ANNEXE:
Key issues arising from the inquiry into the measles outbreak
2013
Introduction
This annexe is not an exhaustive list of all the issues that were
raised during the inquiry – these can be seen in their
entirety by accessing the
written
and
oral
evidence submitted. Rather, the purpose of this annexe is to
highlight a series of key issues the Committee believes require
further consideration and/or future monitoring by the Welsh
Government and partner organisations.
It is clear from the evidence submitted to the Committee that
effective and decisive action was taken by all relevant partners
once the 2013 measles outbreak had been confirmed. We particularly
commend efforts to encourage partnership working across
organisations and jurisdictions.
We believe, however, that there is a clear need to avoid
complacency during periods between outbreaks; it is vital
that the general population is aware of the need for vaccination
against measles, mumps and rubella during intervening periods in
order to maintain what is referred to as “herd
immunity” across the population. Over the months and years
ahead, it will be crucial that awareness of the MMR
vaccination’s importance - which has grown as a consequence
of the recent outbreak - does not diminish as the number of
reported cases falls.
We welcome the Government’s stated priority to drive the
uptake of MMR vaccination to reach the 95% target for both the
first and second doses. We believe that this can only be achieved
by raising awareness of the importance of vaccination and
increasing opportunities for individuals to receive all necessary
doses. In our view, the vaccination and immunisation plans of all
local health boards should include a focus on MMR until take-up
levels have reached a consistent figure – at least 95% - of
the relevant population.
The key issues identified by the Committee for further
consideration/future monitoring are listed below.
1.
Awareness
of the need to receive the MMR vaccination
We
note from the evidence we have received that a pool of
approximately 30,000 children in Wales remain in need of the MMR
vaccination.
Public Health Wales states:
“The
only reason this outbreak could happen was because not enough young
people in Wales were fully vaccinated with two doses of MMR and
there is absolutely no guarantee that this could not happen
again.”
Witnesses
emphasised the need to use all possible opportunities, in a range
of settings and at a broad range of ages, to inform and remind
people of the need for MMR vaccination. The need to remember
the importance of vaccinating against mumps and rubella, as well as
measles, was also emphasised.
Dr Helen Bedford from UCL’s Institute of Child Health told
the Committee:
“It
is a challenge keeping people’s perceptions of the severity
of these diseases high. They are almost seen as Victorian diseases
now, because of the success of the immunisation campaign […]
If you are not seeing these diseases every day, you tend to forget
how serious they can be.”
The
Committee would urge the Welsh Government to work with Public
Health Wales to determine the best methods by which to raise
awareness across the population of the importance of receiving the
MMR vaccination and other scheduled vaccinations. Furthermore, the
Committee believes that further work is needed to:
-
raise
awareness that it is two (rather than one) dose of MMR that confers
the necessary immunity to eliminate the diseases; and
-
ensure
that efforts are redoubled to provide second MMR doses to those who
are yet to receive them.
2.
Increasing
opportunities to receive the MMR vaccination
Providing
increased opportunities for people to receive the MMR vaccine was a
clear theme that emerged in evidence. Abertawe Bro Morgannwg
University Health Board suggested looking at the possibility of
offering MMR to those who hadn’t previously received it at
the same time that other vaccinations are given in secondary
school.
The Chief Medical Officer, Dr Ruth Hussey, told the
Committee:
“We
have new programmes fitting in to the teenage years in schools; can
we find a way of double-checking each time that they [pupils] are
up-to-date with all their vaccinations? Equally, thinking
laterally, are there other services that people might be using as
they enter the young adult years – for example, sexual health
services – and can we build in checks and balances in any
type of encounter where that group may be using services […]
We need to carry on thinking of other ways in ways in which we can
keep having that conversation.”
We
welcome the Chief Medical Officer’s comments and urge the
Welsh Government to work with Local Health Boards and Local
Authorities to ensure that opportunities to receive the MMR
vaccination are increased.
3.
Uptake
of the MMR vaccination among frontline health staff
A
number of witnesses noted the importance of encouraging uptake of
vaccinations among frontline health staff, for their own and
patients’ safety. Both the Minister and representatives of
Aneurin Bevan Health Board referred to this as a professional and
ethical duty
– this is an assertion with which we agree. The Minister
indicated that he was not minded to make this compulsory, as there
may be other ways to encourage uptake. Dr Gillian Richardson,
Director of Public Health at Aneurin Bevan Health Board, noted that
she would be keen to see a ‘health passport’ for staff
introduced, which documented vaccinations. We encourage the Welsh
Government to actively explore this suggestion – and other
methods of increasing staff uptake of vaccinations – over
coming months.
4.
Staff
training
The
need to ensure that all staff receive continuous training to remain
alert and vigilant to the reappearance of infections such as
measles, and are sufficiently trained to be able to respond to
outbreaks, was emphasised by witnesses.
The
Chief Medical Officer acknowledged that:
“There
is a sense that people had forgotten what measles was like as an
illness because we have successfully not had it for a long time.
The same applies to diseases that may re-emerge. We need to make
sure that, in training, people are vigilant to expecting that these
diseases may appear from time to time. We are now in a position
where people do know what measles looks like and are aware of it.
An essential part of general training is to keep that vigilance up
and to incorporate it into all training programmes that infectious
diseases can come back at any time and that we need to be aware and
mindful of that.”
We
urge the Welsh Government to work with professional and regulatory
bodies, and relevant academic institutions, to ensure that staff
receive continuous training to remain alert to infections of this
kind and the need to vaccinate against them.
5.
Data
sharing and ICT systems
The
importance of data quality during an outbreak was raised by a
number of witnesses to this inquiry. Neath Port Talbot County
Borough Council’s written evidence stated that:
“There
appeared to be several health IT systems that were not compatible
with one another and in desperate need of
modernising.”
The
BMA’s written evidence also highlighted concerns around
access to up-to-date information.
Aneurin Bevan Health Board (ABHB) proposed that a shift from paper
processes to more accessible electronic processes would improve
efficiency and accuracy, and that GPs should be able to input data
directly on to the Child Health System for patients registered with
their practice. ABHB also highlighted cross-border issues, stating
that the processes for data exchange between neighbouring Health
Boards/Wales and England need to be improved.
The
Committee believes that further work is needed to improve
information handling and the connectivity of ICT systems within the
health service, including consideration of moving away from
paper-based systems. We welcome the Chief Medical Officer’s
acknowledgement that lessons from the recent outbreak will provide
an opportunity to look at connectivity between ICT systems and
improve the use of electronic processes.
6.
Communication
The
effectiveness of innovative communication tools – including
social media – was highlighted by those who gave evidence to
the inquiry. We welcome the intention on the part of Public Health
Wales to explore the opportunities offered by social media to
communicate with the public in situations of this kind.
We also note the suggestion that ‘immunisation
advocates’ in relevant organisations should use social media
to promote the importance of immunisation on an on-going
basis.
It was also noted that communications strategies and information
need to be tailored to different audiences,
including harder-to-reach groups and those who have traditionally
remained reticent to having their children vaccinated.
Oral
evidence also highlighted the effectiveness of the school text
messaging service as an instant method of communication with
parents and pupils. The Committee was told, however, that this is
not available in all schools in Wales.
We urge the Welsh Government to work with Local Authorities to
explore why all schools do not currently have this service and
scope the feasibility of ensuring it is introduced across all
schools in Wales.
The
role of the media during outbreaks and intervening periods was
raised by many witnesses. We welcomed the Minister’s
acknowledgement that Government and relevant organisations need to
play an active role in providing robust and timely information that
journalists can have confidence in using.
We also commend the work of the Science Media Centre, an
independent charity which provides help to ensure that the public
have access to the best scientific evidence and expertise through
the news media when science hits the headlines.
Next
steps
The
Committee would welcome a response from the Welsh Government to the
key issues raised above. We also look forward to receiving a copy
of the review of the outbreak that will be coordinated by Public
Health Wales over coming weeks.
We
believe that continued efforts to vaccinate during periods between
outbreaks are equally important as the actions taken to handle
outbreaks when they occur. As a consequence, we will continue to
monitor progress in meeting the target of 95% of children receiving
two doses of the MMR vaccine during this Assembly.
