Global Health Challenges: Vaccine Use in the UK and Australia

Introduction

The world is coupled with various health challenges. The global health issues range from vaccine-preventable diseases outbreaks, for instance, diphtheria and measles, growing rates of physical inactivity and obesity, increasing reports of drug-resistant pathogens, multiple humanitarian crises, and environmental pollution health impacts. This paper examines the global health challenge, giving an overview of the challenge. The section examines relevant health data related to Vaccine use in the UK and Australia. The essay critically analyzes the initiative to address the Vaccine use in UK and Australia challenge, including a clear contrast between Australia and the UK using relevant evidence and data to support the analysis. The section also evaluates the initiatives to address Vaccine use in Australia's challenge about the role of the future nurse and contemporary public health practices in addressing this global health issue.

Analysis of relevant health data in the UK and Australia Vaccination rates

The use of vaccines in the UK is licensed for children aging between 6weeks to 10years.In the UK, the 6-in-1 vaccine used is sometimes identified as DTaP/Hib/HepB/IPV standing for 'Diphtheria, Tetanus, acellular Pertussis, Hib, Hepatitis B and Inactivated Polio Vaccine' (Emerson, Robertson, Baines & Hatton, 2019).

Over the past decades, the general vaccination rates for children have gained traction from the experts in the UK due to declining rates of immunization against 13 diseases. UK measles free status loss in 2019 also characterizes the decline in immunization coverage with the NHS reports for 2017 depicting the UK's population general loss of confidence in the vaccine. Between 2018 and 2019, the UK recorded a decline of MMR vaccination rate at 83% from 85.1% between 2017 and 2018 (AIHW, 2018). Worth noting, the drop in trust in vaccines has impacted primary immunization given to babies during their first year in life. Take-up of the five in one vaccine against DTaP/Hib/HepB/IPV has dropped for children aged six years from 93.1% between 2017 and 2018 to 92.1% between 2018 and 2019. Bosely (2019) highlights that routine vaccination decline among children aging 24 months has been registered to 90.3% in 2019 from 91.2% in 2018, while 95% coverage of entire routine vaccinations should be 95%. Bosley further observes that the vaccine immunization rate has been declining over the past five years. Other vaccines affected in the UK are rotavirus, pneumococcal disease (PCV), Hib booster, meningococcal group B (MenB), children flu vaccines, and meningococcal group C vaccine (Hib/MenC).

On the other hand in Australia experienced an increase from 74% in the year 1999 to 92% in 2004, and the rise in vaccine immunization rates were sustainably stable to the year 2013 from 92% to 93% (Australian Institute of Health and Welfare, 2018). However, AIHW (2018) argues that routine vaccine immunization uptake rates in 2015 reduced to 89%, though a slight increment to 91% was recorded in 2016, and a slight decline to 90% was registered in 2017. Moreover, AIHW (2018) highlights that from the year 2014 to 2017, various new routine vaccines were introduced, thus affecting immunization rates during this period. Nonetheless, AIHW (2018) asserts that a tremendous increment in full vaccination for children aging five years has been recorded, increasing to 94% in 2017 from 74% in 2005.

According to the Australian Government Department of Health (2019), child immunization coverage in Australia is the percentage rate of children who have had all the vaccines recommendable for their age. Australia is close to meeting the 95% target with more than 90% coverage for one-year-olds, two years, and five years olds. Australia's success factor in child immunization is traceable in the increased and higher rates of vaccination for one and two year old children. Australia has achieved close to 97.05 % percentage for Torres Strait Islander and Aboriginal five-year-olds.Also, Australia has made about 94.82 % coverage for all children aged five years.

Vaccine use policies in the UK

According to JVCI and NHS (2017), the UK vaccine regulations and policies are formulated by the government collaboratively with the Joint Committee on Vaccination and Immunization. Public Health England (2017) outlines that the vaccination schedule for the UK is founded on an immunization guide of World Health Organization’s (WHO) Green Book that outlines the most recent information on vaccines and immunization procedures

Public Health England (2017) report outlines that the United Kingdom Joint Committee on Vaccination and Immunization advises the health ministers on entire immunization aspects.Recommendations from the committee under recent legislation confer the right to access vaccine to England Wales population. As a vital aspect of both suggestions and advice, the vaccination reaches a threshold that is cost-effective through the use of sophisticated economics and mathematic modeling.

The Joint Committee on Vaccination and Immunization (JVCI), a Standing Advisory Committee that was authentically a Polio Immunization advisory board, became JCVI in 1963. The National Health Service (NHS) established JCVI in the current statutory form under a Standing Advisory Committees) Order 1981 (SI 1981/597) founded on the current provisions of the NHS (Wales) and NHS Act 2006.

According to Lang et al. (2019), the JVCI currently constitutes 17 members, and each member represents a different professional area, and it is mandatory for all the professionals to have specified knowledge on vaccination. The professional members include a paediatric neurologist, a community pediatrician, a general hospital pediatrician, an adult infectious disease professional, two nurses, a general practitioner, a public health professional, an immunologist,an epidemiologist, a virologist, a bacteriologist a layperson alongside with a single representative of Wales ( a public health professional), Scotland (a public health professional) and Northern Ireland (a pediatrician).

Currently, the committee recruits an economist due to the escalating need for economic evaluation (Lang et al., 2019). The committee member’s recruitment is achieved through independent body selection, the Appointments Commission, and national advertisement.Moreover, the chairman is appointed amongst committee members. The Commissioner for Public Appointments Code of Practice determines the length of appointments. The members and the chairman are not rewarded, though expense payments are made for meetings attendance. Under normal circumstances, the committee meets thrice per year. The Department of Health Immunization section provides the committee secretariat. The Agenda on issues raised by the Ministers of Health and the members through letters to the committee is agreed between the secretariat and chairman.

Role of JVCI in policy formulation

In 1st April 2009, NHS Constitution relevant provisions were enacted via Regulations. According to Lang et al. (2019), the Regulation specifies that the public in the UK is entitled to receive vaccination as indicated in any committee Recommendation relating to changes to an existing national vaccination program or a new federal vaccination program. Moreover, it is mandatory for the suggestion to be on a question referred by the state secretary specifically to be based on a cost-effective assessment that does not relate to occupational or travel health. The rest of JCVI decisions are merely advisory.

The committee executes horizon scanning majorly projected to the identification of vaccines likely to be licensed in a couple of 3 to 5 years. To this end, the committee can advise on ideal surveillance prior development of licensure and any essential research to facilitate the process of decision making. For instance, if there is a need to collect the costs of likely vaccine-preventable diseases or the need to estimate the current burden (O'Mahony & Paulden, 2019).

The committee considers vaccination schedules dynamics, for instance, where new evidence recommends a change in dose timing or interval (O'Mahony & Paulden, 2019). Comparably, due to new evidence, there may be changes in vaccine indicators; therefore the committee advises this. During the scope of its work, the committee uses vaccine coverage data and provides advice based on the data. However, the committee is not mandated to run the immunization programs.

O'Mahony & Paulden (2019) argue that the committee reviews data on vaccination adverse events potentiality that includes studies mainly carried out in UK reports, global literature published studies, Health Protection Agency (HPA), Medicines and Healthcare Regulatory Agency (MHRA) surveillance system reports and routine adverse reactions surveillance (AR, AH & Faisal, 2019). Thus, the committee uses this information to weigh its decision making benefits and risks, though it lacks a regulatory role for vaccines. Worth noting the committee is mostly involved in newly licensed vaccines.

Vaccine use policies in Australia

According to (AIHW), Australia’s vaccine policies are founded on WHO (Green Book) guidelines and recommendations. The Australia Technical Advisory Group on Immunization (ATAGI) majorly recommends these policies as well as the research focus area. ATAGI consults with relevant organizations in the implementation of immunization procedures, policies, and vaccine safety.

Australian Government Department of Health (2019) argues that the Australia Technical Advisory Group on Immunization (ATAGI) advises the Australia minister for health on vaccines available in the country, including the vaccines available through National Immunization Program (NIP). The NIP aims at increasing coverage for national immunization to reduce the number of illnesses preventable through vaccination in Australia. Moreover, ATAGI is also responsible for advising research organizations on current immunization research and areas that need further investigation.

ATAGI advises the Pharmaceutical Benefits Advisory Committee (PBAC) on vaccine use and effectiveness in Australia. PBAC is an Australian government-appointed expert body that includes health professionals, doctors, consumer representatives, and health economists (Australian Government Department of Health, 2019). PBAC has a primary role of recommending medicines to PBS for listing and takes into account the medical conditions that the registered medicine is used in Australia, safety, and cost-effectiveness relative to other treatments and its clinical effectiveness.

According to Bali, Capano & Ramesh (2019), ATAGI consults with relevant organizations to formulate the Australian immunization Handbook. Bali and colleagues further argue that the Australian Immunization Handbook is offering health professionals clinical advice on the most effective and safest use of vaccines in the nursing profession. The ATAGI consults with all the stakeholders on suggested dynamics to suggestions for inclusion in the Australian Immunization Handbook.

Vaccine Use interventions in UK and Australia

In the UK, substantial differences exist in vaccine uptake based on gender, social, economic status, geographical locations, ethnic groups, and religious beliefs. A previous systematic review depicts that there is promising evidence for mixed for reminder recalls systems, outreach programs, service delivery interventions, provision of information and interventions limited to text messages. The following interventions can be applied in reducing the UK's inequalities on vaccination coverage:

Multicomponent locally designed interventions: Thee multicomponent interventions are designed for a specified population and context. According to Crocker-Buque, Edelstein & Mounier-Jack (2017), the NICE guidance recommends home visiting as probable cost-effective interventions. Also, social marketing is a promising approach to adolescent's adherence to vaccines.

Reminder call: is another approach to increase the rate of vaccine uptake in the UK and is gradually evolving. In the UK, centralized recall systems are ideal in promoting vaccine uptakes in the UK; however, this only applies to specific health systems in the UK (Crocker-Buque, Edelstein & Mounier-Jack, 2017).Also, the use of educational and interactive messages as text reminders impact vaccine uptake in the UK. Other interventions, such as social media and mobile apps, are useful measures to improve vaccine uptake.

Behavior change interventions: Targeting telephone and postal reminders to parents is ideal at increasing early childhood vaccination in the UK (Crocker-Buque, Edelstein & Mounier-Jack, 2017).Also, client-side financial incentives are a perfect intervention for improving adolescent rates for vaccine uptakes, for instance, HPV uptake. This is because, in most cases, younger children seek routine healthcare as opposed to older children; therefore incentives would entice older children to ask for routine healthcare.

Use of two or more combined strategies: The application of combined strategies is an ideal approach for enhancing Vaccination uptake in Australia (World Health Organization, 2018). Usually, multicomponent policies are projected to improve access and increase community demand for vaccination. Occasionally, provider-based strategies are incorporated with the regulatory interventions underpinning these and evaluating in isolation. The multicomponent strategies increase vaccination coverage for children.

Role of nurse in promoting Vaccine use

Nurse's role in the prevention of diseases such as measles includes the provision of accurate information about vaccine-preventable diseases and advocates for all children to receive vaccinations that are ideal at the right times. To this end, nurses should promote vaccine-preventable diseases awareness, for instance, measles and diagnose such illnesses whenever there is any tangible evidence of symptoms linked to such diseases (Navin, Kozak & Deem, 2019). Moreover, nurses need to be informed of existing vaccine safety parental misconceptions and sensitize the public on such issues to enhance vaccine uptake. Also, nurses should be eager to improve public motivation towards vaccination, ensuring the community adheres to vaccination appointments. Nurses are also responsible for eliminating logical issues the prevent appropriate vaccine use, such as ambiguous clinic policies, complex vaccination schedules, and financial challenges.

ICN has long advocated that nurses can and plays a vital role in immunization globally as part of a nurse's greater involvement in primary healthcare and health promotion. In the UK and Australia, nurses manage the programs of immunization that include training and supervision of various health workers in vaccination administering. However, there is much to be achieved today, since in 2016 statistics indicate that 1 out of 10 infants failed to obtain a vaccination, with the number of children receiving recommended vaccines going down and adult immunization is underutilized (WHO, 2018). Therefore, nurses and various healthcare practitioners, as a public health intervention, must pay more attention to vaccination. Indeed the current involvement of nurses in all immunization aspects, high public trust and extensive presence across health care sectors, ICN believes that enhancement and increment of nurses engagement in immunization full spectrum of activities is a part of expanding nurses role in primary healthcare and is a vital strategy in improving immunization rates globally.

The immunization activities spectrum includes public advocacy and awareness-raising linked with immunization significance, dispelling myths, ongoing health education, administering vaccinations, helping individuals in immunization schedules management, prescribing vaccinations, supervising the immunization team, overseeing vaccination programs and offering advice on immunization strategies and plans. Gidding et al. (2016) argue that nurses are involved in all these activities around the world and have a significant role to play in increasing immunization outreach.

Nurses influence vaccination rates in the UK and Australia, and to a more considerable extent, globally; therefore, nursing has developed a comprehensive immunization strategy (Chen et al., 2019). However, both the public and nursing sector has become complacent about immunization as evidenced by its apparent simplicity and little focus on prevention and high publicity of adverse events.

With various high tech and complex nursing interventions that make up nursing skills and knowledge set, immunization in some contexts lacks the attention it deserves as a single successful and cost-effective intervention in the world. Therefore there is a need for nurses' overall involvement in the degree of preparations and interventions. According to Chen et al. (2019) nurses are engaged in immunization activities, actively teach about immunization, and provides immunization data.

APNs and RNs nurses continued involvement in key intervention strategies of immunization would help in future nurses addressing the Vaccine use in the UK and Australia. RNs are more engaged than APNs in education related to vaccination, proactively identifying immunization needs, and in vaccine administration (Grove, 2019). RNs plays a crucial role in administering vaccines, and they engage in teaching and proactively identifies the need for vaccination.

Collaborative and partnership approaches about Vaccine use inequalities across all ages, beliefs, and cultures

According to Plans-Rubió (2019), herd immunity vaccine uptake levels are still not attainable in some developed countries such as Australia and the UK; usually, these countries have persisting social inequalities in uptake. Ethnicity is a significant factor that influences vaccine uptake levels. Therefore, equitable access to preventive health services for children has the capability of reducing health inequities in their childhood and adulthood life. A fundamental preventive service in the 1st year of a child's life is the vaccine provision and delivery. Low vaccine uptake in developed countries is linked with persistent social inequities. To prevent infectious disease transmission, herd community to be reached out within the social strata to avoid the creation of subpopulations with low vaccine coverage where epidemics start.

Various organizations in the EU, as well as Australia, publically funds vaccination programs for children intending to overcome financial barriers for poor households accessing vaccinations. However, the organization of preventive care and the structure of primary care services matter and substantially differ across Australia and Europe.

Decentralized authorities control primary Care Services (PCSs) with a hierarchical model work under government regulation and. In the UK, the government provides, regulates, and fund health services with relatively low practitioner's freedom to set up healthcare clinics.

Another crucial distinction across nations is the organization of preventive healthcare services for preschool children. In Australia, a separate organization is responsible for children preventive services identified as well-baby-clinics while in the UK, preventive health services are integrated within the regular primary care services. The Well-baby clinics are built around a public health nurse that works within a team of various child health professionals or child. Such nurses schedule visits with families at the clinic based on a preset age-dependent schedule allow for some on-demand visits and provide telephone counseling.

The provision of preventive services that are equitable is dependent on organizational and structural factors. Much attention is paid to micro-level intervention roles within single health care systems, for instance, implementation of outreach programs, reminder/recall, and educational programs for healthcare workers and parents.

Child immunization in the UK is lower among the Black and Asian Minority Ethnic (BAME) backgrounds. Low uptake of vaccinations makes the people living in ethnically dense areas more vulnerable to disease. A study carried out in London indicated that immunization uptake varies with ethnicity, where the BAME have lower vaccine uptake levels compared with the whites.

Moreover, unprotected individuals traveling to countries where infectious diseases are prevalent are usually at a risk of getting infected and subsequently importing it into the UK and are vulnerable to infections obtained from families visiting in the UK and are unprotected. Although low immunization uptake is usually linked with deprivation, a study in London about diphtheria immunization coverage established that immunization uptake varies with ethnicity; however, there is no relationship between coverage and deprivation in most ethnic groups. This is an indicator that ethnicity is crucial in understanding immunization uptake, independent of deprivation.

Mental illness as a health challenge in Australia and the UK

Mental illness is a global health issue, with more than 300 million people equitable to 4.4% of the worldwide population suffering from depression. According to Stuart, Sartorius & Thornicroft (2019), mental health condition is likely to affect at least one person in a group of four in people’s lives. Disparities abound both between an identified group and countries.

In Australia, Over 75% of mental health challenges occur before the age of 25 years. In essence, almost a quarter of Australian youth is facing mental health challenges. The young women fighting mental health challenges are twice the number of young men grappling with psychological issues.

In 2018 a report indicated psychological distress rates among the youths have risen by about 5.5% in the last seven years (Nghiem, Khanam, & Tran, 2019). In this year, 24.2% of youths experienced mental distress up from 18.7 % in 2012. These study findings were consistent with other recent reports and indicate that mental health issues among teenagers in Australia are an area of concern due to the deteriorating conditions.

According to Nghiem, Khanam, & Tran (2019), 30 % of young women aged between 15-19 experienced psychological distress in research carried out in 2018 in Australia. Among young men, the rate was 15.6%. Moreover, the rate among Torress Strait Islander and Aboriginal youths was higher relative to other ethnics as it was 31.9% or a third experienced mental distress. The survey covered about 28000 teenagers in Australia, and the findings necessitated deepening concerns on youths' mental health and should be a priority in the health sector.

Mixed anxiety and depression in Britain is a major mental disorder, with 7.8% of the population meeting the criteria for diagnosis (Abel et al.,2019).Common health issues such as anxiety and depression are distributed across society, depending on a gradient of economic disadvantage. In England, between 4 and 10%, people are likely to experience depression in their lifetime.

Poor mental health among young people and children is an epidemic in the UK. The number of children obtaining aid from Child and Adolescent Mental Health Services in England has doubled over the last two years (Abel et al., 2019). Though establishing the triggers of youth and children's mental health issues and the symptoms and diagnosis is a challenge. However, girls with mental illness are linked with emotional disorders such as anxiety and depression. The proportion of youths under 16 experiencing mental disorders rose from 11.4 % in 1999 to 13.6% in 2017. This total includes things such as depression and anxiety, hyperactivity, and behavioral disorders.Additionally, young women aged between 17 and 19 years were twice likely to experience poor mental health when compared with their male peers and two thirds more likely to succumb to mental disorders compared to younger girls. The rise of mental disorders cases among the youths and children in UK necessities ideal strategies to fight the epidemic.

References

Abel, K. M., Hope, H., Swift, E., Parisi, R., Ashcroft, D. M., Kosidou, K., ... & Pierce, M. (2019). Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. The Lancet Public Health, 4(6), e291-e300.

AR, N. I., AH, S. H., & Faisal, I. (2019). THE ROLE OF POLICY ANALYSIS IN NATIONAL IMMUNIZATION PROGRAMS: A SCOPING REVIEW. International Journal of Public Health and Clinical Sciences, 6(5), 70-88.

Bali, A. S., Capano, G., & Ramesh, M. (2019). Anticipating and designing for policy effectiveness.

Chen, I. H., Hsu, S. M., Wu, J. S. J., Wang, Y. T., Lin, Y. K., Chung, M. H., ... & Miao, N. F. (2019). Determinants of Nurses’ Willingness to Receive Vaccines: Application of the Health Belief Model. Journal of clinical nursing.

Crocker-Buque, T., Edelstein, M., & Mounier-Jack, S. (2017). Interventions to reduce inequalities in vaccine uptake in children and adolescents aged< 19 years: a systematic review. J Epidemiol Community Health, 71(1), 87-97.

Emerson, E., Robertson, J., Baines, S., & Hatton, C. (2019). Vaccine Coverage among Children with and without Intellectual Disabilities in the UK: Cross Sectional Study. BMC public health, 19(1), 748.

Gidding, H. F., Martin, N. V., Stambos, V., Tran, T., Dey, A., Dowse, G. K., ... & Lambert, S. B. (2016). Verification of measles elimination in Australia: Application of World Health Organization regional guidelines. Journal of epidemiology and global health, 6(3), 197-209.

Grove, S. K. (2019). Building an Evidence-Based Nursing Practice. Understanding Nursing Research: First South Asia Edition, E-Book: Building an Evidence-Based Practice, 387.

Lang, S., Loving, S., McCarthy, N. D., Ramsay, M. E., Salisbury, D., & Pollard, A. J. (2019). Two centuries of immunisation in the UK (part II). Archives of disease in childhood, archdischild- 2019.

Navin, M. C., Kozak, A. T., & Deem, M. J. (2019). Perspectives of Public Health Nurses on the Ethics of Mandated Vaccine Education. Nursing Outlook.

Nghiem, S., Khanam, R., Vu, X. B., & Tran, B. X. (2019). Implicitly Estimating the Cost of Mental Illness in Australia: A Standard-of-Living Approach. Applied Health Economics and Health Policy, 1-10.

O'Mahony, J. F., & Paulden, M. (2019). Appraising the cost-effectiveness of vaccines in the UK: Insights from the Department of Health Consultation on the revision of methods guidelines. Vaccine, 37(21), 2831-2837.

Plans-Rubió, P. (2019). Low percentages of measles vaccination coverage with two doses of vaccine and low herd immunity levels explain measles incidence and persistence of measles in the European Union in 2017–2018. European Journal of Clinical Microbiology & Infectious Diseases, 38(9), 1719-1729.

Stuart, H., Sartorius, N., & Thornicroft, G. (2019). Fighting Mental illness-related Stigma: What We Have Learned. In Advances in Psychiatry (pp. 621-635). Springer, Cham.