An update on the use of influenza vaccination in Wales and the impact of changes in government policy

Abstract

Background: Influenza vaccine uptake in the United Kingdom has been improving steadily during the 1990s. In late 1998 the government announced that it was revising its guidelines for vaccine use to include all those 75 years and above as well as those in the previous high-risk categories. The author and others have shown that these changes would increase the high-risk pool of individuals, in Wales (population 2.9 million), recommended for vaccination to 15%. This present study builds on previous work on vaccine usage by Welsh general medical practitioners and quantifies the response to the policy change at both a national and practice level. Methods: Using information from the prescription pricing authority for Wales and computerised medical practices, vaccine uptake rates were calculated nationally for Wales, by administrative health regions, with a population of 550,000 on average, and by individual practices in southeast Wales. This data has been available from the early 1990s to the present day and covers the winter of 1998/1999, when policy was changed. Results: Since the 1980s, the uptake of vaccine has risen marginally in Wales from 8.7% of the population being vaccinated in 1993 to 9% in 1998/1999. Despite the change in government policy, no significant increase in response to this was seen at any population level. Less than 50% of those recommended for vaccination received it, with a 10-fold variation in the percentage of the population vaccinated by individual general medical practices. Conclusions: This study demonstrates that changes in government vaccination policy have made little difference to the vaccination practices of individual doctors. There still exists a shortfall between 2% and 6% (assuming that all vaccine doses are given to those who require it) between the vaccine delivered and the pool of the population at risk. In the United Kingdom, a vaccination policy left to individual practices to organise, with little central coordination or funding, leads to wide-scale variation and a large percentage of the population left unprotected.