The report from NI Audit Office states that overall vaccination coverage has steadily been declining for almost all diseases and increasing numbers of children have not received all the vaccinations available to maximise protection against harmful diseases. Across Northern Ireland, there are 15,000 children who have not been fully immunised against Measles, Mumps and Rubella (MMR) over the last seven years. In addition, a total of 10,200 children have not received all the recommended doses of the Pneumococcal Conjugate Vaccine (PCV) since 2015.
The report also notes regional variation in the uptake of vaccinations, with particularly low levels in Belfast. Within the Belfast Health and Social Care Trust area, 1 in 3 children have not been fully immunised against pneumococcal disease since 2015, and 1 in 7 have missed ‘6-in-1' vaccine doses which protect against multiple diseases, over the last seven years.
The report includes 3 recommendations for action, which we support:
- Primary care settings require access to an available workforce (scaled–up as necessary to meet immunisation delivery targets) with appropriate clinical training, in order to maintain standards of patient safety.
- Clear, fact-based and consistently presented positive messaging is key to mitigating against genuine uncertainty around vaccination within the population and increasing rates of coverage.
- Given the concerns around the completeness and accuracy of vaccination records, the Department of Health should ensure that remedial action is taken in order that existing information systems supporting vaccination are fit for purpose. Over the longer-term, maintaining the integrity of immunisation data will be necessary for its seamless inclusion within an electronic patient record system for Northern Ireland which was announced in late 2020.
In response, Officer for Northern Ireland Ray Nethercott says:
The falling vaccination rate is extremely concerning. These vaccinations protect us all against a range of highly infectious disease – that should by now be consigned to history. The diseases carry potentially serious complications, especially for the very young.
The report from the Northern Ireland's Comptroller & Auditor General is therefore highly welcome. The report contains three clear recommendations for change which must be instigated immediately to help protect all our children, covering increasing the scale of the workforce; providing positive public facing messaging to increase rates of coverage; and ensuring vaccination records are up to date, backed up by the roll out of the electronic patient record system.
The RCPCH has and will continue to advocate for the full integration of electronic child health records which also captures this crucial, lifesaving data around immunisation uptake for the protection of the child population as well as overall public immunity.
As paediatricians, protecting children from communicable disease is crucially important to us and we talk to families about immunisation at the opportunities available to us. It is important that we work together to make sure children are as safe as they can be from these potentially serious illnesses. However, real change lies in the ability to implement the recommendations of the C&AG report.
Ultimately the fact we still have no ministerial direction in health in NI, coupled with cuts to services from a flat-cash health budget from the UK Government, services are struggling and the child health workforce are strained under the pressure. As paediatricians, we are acutely aware of the implications these overarching issues will have on children and the dangers are too great not to do all we can to increase vaccination uptake.