‘We can't change the past but this vaccine will change people's futures.’ These were the words of Kelly Mellor, whose daughter contracted meningococcal disease when she was 11 months old, quoted in a news release announcing that as of 1 September 2015, the meningococcal B (MenB) vaccine would be added to the NHS childhood immunisation programme in England (Public Health England, 2015a).
Public Health England (PHE, 2015b) has also urged pregnant women to get immunised against whooping cough, with figures showing 1744 cases of the disease notified to the end of June 2015, compared to 1412 for the same period last year. These recent examples show how research and surveillance can be translated both into the production of new vaccines, as with MenB, and trigger warnings to encourage vaccine uptake. These developments, however, must be tempered with a realisation that more remains to be done. Larson (2015) offers a global perspective, stating that approximately 600 000 neonates still do not survive infections every year.
Despite the fact that maternal immunisation prevents specific infectious diseases in pregnant women and their infants, a study by Wilson et al (2015) showed that vaccine uptake on a global scale remains low in some areas, a fact that could be usefully contemplated by UK health professionals, given the large population shifts occurring around the world. The study found that the main obstacles to vaccine uptake for pregnant women were related to vaccine safety, low knowledge about the vaccines, their efficacy, availability and/or the diseases they prevent, and the absence of recommendations. For health professionals, the chief obstacles were poor training, poor pay and heavy workloads.
Although Wilson et al (2015) reported lower rates of vaccine coverage among ethnic minorities, when Baker et al (2011) studied an ethnically diverse population of over 20 000 children in Manchester, they found that White infants were less likely to receive primary vaccines. Also, for White infants there was a significant association between vaccine coverage and living in a deprived area. By contrast, for Black infants, Black British infants and Pakistanis, no significant association between vaccine coverage and deprivation was found.
Wagner et al (2014) acknowledge that while the UK's childhood immunisation programme has high overall vaccine coverage rates, uptake is lower in London, where the population is ethnically diverse. Their analysis of the vaccine records of over 315 000 children born in 2006/07 and 2010/11 in nine London Trusts found that, although the largest ethnic groups have good coverage, newer and smaller communities within a Trust may need help; better record-keeping and improved information transfer promote better vaccine coverage; and children who are not registered with a GP are likely to miss out on key primary care initiatives.
In an attempt to further identify ethnic groups that may be at risk of slipping through the net, Jackson et al (2015) have described a protocol for ‘the first large-scale multi-community qualitative study exploring barriers and facilitators to childhood and adult immunisation for Travellers in the UK’. Their findings, they hope, will highlight new ways to help marginalised and socially excluded communities to access immunisation services, although the authors acknowledge they might be perceived as ‘outsiders’.
Vaccine uptake in the UK continues to recover after the dip following the notorious—and discredited—Wakefield et al (1998) report on the MMR vaccine. However, in a study of rubella-susceptible pregnant women in South Wales in 2010, Matthews et al (2013) found that almost 40% of a small sample of women whose immunisation records were examined had not received two doses of rubella-containing vaccine; they speculated that the immunisation decisions made by parents may have been influenced by the adverse publicity generated about the MMR vaccine by the Wakefield paper. The authors made clear, however, that the dates meant this would only affect a relatively small number of women in their study.
Pregnant women, being responsible not only for their own welfare but that of their unborn child, may be understandably cautious about taking medications and undergoing vaccinations. As Larson (2015) observes, different norms may be established around the time of pregnancy.
It seems that in the context of an increasingly multicultural society, and with Western Europe becoming more ethnically diverse, there is a growing need for midwives to be ready to take account of the cultural dynamics involved in explaining which vaccines are appropriate, and inappropriate, for pregnant women.