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Vaccines are a type of prescription-only medicine. Their purpose is to stimulate a person’s immune system to produce antibodies that fight a specific disease, so that the person develops ‘immunological memory’. If the body is later exposed to the same infection, immunological memory enables the immune system to recognise and respond to it rapidly, thereby preventing or modifying the severity of the disease.

Vaccines are an important part of preventative medicine and are described by the NHS as “the most effective way to prevent infectious diseases.”

What is in vaccines?

The main ingredient of a vaccine is a “small amount of bacteria, virus or toxin that has been weakened or destroyed in a laboratory first.” This means that the vaccine generates an immune response but does not cause disease.

There are different types of vaccines which are made using different processes. They include:

  • Live attenuated vaccines, which contain bacteria or viruses that have been weakened.
  • Inactivated vaccines, which contain whole bacteria or viruses that have been killed or altered so that they cannot replicate.
  • Subunit vaccines, which feature small parts from the surface of bacteria or viruses, such as proteins or sugars.
  • RNA vaccines, which contain genetic material (DNA or RNA) from viruses or synthetic copies of that material. This is a new approach and has been used in the Pfizer/BioNTech and Moderna vaccines against Covid-19.

Vaccination programmes

The UK’s current routine immunisation schedule provides protection against 14 infections, including measles, meningococcal disease and polio. Most vaccinations are given during childhood but some are aimed at adults, such as vaccination against shingles, where those aged 70-79 years are eligible in the UK.

The Department of Health and Social Care (DHSC), and its devolved nation counterparts, have adopted recommendations made by the World Health Organization (WHO) that at least 95% of children should be immunised against vaccine-preventable diseases.

In 2020-21, the UK only met the 95% target for the ‘DTaP/IPV/Hib’ vaccine at age five (diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b). There is also geographical variation in vaccine coverage. The National Audit Office, for example, has highlighted lower levels of uptake in pre-school vaccinations in London, compared with the rest of England.

According to NHS England and Public Health England, factors that affect the uptake of childhood vaccines in England include:

  • inconsistent communication between healthcare providers and parents or carers;
  • difficulties making suitable and timely appointments;
  • incomplete and potentially inaccurate data on vaccination;
  • ‘under-served’ (or ‘hard-to-reach’) populations;
  • anti-vaccination messages;
  • vaccine hesitancy among a small minority of parents and carers.

Vaccination policy in England

Health is a devolved matter.

The DHSC provides national strategic oversight of vaccination policy in England, with advice from the independent Joint Committee on Vaccination and Immunisation (JCVI) and the Commission on Human Medicines.

NHS England is responsible for commissioning national immunisation programmes in England. The DHSC sets performance targets and the UK Health Security Agency undertakes surveillance of vaccine-preventable diseases.

Pre-school and adult vaccinations are usually delivered by GP surgeries. They are commissioned through the NHS GP contract. School-age services are commissioned by seven regional NHS England teams and delivered through School Immunisation Teams.

Additional support was put in place specifically for the Covid-19 vaccine programme. This included a new UK Vaccine Taskforce to promote “the development and production of a coronavirus vaccine”. Links to more resources on vaccination and Covid-19 from the House of Commons and Lords Libraries, and the Parliamentary Office of Science and Technology, are available on  the Vaccination and Covid-19 webpage.

In August 2019, the WHO’s European Regional Verification Commission for Measles and Rubella Elimination (RVC) determined the UK had lost its measles elimination status. The UK Government responded with measures to increase immunisation rates for the MMR (measles, mumps and rubella) vaccination, such as promoting ‘catch-up’ vaccination programmes for 10-11-year-olds.

The DHSC is also due to publish a wider 10-year vaccination strategy but it has been delayed by the Covid-19 pandemic.

Mandatory vaccination

Vaccines offered through the national immunisation programme in the UK are not mandatory. Vaccinations are also not currently mandatory in the UK during a pandemic. The Government took steps in 2021 to make vaccination against Covid-19 a pre-requisite for working in health and social care in England, with limited exemptions. These regulations, however, are set to be revoked, subject to parliamentary approval. For further information, see section 8 of the Commons Library briefing on Coronavirus: Adult social care key issues and sources (February 2022).

Medical and ethical opinion is divided on immunisation policies that involve some degree of coercion. Some countries, such as Italy and France, have mandatory vaccination policies in place. In response to falling vaccination rates, some have extended existing mandatory vaccination programmes, or introduced them for the first time, such as in Germany. Such policies may, for instance, fine parents who refuse vaccination for their children, or exclude unvaccinated children from state-run schools.

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