Vaccine hesitancy training

Vaccine hesitancy, also known as anti-vaccination or anti-vax, is a reluctance or refusal to be vaccinated or to have one's children vaccinated against contagious diseases. It is identified by the World Health Organization as one of the top ten global health threats of 2019. Vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases and is threat to public health. Where vaccines for contagious diseases are available, we need to ensure as many patients take up the offer to ensure herd immunity for our population. Herd immunity is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune. 

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines. 

Enfield CCG is aware from working closely with our member practices that vaccine hesitancy is an issue in Enfield across all population groups and all vaccinations. The NHS needs to make every contact count and to address this our Community Education Provider Network Enfield CEPN in partnership with London Borough of Enfield's public health team, developed specialist training for staff working at our member practices, using Health Education England Funding. CEPN commissions, designs and organises variety of training events for the local health and social care workforce. Some of these courses and events are for individual professions and others are multi-disciplinary. Where possible we try to encourage the mixing of professional groups as research has shown that learning is enhanced when there is a mixed group.

At this training course held on 14 November 2019, doctors, nurses and other health professionals learned how best to talk to patients about vaccination hesitancy, which primarily results from public debates, media coverage or social media around the medical, ethical and legal issues related to vaccines. Participants were given an overview of local statistics on vaccination *. Enfield has a lower uptake in general of most vaccines. There is a variety of reasons for this, some of which were identified in the training and also discussed at the Health Scrutiny Committee.

Vaccine hesitancy stems from multiple key factors including a person's lack of confidence (mistrust of the vaccine and/or healthcare provider), complacency (the person does not see a need for the vaccine or does not see the value of the vaccine), and convenience (access to vaccines). Healthcare staff know that vaccinations offered by the NHS are safe and effective, as well as providing a public health benefit, but this course has enabled staff to more confidently have a discussion with people who have personal views or concerns relating to vaccination and make a clear case for them to understand the benefits of being vaccinated for themselves as well as the whole community.

Enfield CCG attended the Health Scrutiny Committee in January 2020 to discuss immunisation in Enfield and did a joint presentation with NHS England and Public Health England. We discussed our vaccination hesitancy training as part of the local action plan that the CCG has produced to support our member practices with their uptake figures. As part of these discussions we understand that our local training is unique to the NHS. Our vaccination hesitancy training is part of a range of measures that has improved local vaccination uptakes and will continue to have a positive impact on our community.

Since the training and the other interventions in our action plan, flu vaccination for in the winter 2019/20 season has already improved in certain age groups and our aim is that the training will also have a positive impact across the NHS vaccination schedule. This has improved the health of our local population and will have indirectly also improved patient experience, as patients now have confidence to have their vaccinations.

We have had the following feedback from the training session. Overall the training gave participants time to reflect on their individual consultations with patients and their practices' approach to vaccination uptake. Following the training, all participants felt that they had a better understanding of vaccination hesitancy and more confidence to talk through these issues with patients - which will lead to better outcomes. 

“I would like to say how great the vaccine hesitancy meeting was on Thursday. ”  Nurse

 “ You have inspired us to do a quality improvement initiative on immunisations.” - Nurse

 “We certainly have gained insight into some of the issues faced by the Primary Practitioners in this area, which we were not previously aware of. We [certainly at PH] will be going away and doing some rumination.” - Public health strategist

 “It went very well and raised some interesting points.” -  GP


 * Adult slides info Based on 2017-2019 data:

*  Children’s slides Based on 2018-2019 data: