Chapter 7
Informing Choices Within Communities
Immunisations
Uptake levels of childhood vaccines in England have been falling over the past decade. Lower vaccination rates include those for whooping cough, measles and polio. England no longer has the levels of population immunity recommended by the World Health Organization. This is the rate that is needed to prevent outbreaks. In Liverpool the drop in vaccination uptake has fallen steeply during and since the Covid pandemic. It isn’t just children who have been affected – influenza (flu), Covid and whooping cough vaccination levels are low amongst adults with long term conditions and pregnant women. Lower vaccine uptake within communities is directly linked to wider health inequalities. This means there is an increased risk of outbreaks, morbidity and mortality from vaccine preventable diseases.
Two new vaccination programmes were launched in the UK in September 2024 as a proactive measure against Respiratory Syncytial Virus (RSV):
- A programme to protect infants by vaccinating pregnant women (from 28 weeks) through maternity services and GP practices.
- A programme for older adults aged 75 to 79 years old. Adults in this age group will be invited for the vaccination by their GP.
This year we saw an increase in pertussis (whooping cough) cases across the country. The 6 in 1 vaccine given to babies in 3 doses starting at 8 weeks provides protection against whooping cough as well as other diseases. Uptake of this vaccination in Liverpool is well below the 95%. Up until this age vaccination of pregnant women with the pertussis vaccine helps protect new born babies. Antibodies are passed to the baby during pregnancy. Pertussis vaccination uptake amongst pregnant women is also lower than where we want it to be.
The national childhood immunisation campaign was launched in March. Jenny Harries Chief Executive of the UK Health Security Agency visited Liverpool. The campaign was developed by the national team using insight we gathered in Liverpool. The insight considered attitudes and barriers to vaccinations for local people.
Phase 2 of the campaign was launched in August. It included radio and bus stop adverts all over the city. Public Health worked with BNENC, Ice Creates and NHSE. Together we did community engagement with parents and carers in Anfield, Everton, and Vauxhall, engaging families in conversations about vaccinations. There were 10 ‘How to keep your child well’ roadshow events. Events were supported by the Living Well Service and the School Age Immunisation Team. Over 530 members of the community engaged with the project. The aim was to increase confidence in childhood immunisations and overcome vaccine hesitancy.
We have seen vaccination rates increase in some of the areas of lowest socioeconomic status. We are starting to address inequalities; however, overall vaccination rates are declining. Vaccination rates are lowest in areas of low socioeconomic status. This means that the most disadvantaged and most vulnerable people are more at risk from vaccine preventable diseases. The city has an ambition to reverse this trend and ensure more of the local population is protected from preventable illnesses.
Health Equity Liverpool Project (HELP)
- Primary care networks,
- GP practices,
- community organisations,
- community champions,
- volunteers,
- creatives,
- neighbourhood leads,
- public health,
- integrated care board,
- academics
This provided a dynamic and inclusive forum for Community Innovation Teams (CITs) to showcase their work, share good practice, celebrate impact and innovation, and advocate for different ways of working.
Public Health Liverpool made a call to action for national government, local government and local partners to work together to reverse the widening inequities seen across the city with an urgent need to do things differently.
Jenny Harries the Chief Executive of the UK Health Security Agency attended the event to learn about this work driven by communities for communities in partnership with primary care.
Outputs of the Health Equity Liverpool Project include a toolkit to support primary care trusts who may want to adopt this approach in the future and an end of project report. The toolkit should help support sustainability of the approach. The aim of the vaccination element of this work is to see an increase in MMR vaccination rates. Vaccination rates will continue to be monitored closely.
The HELP Toolkit is a living resource for Primary Care Networks and other community health organisations in Cheshire and Merseyside to help tackle health inequities and improve uptake of preventative health services.
In August the project was shortlisted for an HSJ award.
Attendees at the Festival of Learning
“None of us are prepared to accept this as a future reality. We believe that we can create better health and tackle these difficult health inequalities by working together. Some of the key answers are about working differently and working with local communities to understand local experiences and come up with local answers. This project is exactly what we need to be doing and doing more of. What can we learn, roll out and scale up? We are excited to continue this journey together.”Emer Coffey, Public Health Liverpool.
HELP Festival Transcript
We’re going to start now, so, present, you have seven minutes, so let’s get started.
For me, I love learning events, I really do. I love the colour, I love the energy, I love the excitement. And what we’re trying to do is create an environment where people are learning, and they don’t even realize they’re learning.
It’s meant to be fun, it’s a festival of learning, it’s a way of sharing experiences, and it breaks down hierarchies, so everybody is an equal at a learning event, and everybody has their expertise to share.
The CIT gang was made up of community people, PCNs, GP staff, volunteers, professionals, and over 100 stakeholders in the local community.
The learning events’ Community Innovation Teams made up of community members, volunteers, community organizations, general practices, and general practitioners, and other social prescribers, and others working on health equity in the community.
As well as having the teams and members of the community, we also have Liverpool City Council. We’ve got decision-makers, we’ve got funders here, and so it’s a chance for them to really understand when people talk about what’s the community-led approach, they can understand how it’s put into practice, and the learning event provides that forum for doing that in a very interactive, dynamic, and inclusive way, and there to break down silos between people all working on the same thing but separately.
In there, within the workplace, you know, asset as a big employer.
Yeah, I think it feels positive, and it’s energizing, so it creates the space for discussion in a way that would not happen in a traditional sort of lecture or conference-style event.
There’s none of this Death by PowerPoint, it’s about people, it’s about movement, it’s about visuals, music, we’re trying to stimulate. You know, people learn in different ways, so we like to try and use as many different methods as possible, so that everyone has a chance to have their say.
I was wondering what the panel thought about the potential for widening the scope of this model.
Yeah, often people from the community don’t have a chance to ask difficult questions to senior people, and this allows that, and it also gives a platform, though, to some of those other representatives on the panel as well, so you get that rich debate there.
Liverpool School of Tropical Medicine, we’re also collaborating in Kenya, doing very similar work, and, in fact, the model that we’re using here came from Kenya, and we’ve adapted it to the UK context.
So how we work in Kenya is in the sense that we have Community Health Promoters. So, Community Health Promoters are like Community Champions here in Liverpool. So, the Community Promoters visit households level where they pass health promotion messages, health prevention messages. The learning event here and the learning event in Kenya is actually very similar. So, lastly for me is, let’s empower the Champions.
So again, very exciting to look at: What can Kenya teach Liverpool? And what can Liverpool learn and also teach Kenya? So, it’s really trying to get this exchange.
So, the judge’s choice is Anfield and Everton.
The overall purpose:
Number one, I think, is to celebrate the really hard work that all these teams have done.
I think number two is, we often don’t have that space for reflection and evaluation. We’re so busy just delivering, we don’t have time to actually stand back and say, well, what is it that we’ve done?
And then number three is really about advocating then to the authorities, to say, look, we think this could work, and how can we now sustain this longer term? Because this is project-funded, so it’s advocacy, it’s celebration, it’s learning.
I always really look forward to the learning events, um, because of the opportunity to showcase the work, but also to trigger new ideas, meet people who are working on similar things and think, oh, we must do this, we must do that. It’s like it refuels us to have more passion for the work going forward.
It’s not the end of something. For me, a learning event is the beginning of the next phase.
