Prevention Is Better Than Cure - A New Model For UK Vaccine Delivery

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Prevention Is Better Than Cure - A New Model For UK Vaccine Delivery

Commentary
Posted on: 8th December 2022
Paul Blakeley
Life Sciences Policy Lead
  • The NHS is in for a punishing winter, with pressures piling up, capacity constrained and the annual peak in respiratory viruses creating huge demands on services
  • We must make use of vaccines to protect ourselves and our NHS. Increasing the uptake of flu vaccines by just 10% could save the NHS 23,000 ‘bed days’ and 2,600 admissions this winter
  • But exclusive polling for the Tony Blair Institute shows 3 in 10 people who are eligible have still not received either their flu vaccine or their Covid-19 booster
  • To increase uptake, we need to move to a community-based and digitally-enabled delivery model, with vaccination centres closer to peoples’ homes - making vaccines easier to access and relieving pressures on frontline NHS services
  • In the longer-term this new delivery model can also be used to rollout new vaccines and long-acting prophylactic injectables, to improve the health of our nation, create a permanent protective shield around our NHS and bolster our future pandemic preparedness

 

Today marks two years since the UK administered the world’s first Covid-19 vaccine. A moment of national pride for our NHS and life sciences industry.

But our health service is now in the grip of a punishing winter. Pressures are piling up, capacity is constrained, and the workforce is on the brink of collapse. Forecasts are dire, with people suffering from severe respiratory infections, including Covid-19, seasonal influenza (flu) and respiratory syncytial virus (RSV), expected to occupy up to 50% of all beds during the coming months.

It’s not surprising that the Secretary of State for Health has therefore hammered home the need to improve discharge rates to release beds, with £500m announced to support efforts across the NHS.

This is a good start, but it’s not enough.

To prevent the NHS from falling over this winter, and to keep our health system afloat in future years, we need to prevent more people from becoming sick and being admitted to hospital.

Vaccines remain a critical piece of this prevention puzzle. Research shows that flu vaccinations in England alone prevent between 180,000 - 626,000 cases of flu per year, help to avoid 5,600 - 8,800 premature deaths and save millions for the economy by averting lost employment.

However, while the UK government is promoting the importance of vaccines and boosters for those at risk, there is inconsistency in delivery on the ground. And pressure to roll out vaccines is being heaped on GPs at a time when their capacity and ability to see patients is already stretched to its limit.

Even worse, the government seems to be actively steering us in the wrong direction – with a third of dedicated Covid-19 vaccine centres closing last year and the advertising budget for Covid-19 boosters being slashed.

These backwards steps are throwing up more barriers to uptake and unsurprisingly causing many eligible people to delay getting the protection they need. Indeed, an exclusive poll conducted for the Tony Blair Institute by Deltapoll shows the scale of the problem, with 3 in 10 people who are eligible reporting they have still not received either their flu vaccine or their Covid-19 booster this year.

But it’s not too late to change course. By properly funding campaigns to increase awareness amongst target groups and by streamlining delivery, more people across the UK can access life-saving vaccines.

This will help to relieve some of the worst of the winter pressures facing the NHS. Indeed, our estimates suggest that halving the target population unvaccinated against flu in England would see 2,600 fewer admissions and free up over 23,000 bed days in the coming months. 

Whilst this would be game changing, we could go even further if we expanded vaccine coverage for other respiratory infections, including Covid-19, respiratory syncytial virus (RSV) and pneumococcal disease.

Making vaccines more accessible is key to increasing uptake and unlocking these benefits. Nearly half of the people we polled said that making access simpler and easier would make them more likely to get vaccinated.

In future, this means creating vaccination centres closer to peoples’ homes and using digital platforms to make it easier to book and manage appointments.

We know this model works because we used it to respond to the pandemic. Councils and the NHS partnered with community organisations, including temples, mosques and sport centres to administer vaccines, and they worked with trusted members of the community, such as faith leaders, to increase uptake amongst underserved groups.

Digital platforms and data were also harnessed, with the creation of a National Booking System that, at its peak, was handling 750 bookings per minute. These digital tools allowed for the collation of detailed local information on disparities in vaccine uptake. This data was then used to deploy flexible and mobile resources, like ‘vaxi-taxis’, which would travel to under-vaccinated and under-served areas to increase access and uptake.

By re-adopting and adapting this community-based model for vaccine delivery, underpinned by digital technology and national procurement, we can expand access to all vaccines and have a seismic impact on the prevention of ill-health. What’s more, this same sustainable and robust delivery infrastructure will be ready to respond when the pandemic strikes - providing a permanent, effective and efficient model for the future of UK health security. 

The Scottish Government is already taking steps to deliver on this vision. Their Vaccination Transformation Programme is enabling routine vaccinations to be delivered outside of GP practices, by utilising community-based vaccination centres set-up during the pandemic to relieve burdens on frontline services and increase access.

But the rest of the UK seems to be going backwards… And it was therefore no surprise to hear recent calls from leading experts who are, rightly, furious that the government is failing to learn lessons from Covid-19.

As well as disrupting current vaccine delivery, this failure to learn from experience also threatens our ability to capitalise on the forthcoming revolution in preventative healthcare.

The coming years will see an explosion in innovation and development - from a combined vaccine for Covid-19, flu and RSV to a potential universal vaccine for influenza.

And in tandem, we’re seeing the emergence of a whole new class of long-acting prophylactic injectables for those at risk of non-communicable diseases (NCDs), such as cancer and cardiovascular disease.

These conditions are a huge driver of ill-health and a major source of NHS pressure - accounting for over 88% of all deaths across England in 2019.

As these new vaccines and injectables arrive, we need a system that is ready and able to take them up and get them into the arms of the people who need them.

But our inability to adapt our approach to delivery and our constant over-burdening of the frontline NHS services continues to hold us back.

This has to change.

By moving to a new community-based model for delivery, we can increase access to existing vaccines, prime our system to adopt new vaccines and injectables, and secure our future pandemic preparedness – all whilst reliving the burden on our health service.  

This is at the centre of the Global Health Consortium’s new ‘One Shot’ campaign, and the UK could be at the forefront of turning this vision into reality.

The opportunity is there, and we must take it. To protect our people and our NHS.

 

Additional Information

Calculating potential NHS secondary care savings by increasing flu vaccination coverage 

If we assume that:  

  1. This year’s flu vaccine efficacy will be c. 40%, in line with conservative averages; 
  1. Overall flu vaccine coverage will be comparable to 2021-2022, reaching c. 80% of the overall target population;  
  1. This will be a ‘bad flu season’ with high levels infection. The last ‘big’ flu season in 2017-18 resulted in 45,000 hospital admissions and 400,000 bed days during winter; and  
  1. Annual secondary care costs for a flu season can range from c. £100-130m  

Then using Bayes theorem we can estimate the proportion of those who will be hospitalised during this flu season who are vaccinated, which will be  c. 70.6%. This means that 29.4% of hospitalisations for severe flu will be for those who are not vaccinated.  

Within this unvaccinated population, 20% could of hospitalisations could be prevented by increasing overall vaccination rates across target groups to 90%. As a result, hospitalisation numbers would fall by 5.9%.  

As a result, you would see c. 2650 fewer admissions for sever flu across the NHS in England this winter (45,000 * 0.059), which would lead to over 23,000 fewer bed days and savings of up to £8m.  

Note: Bayes' theorem says that Pr(vaccinated | hospitalised) = Pr(vaccinated) x Pr(hospitalised | vaccinated) / Pr(hospitalised) so in this case, the probability that someone who is hospitalised is vaccinated is (0.8 x 0.6 x h)/(0.8 x 0.6 x h + 0.2 x h) where h is the risk of hospitalisation for an unvaccinated person. Since the h terms cancel, the probability is 70.6%. 

Polling of public views on Covid-19 booster and flu vaccination delivery during 2022 

Deltapoll interviewed 1,632 British adults online between 1-5th December 2022.  Data has been weighted to be representative of the British adult population. 

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