National Immunisation Programme

Baroness Ritchie of Downpatrick Excerpts

Thursday 18th January 2024 Grand Committee

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what plans they have to accelerate the adoption of new innovative vaccines by the National Immunisation Programme.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I was delighted to secure this debate as it is a subject of significant importance and one in which I have a close interest. Noble Lords will be aware of my particular interest in RSV, on which I had a Question only yesterday. But this is more about the global issue of which vaccines can get accelerated on to the national immunisation programme.

Undoubtedly, vaccines have contributed significantly to health and prosperity around the world ever since the pioneering work of Edward Jenner, who developed the world’s first vaccines for smallpox. The World Health Organization has said that vaccinations are

“one of the best health investments money can buy”.

Vaccines are critical to the prevention and control of infectious disease outbreaks, and they underpin global health security.

The Covid-19 pandemic imposed enormous pressure in 2020 and 2021, and it showed the importance of having robust plans and systems in place to address emergencies. Despite some setbacks, what both the UK and other countries achieved was remarkable. The pace at which vaccines were developed, manufactured and rolled out to patients was excellent. It was good that government, industry and the NHS came together to collaborate in order to accelerate existing timetables, taking months rather than years to get the job done.

I welcome the recently published NHS Vaccination Strategy and its emphasis on improving uptake rates and optimising the quality of the delivery of clinical trials. However, the strategy focuses on the better rollout of existing vaccines but does not include what more can be done to ensure that the UK has in place the right infrastructure for approvals and delivery, in order to enable new vaccines to reach patients as quickly as possible. I believe this is a mistake: we should focus on both. Put simply, we must improve the delivery of existing vaccines and spend existing money more effectively and efficiently in order to get new vaccines to patients more quickly and effectively. In fact, I received briefings this week from the Royal Pharmaceutical Society about the value of community pharmacies—their work had already been seen in the rollout during Covid-19—and how they can be used in this new deployment.

I was delighted recently to chair a round-table discussion with key stakeholders, hosted by GSK in your Lordships’ House on 19 October. It looked at this issue, lessons learned from Covid and how they could be applied to the national immunisation programme as we move forward. That discussion was very timely, following the Health and Social Care Committee’s report on vaccination, in which it said:

“It would be incredibly disappointing to reach a point where the vaccines themselves were ready but the infrastructure to approve and deliver them was still some time away”.


Our round table concluded many things, such as that quicker availability and increased uptake of vaccines would lead to a healthier nation, which in turn would have direct and immediate benefits for our economy.

Rather than looking at vaccines as a cost, we should see them as an investment. Recent studies have shown that the return on investment for vaccines can be as high as 14:1. Slow and low uptake of vaccines can cost the NHS money and soak up valuable resource. Each month that vaccine rollout is delayed means more patients attending general practice and A&E, and being there for hours on end, as well as more patients being admitted to hospital.

Working together, the Government, the NHS and industry can deliver a first-class national immunisation programme that gets new vaccines to patients as quickly as possible and delivers significant financial, operational and economic benefits. At a time when the Prime Minister has said that reducing waiting lists is a key priority for his Government, we must not forget the role that vaccines can play in helping to deliver this. I hope the Government are listening and will act. I am happy to share the round table’s report and its key recommendations with Members of your Lordships’ House, but we must turn words into action. We should be ambitious for patients, because we want to deal with all the health implications. We also want to address the new diseases that have not been subject to vaccines and could be readily dealt with.

We need a clear commitment from the Government to accelerate the NIP, and a clear and timetabled plan to achieve that. We need a commitment to work with industry and other stakeholders to deliver that plan. We must not let capacity or capability determine the speed at which vaccines enter the programme. That will mean a commitment to resourcing the JCVI adequately, and we need to improve JCVI horizon scanning and the liaison with industry. As we did during Covid-19, we should also establish a single front door to help industry navigate across government on routine vaccines.

I have some questions for the Minister. Will he give concrete commitments today to ensure the acceleration of the NIP, with a clear and timetabled plan to achieve it, and to work with industry and other stakeholders to develop that plan? If such commitments are given, can the Minister provide us with the timetabled plan, including an indication of the resources—staff and money—to deliver it? I know that there are many competing priorities for the Government, but there are also many for the National Health Service, not least the need to keep people well. However, these recommendations are all based on valuable lessons learned during Covid. I therefore seek your Lordships’ support for delivering them, as they will benefit patients, the NHS and the economy.

The UK built a world-leading vaccine development and deployment system during Covid-19 that enabled it to be at the forefront of global pandemic efforts. It is vital that the lessons learned during the pandemic are built on, to ensure that the UK has the right infrastructure in place for the approval and delivery of new vaccines on to the NIP, reaching patients as quickly as possible. We have the proven wherewithal to do it through the NHS and all the associated bodies.

Finally, when will the acceleration and accompanying works for NIP take place, and when will the funding be in place? I look forward to the Minister’s response and the contributions of other noble Lords on this very important issue, which impacts right across the UK. It relates specifically to NHS England, but I come from Northern Ireland, where this is a devolved matter. I am sure Scotland, Wales and Northern Ireland would like to do the same and see these approvals on to the national immunisation programme. It is vital for our health, our economy and our society.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.

As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.

The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.

As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.

The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.

As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.

The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.

As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.

I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.

The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.

The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—

[Baroness Ritchie of Downpatrick (Lab)]

I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?

[Lord Markham (Con)]

Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.

In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.