow European
member states must be ready to implement a programme of prevention
and treatments that will limit the inevitable death toll. This
planning must include investment to ensure adequate supply of
vaccine, but most also prepare the NHS and associated bodies to
be able to deliver a mass vaccination programme on a grand scale.
The use of influenza vaccination as part of a national policy
is proven to be a cost effective intervention for either a targeted
or a more mass vaccination approach.
The UK has enjoyed a reputation of having one
of the most effective vaccination programmes to manage infectious
disease—high coverage rates with low incidence of diseases
and associated morbidity such as congenital rubella syndrome being
a distant memory. If new policies fail to address issues of implementation,
investment in new vaccines, greater use of licensed vaccines and
communication, the UK may lose its status as a leader in public
health. The challenge for the Government is to take vaccination
strategy as part of public health on to the next level. Working
with stakeholders, including companies that research, develop
and manufacture vaccines, to develop a comprehensive plan with
clear goals, responsibilities and timelines for delivery.
UVIG would welcome more dialogue on these matters
and is prepared to work openly and transparently with Government,
the Department of Health and other public health agencies.
ABOUT UVIG
UVIG, working within the Association of the
British Pharmaceutical Industry (ABPI), represents the six pharmaceutical
companies that research, manufacture and supply vaccines to the
UK—Baxter Healthcare, Chiron Evans Vaccines, GlaxoSmithKline,
Sanoffi Pasteur MSD, Solvay Healthcare and Wyeth Vaccines. UVIG
aims to promote the positive benefits of vaccination as a key
element in public health, and to represent the UK vaccine industry
to all interested parties.
February 2005
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