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This paid editorial was funded and initiated by Sanofi, reviewed by Sanofi for compliance and written by Rebecca Catterick, General Manager, Sanofi Vaccines UK and Ireland.
Winter is a test of how robustly national immunisation programmes are performing in reducing winter respiratory illnesses and their burden on our NHS.
The current pressure on our paediatric units is unsustainable. Average infant A&E waiting times have increased by around 60% over the last 15 years (see Ref 1 below), and paediatric intensive care units are frequently at or over 90% occupancy in November and December, often reaching close to 100% capacity in winter months (Ref 2).
Vaccinations, ranked one of the most effective public health interventions in the modern era (Ref 3), are important tools we can leverage to keep infants out of hospital in winter helping us move from treatment to prevention. Prioritising implementation of best-in-class childhood immunisation programmes must therefore be our central aim.
Ahead of the publication of the 10-year NHS plan in Spring next year, and with a clear directive from the Government to deliver Labour’s child health plan, I am optimistic about what we can achieve together. Our focus must remain on the Government’s goal to give infants and children the best start in life.
A robust approach to monitoring and evaluation of immunisation programmes
We are now at a critical point in the winter season where assessing uptake and the impact of current immunisation programmes is essential to understand if they are delivering a sufficient impact on hospitalisations. This data can inform best practice for future programmes.
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infection in children and one of the principal reasons for the hospitalisation of babies in the UK (Ref 4, 5).
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The new RSV maternal vaccination programme, launched in September 2024, should be a testbed for the value of close monitoring and evaluation of impact this winter.
Last year, Sanofi organised and funded research with a multidisciplinary focus group of eight healthcare professionals on the impact of RSV ranging from respiratory physicians to paediatric nurses. Survey respondents reported that due to RSV pressures on paediatric wards, some elective admissions and clinics are cancelled with staff at times being re-deployed from other settings causing delays (Ref 6).
My indicators for assessing the impact of vaccination programmes:
- Impact on infant hospitalisations and the healthcare system – what has been the reduction in hospitalisations, and is this the most effective option for keeping infants out of the hospital?
- Economic impact – has there been a reduction in productivity losses from parents taking time off work to provide care for infants hospitalised with RSV-related illness?
- Uptake rates of current vaccination programmes – are they high enough to effectively reduce the burden on the healthcare system, and what is acceptability of the maternal RSV vaccine amongst different population groups?
- Impact on NHS workforce – have primary care and secondary care professionals such as paediatricians, nurses, A&E doctors and GPs seen a reduction in the infant RSV burden on the healthcare system?
- Comparison to other countries – how do uptake rates and reduction in hospitalisations compare to results seen in other countries who have implemented an RSV programme?
The impact of low coverage rates
In the UK, we’ve witnessed the significant impact of low vaccination coverage rates on the resurgence of infectious diseases.
This includes the measles outbreak and the uptake of whooping cough (pertussis) vaccination among pregnant women, which has been as low as 25% in some areas (Ref 7, 8).
These examples are a sobering reminder that there is more to do if we are to achieve high uptake immunisation programmes.
What action can we take?
Labour’s Child Health Action Plan, updated in January this year, set out bold ambitions to create the ‘healthiest generation of children ever’ (Ref 9). It includes a pledge to ‘protect children from the growth of infectious diseases’. This must be our standard and there is no time to waste.
All corners of the health system ─ from government, the NHS and UKHSA ─ to industry, must collaborate.
We stand ready to support policy measures set by the Government to support implementation, such as enabling health visitors to administer immunisations and enhancing data recording via the Red Book (Ref 10). Equally, we must now consider real-world evidence from other countries to inform our approach.
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From our experience, we believe these are the benchmarks of success: rapid reduction of hospitalisations, high vaccine uptake and freeing up clinician time for other essential services.
The next few weeks will be critical for closely monitoring and assessing respiratory illnesses in infants, an important strive in our mission for economic growth. Now is the time to listen and act.
MAT-XU-2404433 (V1.0) December 2024
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Ref 3: NHS vaccination strategy, NHS England
Ref 4: ‘Understanding RSV, a major cause of respiratory illness in infants’, Oxford Vaccine Group
Ref 5: Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR. Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Heal th Organization-sponsored meeting. Vaccine. 2020 Mar 4;38(11):2435-2448. doi: 10.1016/j.vaccine.2020.01.020. Epub 2020 Jan 20. PMID: 31974017; PMCID: PMC7049900.
Ref 6: Sanofi data on file
Ref 9: Labour’s child health action plan, Labour Party
Ref 10: ‘Build an NHS fit for the future’, Labour 2024 manifesto
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