Helen Sisson is a Lecturer in Public Health, in the Department of Midwifery and Child Health, Faculty of Health Sciences, at the University of Hull. She is currently undertaking a PhD investigating timeliness of vaccination in preterm infants.  @hsisson1

April 24^th – 30^th 2021 marks World Immunisation Week¹, and this year presents even more reason to observe and celebrate this vital public health accomplishment. Vaccination has long been a principle global public health activity, but the current COVID-19 pandemic has emphasised just how vital this activity is; it serves as a reminder of the devastating impact disease can cause. COVID-19 continues to cause significant global morbidity and mortality and vaccination is viewed as an essential response to this.

Public awareness of vaccination and vaccines is currently high, undoubtedly influenced by media coverage. Daily updates on the number of vaccines are given, and as of 28^th March this year, the UK had the highest COVID-19 vaccination rate at 49%. This was significantly higher than the EU where rates are reported as 12-14%².

This has generated debate over vaccine supply, and concerns over COVID-19 vaccine safety. Notably the suggestion of a very low risk of thrombosis following vaccination with the AstraZeneca COVID-19 vaccine. These concerns are currently being investigated and the European Medicines Agency indicate that the number of thromboembolic events in those receiving the vaccine is no higher than that seen in the general population^3. However, this has led to a temporary suspension of the use of this vaccine in some countries⁴. Whilst this does not appear to have significantly impacted on uptake in the UK, there is low uptake in some groups, for example those from Black, Asian and minority ethnic groups⁵. Indirectly, the pandemic has had a positive effect on influenza vaccine uptake. England data for the over 65s indicate an increase of almost 10% in uptake in flu vaccination in the 20/21 season compared to 19/20⁶. Similarly, data from the US indicate an increase of 7% in vaccine uptake and intention to get vaccinated⁷.

The COVID-19 pandemic and the roll out of the vaccination programmes appears to have increased understanding of the value and benefits of being vaccinated. However, there are concerns regarding COVID-19 vaccines which are not unique. Rates of all vaccine preventable diseases must remain low, and in order for vaccination to be most effective, uptake must remain high. For example, to achieve population (or herd) immunity against measles, uptake of 95% is required⁸.

The devastating reality of COVID-19 and its associated restrictions on society may have motivated many to have the vaccine. Nurses and other health professionals continue be key influencers on vaccine uptake – not just for COVID-19, but for all vaccines. People view the nurse or health professional as the most credible and trusted source of vaccination information⁹. This indicates two important actions for nurses: firstly, that they need current evidence-based information about vaccination, and secondly, that all opportunities to promote (and even administer) vaccination are taken¹⁰.

Nurses and healthcare professionals also need to understand what prompts decision making about vaccination and vaccine hesitancy. In its report of vaccine hesitancy, the World Health Organisation developed a model based on the “3Cs” – complacency, confidence and convenience¹¹. Complacency may occur where it is perceived that vaccination is unnecessary (that the disease is not severe or that the risk to the individual is low). Confidence may be thought if in terms of trust – trust in the vaccines, in the health service and health professionals, and in the wider systems behind vaccine policy making. Convenience can refer to the ease of access to vaccines, and this could be related to physical access, or affordability and understanding.

For nurses and healthcare professionals to address the “3Cs”, clinical and epidemiological knowledge of the disease is needed. In addition, building trust when talking about vaccines, confidence and the use of positive language is essential; again, such attributes are only possible through up to date and accurate vaccine knowledge. Convenience may be more difficult to address as the challenges here could be rooted in services and ways of working. Nonetheless, all opportunities to check vaccination status and start individually tailored discussions with a view to recommending vaccination must be taken. Nurses and healthcare professionals are central in supporting decision making and assisting understanding of the benefits and risks associated with any decision.

The theme for World Immunisation Week is “Vaccines bring us closer”. Whilst we are still witnessing the devastating effect of COVID-19, we are also seeing the impact vaccination is having on easing restrictions and enabling families and friends to reconnect. There will be continued focus on COVID-19 vaccines to protect people – however, we must not forget that routine vaccinations are also important. They are essential in the prevention of many infectious diseases and the future health and wellbeing of our communities. Nurses are ideally placed at the forefront of healthcare delivery to provide evidence-based information to inform decisions on immunisation and vaccines. They must have the required skills and knowledge to be able to do this effectively.

References:

1. World Health Organisation (WHO) (2021) World Immunisation Week – Vaccines bring us closer. Retrieved from World Immunization Week 2021 – Vaccines bring us closer (who.int)
2. Statista (2021) Number of COVID-19 vaccination doses administered in Europe as of 28^th March, 2021, by country. Retrieved from Europe: COVID-19 vaccination rate by country 2021 | Statista
3. European Medicines Agency (2021) COVID-19 Vaccien AstraZeneca – Update on ongoing evaluation of blood clot cases. Retrieved from COVID-19 Vaccine AstraZeneca – Update on ongoing evaluation of blood clot cases | European Medicines Agency (europa.eu)
4. Wise, J. (2021) Covid-19: European countries suspend use of Oxford-AstraZeneca vaccine after reports of blood clots. British Medical Journal 372:n699. Retrieved from doi: https://doi.org/10.1136/bmj.n699
5. Royal Society of Public Health (2020) Public attitudes to a COVID-19 vaccine. Retrieved from RSPH | Public attitudes to a COVID-19 vaccine
6. Public Health England (2021) Seasonal flu vaccine uptake in GP patients: monthly data, 2020-2021. Retrieved from Seasonal flu vaccine uptake in GP patients: monthly data, 2020 to 2021 – GOV.UK (www.gov.uk)
7. Lindley, M.C., Srivastav, A., Hendrich, M., Fisun, H., Nguyen, K., Pedraza, O., Razzaghi, H., Singleton, J.A. & Williams, W.W. (2020) Early Season Influenza Vaccination Uptake and Intent Among Adults – United States, September 2020. Retrieved from Early-Season Influenza Vaccination Uptake and Intent Among Adults – United States, September 2020 | FluVaxView | Seasonal Influenza (Flu) | CDC
8. GAVI (2020) Measles and measles-rubella vaccine support. Retrieved from Measles and measles-rubella vaccine support (gavi.org)
9. Public Health England (2019) PHE offers support to UK vaccine heroes. Retrieved from PHE offers support to UK vaccine heroes – GOV.UK (www.gov.uk)
10. Bedford, H.E and Elliman, D.A.C. (2020) Child and adolescent immunisation in the UK: current issues. Paediatrics and Child Health. 30(5) 169-174. Retrieved from doi: https://doi.org/10.1016/j.paed.2020.02.003
11. World Health Organisation (2014) Report of the Sage Working Group on Vaccine Hesitancy. Retrieved from Microsoft Word – Oct 3 WORKING GROUP on vaccine hesitancy_final.docx (who.int)