Health Protection

Prior to the COVID-19 pandemic, childhood vaccination rates in Liverpool were high, with good coverage achieved. Whilst there had been a gradual decline in childhood immunisations, both nationally and locally after 2013, during and since the pandemic rates dropped very significantly across the city. At the same time, we have seen record high levels of Measles across Europe and the detection of vaccine-derived Polio in London wastewater. ​​

Two doses of the MMR vaccine are required to protect children from Measles, Mumps and Rubella. To ensure herd immunity we aim to ensure that 95% of the eligible population is vaccinated. The latest data for 2021-2022 shows that on average only 82.1% of children have had a first dose of MMR by their second birthday in Liverpool – this compares to an England average of 89.2%. There is considerable variation locally, with rates falling below 60% in some areas of the city. This means there is now a high risk of a measles outbreak.  

The immunisation rate for the 6-in-1 vaccine, which protects children against polio, diphtheria and whooping cough, has seen a similar dramatic fall. There is a complex range of factors responsible for this reduction in rates, including pressures on primary care, ongoing workforce and capacity issues due to sickness and isolation, national stay at home messages and lockdowns, public perceptions of the risks of attending GP practices and the population’s focus being taken up with dealing with both a pandemic and surviving austerity. Whether or not there is an increased level of vaccine hesitancy or fatigue has yet to be understood. ​

In response to this decline in child immunisations, local place-based partners have formed a Liverpool Childhood Immunisations Group –a  subgroup of Liverpool’s Screening and Immunisations Oversight Group. A comprehensive action plan has been developed to support recovery of the childhood immunisations programme, reduce inequalities and increase uptake.

An innovative approach to increasing vaccination uptake through primary care has been implemented using Liverpool City Council’s team of Public Health Advisors. These trained and experienced advisors are working with general practices, telephoning parents to support them to book into vaccination clinics. During these calls insight is also being gathered from parents to understand more about the reasons behind the decline in rates. A toolkit to support general practices increase uptake is also in development. ​

A programme of community engagement has commenced, initially working with our community champions to promote child immunisations and get the message out to local communities. Communications have been developed and sent out to parents and carers via schools and nurseries and through social media, and work is underway to strengthen vaccination promotion within the Health Visiting Service and across the Early Years system. Liverpool City Council are also working with NHS England and Mersey Care’s Vaccination and Immunisation team to pilot a community catch up clinic in a local children’s centre for children with overdue immunisations. Learning from this will be used to shape the future local offer. ​

Additionally, this year Mersey Care NHS Foundation Trust have delivered a flu vaccination pilot to 2 and 3 year olds in local authority nursery schools, alongside delivering the usual flu vaccination programme to primary school pupils across the city. It is hoped that this increased activity and focus on childhood immunisations will reverse the downward trend in coverage rates within Liverpool and ensure that vaccine preventable diseases do not make a comeback. Progress will be monitored and reported in next year’s annual report. ​

During 2022, it was the intention of Public Health to include and introduce a more prevention-focused and behaviour change programme in relation to HIV locally, to sit alongside a current support offer to people already living and diagnosed with HIV in the city. This would seamlessly link to the main ‘Axess’ integrated sexual health service and form a robust approach to prevention, testing and behaviour change.

The redesign led to a new provider, Passionate about Sexual Health Partnership (PaSH Partnership) leading this innovative local programme. This is a collaboration between BHA for Equality, George House Trust, and the LGBT Foundation. 

The PaSH Partnership delivers a comprehensive programme of interventions to meet the changing needs of people newly diagnosed with HIV, living longer term with HIV, or at greatest risk of acquiring HIV. This includes any Liverpool resident living with HIV, regardless of sexuality or gender.  

Medical advances now mean that HIV is a manageable long-term health condition when diagnosed early, but continuing levels of misunderstanding and a lack of up to date knowledge mean that HIV remains a highly stigmatised medical condition.​

The work being delivered in this area now in Liverpool will be key to ending new cases of HIV transmission.  ​

The main aims and objectives of this new offer are to improve awareness of:​

• HIV and other sexually transmitted infections​
• The risks associated with unprotected sex ​
• Potential harms associated with other risk-taking behaviours (e.g. alcohol and drug misuse, chemsex etc) ​
• The importance of using condoms and other forms of contraception ​
• HIV preventative methods (e.g. Post-Exposure Prophylaxis/PEP and Pre-Exposure Prophylaxis/PrEP) ​

It is vital that we improve access to testing, improve knowledge of (and uptake of) PrEP to prevent people getting HIV and ensure that those people diagnosed with HIV who require support and advice receive it. By way of recovery/re-build from the pandemic, we aim to:​

• Re-engage those people living with HIV that have been lost to treatment and care ​
• Lift our testing coverage across the city, with a particular focus on women ​
• Address the issue of HIV late diagnosis, particularly in heterosexual and bisexual women ​
• Broaden the access to, and uptake of, HIV prevention drug (PrEP – Pre-Exposure Prophylaxis) – the drug that prevents people becoming infected with HIV ​
• Work closely with our communities to understand how the pandemic has impacted and ensure services are fit to respond ​
• Undertake further research in relation to under-served populations to ensure that we reach populations with effective messaging and information and reduce any barriers to accessing care ​
• Complete an LGBTQ+ Needs Assessment more broadly, but that includes key recommendations in relation to SRH and HIV and how we ensure we collaborate and enable better access to provision, without fear of stigma​
• Liverpool further aims to produce a new system-wide joined up strategy and action plan on Sexual and Reproductive Health and HIV commencing during 2023 ​

Several cases of Monkeypox were identified in England in May 2022, and these initial cases spread and infected a total of 3,591 people (at time of writing). A high proportion of cases so far have been in London (69%), with cases across the North West being relatively low (229). The number of cases in Liverpool stayed low (15), one of the lowest of the core cities and urban areas, and signalled that the local response to controlling the spread of the virus was good. ​

A notable proportion of cases identified to date have been in gay, bisexual and men who have sex with men (GBMSM) (greater than 95% of cases), so awareness raising of symptoms was particularly targeted at these groups, especially if they had a new partner, or multiple partners within a 21 day period. We ensured though that the overall communications and messaging raised awareness of risk to our whole population to help try and control the outbreak. ​

UKHSA led on the outbreak response nationally, and coordinated contact tracing to ensure we notified possible contacts of cases as quickly as possible. ​

Sexual Health clinics/services have been heavily involved across the country, including our own Axess service (and Infectious Diseases team at LUHFT) as they led the testing, identification and support of residents with suspected Monkeypox virus.  ​

Locally We:​

• Ensured that sexual health services (Axess) and infectious diseases teams (ID) assessed and managed patients with suspected Monkeypox and liaised with national colleagues as appropriate ​
• Developed a series of local messages and effective communications, utilising the national and major events toolkit ​
• Led the national charge around research via our collaboration with partners including LUHFT and the Pandemic Institute to understand the most effective and non-stigmatising communication strategies around sexual health and Monkeypox ​
• Rolled out a vaccination programme and campaign that aimed to protect  those people most affected by the outbreak (in total we have now vaccinated over 900 out of the initial 1,440 people identified as high risk) ​

There are now very few new daily cases of Monkeypox being reported. It is being well managed and is on the decline. However, it is important in this phase that we: ​

• Continue to run effective communications plans to ensure people are aware of the potential risk, including providing messaging around symptoms and stay safe at large events and gatherings ​
• Opportunistically vaccinate all people deemed at risk as they enter clinics ​
• Hold some dedicated vaccination clinics at weekends to ensure we can reach as many people as possible who require it ​

COVID-19 prevalence across the winter, and variants of concern remained possible. Catching flu and COVID-19 together would increase the risk of severe illness, and place further pressure on health and care services. ​

After an intense 2.5 year response to the COVID-19 Pandemic, the resilience of complex care settings, education establishments, businesses, voluntary sector organisations, and the general public, had been severely tested, and COVID fatigue was evident. Yet the threat of COVID-19, infectious diseases and other acute respiratory infections had not dissipated. Continued commitment was required to prepare for and respond to the oncoming challenges.  ​

Close partnership working was needed to prepare for and respond to the anticipated challenge. The focus needed to be on complex settings, but work was also required to support clear and consistent communication to all settings, including Further and Higher Education Institutes; schools and early-years provision; and the general public. Preparatory work concentrated on: ​

• Strengthening the protection of the most vulnerable within our communities through increased uptake of vaccination for flu and COVID ​
• Maintaining a focus on marginalised groups such as ethnic minority communities, asylum seekers and refugees, homeless/complex lives and learning disabilities ​
• Reducing the spread of infectious diseases through promotion and monitoring of robust infection prevention control measures, and COVID and flu testing in complex settings ​
• Developing and testing outbreak response arrangements ​
• Embedding learning from the pandemic to inform prevention measures ​

As winter extends into 2023-24, we continue to support ARI and COVID preparedness and response.  Work will focus on: ​

•  Guidance and messaging for all sectors, including Adult Social Care; Education; businesses and the general public ​
• Monitoring and driving COVID-19 and flu vaccination uptake, and delivery of the Health Inequalities plan, through the Screening and Immunisation oversight group ​
• Supporting schools and early-years settings to enhance prevention measures based on the recently completed COVID-19 review ​
• Supporting Care Homes, and other complex care settings, to enhance prevention and response measures, based on the COVID-19 review currently underway ​
• Incorporate learning from local event planning, to ensure an all-risks approach to future events guidance   ​