Top (ten) immunisation communication lessons learned Jo Yarwood Department of Health March 2007

Thanks to - Robert Duff Steve Thorogood Chris Owen Judith Moreton

UK immunisation programme What are the differences? national health service delivered through Primary Care (mainly nurses) no cost to the family or individual - it’s free not compulsory – no exemptions established call and recall system national surveillance

UK immunisation programme Centrally managed though Department of Health - JCVI secretariat policy development vaccine purchase and supply immunisation informatics immunisation information inequalities and performance correspondence briefing ministers

The childhood immunisation schedule When to immuniseDisease protected againstVaccine given Two months oldDiphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib) Pneumococcal infection DTaP/IPV/Hib Pneumococcal vaccine (PCV) Three months oldDiphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib) Meningitis C (meningococcal group C) DTaP/IPV/Hib MenC Four months oldDiphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib) Meningitis C Pneumococcal infection DTaP/IPV/Hib MenC PCV Around 12 months oldHaemophilus influenza type b (Hib) and meningitis C Hib/MenC Around 13 months oldMeasles, mumps and rubella (German measles) Pneumococcal infection MMR PCV Three years four months to five years old Diphtheria, tetanus, pertussis and polio Measles, mumps and rubella DTaP/IPV or dTaP/IPV MMR Thirteen to eighteen years old Tetanus, diphtheria and polioTd/IPV

Communication as integral part of policy and planning

Adverse events surveillance Surveillance of population susceptibility Vaccine delivery - supply, clinics Vaccine development Policy development Surveillance of coverage Predicting the future - modelling Monitoring attitudes to vaccination Surveillance of diseases Communication

... and of course funding – about 1.5% of annual vaccine budget

Understand the environment

Where do the challenges to immunisation come from? social change suspicion of institutions rejection of ‘modern’ medicine history science? media influence other groups concerns about safety

History matters

"The Cow-Pock or the wonderful effects of the new inoculation”. James Gillray, 1802

“The Vaccination Monster” “A mighty and horrible monster, with all the evils of Pandora's box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body...” London,

Whooping cough cases and vaccine coverage England and Wales, Immunisation introduced in 1950’s Source: Health Protection Agency; Department of Health

Science?

Wakefield AJ et al 1998 The Lancet 351: “We did not prove an association between measles, mumps and rubella and the syndrome described.”

Media influence (and don’t think you are immune!)

The Mirror Thursday February 7, 2002

‘Journalists aren’t employed to keep you healthy, or even informed: it is our job to sell readers to advertisers, to entertain you, and experience has taught us that we can do this very effectively with scare stories.’ Ben Goldacre The Guardian16th September 2003

Thanks to Professor Brent Taylor

Other groups

Minutes Action Against Autism AGM 22nd May 2004

8.Chairman’s overview and strategy for AAA – Bill Welsh The autism epidemic is now our key card and just as we managed to place the word “controversial” before MMR till its usage became universal we must do the same with the expression “autism epidemic”.

Listen to your audience

POSITIVE ACTION PASSIVE ACCEPTANCE REFUSALDILEMMA (FEAR) No fear of vaccine No fear of disease Fear of disease Fear of vaccine Adapted from, D.Salisbury,2004

Base understanding and approaches on research

Research strategic developmental pre-testing evaluation tracking health professionals parents

Bi-annual surveys knowledge of immunisation attitudes towards immunisation and experience of immunisation services response to advertising to provide information on respondents’:

Perceived severity of diseases Meningitis Polio Diphtheria Hib % very serious Oct 03May 04Nov 04 Rubella Measles Mumps Mar 03 Nov 05 Base: All primary care givers of 0-2s (W30 n = 1016) Nov 06 * Pneumococcal

Spontaneous awareness of immunisations Polio Whooping Cough Hib MMR Oct 03May 04 Men C May 05 5 in 1 vaccine Mar 03Nov 04 Children’s flu Pneumococcal Nov 05 Base: All primary care givers of 0-2s (W30 n = 1016) Nov 06 * ** Hib MenC Pre-school booster

5 in 1 vaccine Perceived safety of immunisations Old Polio (by mouth) % completely safe / slight risk Oct 03Nov 04 MMR Men C May 05 DTaP Mar 03 May 04 Pre-school booster Nov 05 Base: All primary care givers of 0-2s (W30 n = 1016) Nov 06 Pneumococcal * **

Which immunisations would not allow a future child to have (prompted) Base: All primary care givers of 0-2s (W30 n = 1016) *

What do we do? develop and deliver material to – the public health professionals seminars conferences advertising implement policy research

Give people the information they say they want - tell the whole story

clarity consistency facts openness range of information/resources What do people want?

Discussions about immunisations before child was immunised Sep 02 Benefits (HP) Any HP May 04 Side effects (HP) Oct 03May 05Mar 03 Nov 04 Nov 05 Base: All primary care givers of 0-2s (W30 n = 1016) Nov 06 Autism (HP)

Someone to talk to – someone to trust

Whether discussed immunisations with a health professional before immunisations were due Mar 03 Any Health Visitor GP Midwife May 04Nov 04May 05Sep 02 Practice Nurse Oct 03 Nov 05 Base: All primary care givers of 0-2s (W30 n = 1016) Nov 06

Trust advice about immunisation given by health professionals and government GP Health Visitors Practice Nurses Gov’t Base: All primary care givers of 0 - 2s – Four-fifths sample Strongly agree Tend to agree Nov 05 23%22% % DISAGREE NHS Nov 05 Nov 06 ** * *

‘The two public health interventions that have had the greatest impact on the world’s health are clean water and vaccines’ World health Organization

Professional responsibility · for being scientifically informed · to provide our own informed opinion and powerful support for immunisation · for promoting immunisation as the most important of all medical interventions

Protecting children – your commitment