Overcoming Barriers to Immunisation: Lessons Learnt from the community

What is the problem?

Since the COVID-19 pandemic, immunisation has become a difficult topic for some. Alarmingly, the rate of measles is rising in London. Between 1 January and 20 April this year, there have been 49 cases of measles compared to 54 cases in the whole of 2022. This has been due to a reduced rate of immunisation among children under the ages of 5. For example, in the London Borough of Hammersmith and Fulham MMR vaccine uptake is 72.8% (before age 5). To prevent spread of measles(herd immunity) the World Health Organisation(WHO) recommends 95% uptake. 

What’s contributing to reduced rates of immunisation?

We spoke to health visitors working in Hammersmith and Fulham. They all described the enduring impact of the Andrew Wakefield paper which falsely linked MMR vaccines to increased rates of autism. This still remains a common belief in the community. The health visitors also cited the impact of the COVID-19 pandemic, which has raised concern around vaccines, with parents wanting to know more about the vaccines before taking their child to be immunised. 

What we heard from parents attending community centre sessions?

Naturally, we wanted to find out from the parents what was preventing them having the lifesaving MMR Vaccine, so we reached out into the community centres in the north of Hammersmith and Fulham (where vaccine uptake is lowest). We spoke to a total of 29 families. 10% of parents we surveyed had not vaccinated their children. The most common reasons for vaccine hesitancy were anecdotal - parents hearing stories from friends or loved ones that a child had had a reaction to the vaccine and concerns about autism. Autism was mentioned by almost every parent who declined a vaccination. Several of the parents who declined MMR had immunised their children for other illnesses, however, if any vaccine was refused it would consistently include the MMR Vaccine.

The questions we most commonly hear from parents are:

  • Can the MMR be given as separate vaccines?
  • Can it be delayed until my child starts speaking?
  • Is there a cut off for the vaccine?
  • Is there a link between the MMR & Autism? 

Parents are reassured when they speak to professionals who have detailed knowledge and confidently answer questions. Our ‘Guess the Rash game’ is a helpful tool as it expands parents’ knowledge of common childhood rashes and encourages them to ask their questions.  We are sharing this with health visitors and parents to explain about common childhood rashes, including measles. 

Health visitors work to promote vaccine uptake

We talked to 18 health visitors in two separate sessions. They encourage uptake of vaccines and help parents understand the importance of being up to date with the NHS vaccine schedule.

The questions health visitors most commonly hear from parents are:

  • Are there any side effects to MMR vaccine? (90%)
  • When is it not safe to vaccinate my child- can I give them the vaccine if they have a fever? (20%)
  • Is it safe to have it as a combined vaccine? / are separate vaccines better? (50%)
  • Can I postpone the vaccine until my child is talking? (5%)  

How to support families who have questions about the MMR vaccine

We spoke to 65 families at seven different community events. We have put the tips from these conversations into a poster for GP practices

Here are the key themes that came out of our conversations:

  • Some parents have concerns about the MMR vaccine
  • Since Covid 19 people have more questions about vaccines
    • If a parent has questions encourage them to book an appointment to chat through their questions before the vaccine appointment
  • There’s not enough information on what to expect or after care
    • Share advice with parents when they book in. A re there any flyers they could be sent?
  • It can be hard to book or attend appointments
    • Phone calls are valued by parents with babies as they can be hands free. Call to let them know their child is due a vaccine and use the call to book them in
    • Parents say all reminders are helpful
  • Clearer information is needed about when a child is too unwell to have a vaccine and when to reschedule
  • Negative experience from families and friends can put people off from getting their child vaccinated
    • Ask about concerns and listen. Signpost to reliable sources for future reading but don’t try and present all the facts, focus on listening

How have we used this data/ What are our next steps?

  • The CC4C team have arranged for multiple immunisation advice sessions in the London Borough of Hammersmith and Fulham to explore parents’ concerns and to educate parents on the signs of measles, to help parents make an informed decision about immunisation. Additionally, this helps parents to spot the signs of measles early, and self–isolate to reduce spread.
  • We are doing ongoing work with health visitors to answer their questions about immunisations and help them answer questions from parents.
  • We have created a frequently asked questions poster about the MMR vaccine (using data from our immunisation advice sessions with parents).