Targeted letter initiative to increase Flu vaccination uptake for 2- and 3-year-olds

Insight

Our Immunisation Management Service (IMS) regional support team worked with the Lancashire and South Cumbria Screening and Immunisation team. Uptake of the Flu vaccine in 2- and 3-year-olds in 4 BwD Primary Care Networks (PCNs) was analysed to examine low uptake by ethnicity and deprivation.

This analysis identified that 11 GP practices across 3 bordering PCNs had poorer uptake in 2- and 3-year-olds of between 25 to 35%, significantly lower than neighbouring Darwen PCN which achieved 56% and the rest of the Lancashire area which achieved significantly greater uptake.

More detailed analysis showed that over 75% of the registered population at these GP practices lived in the most deprived areas with a diverse ethnicity mix. The Pakistani population became a specific focus with over 1,000 eligible children not vaccinated against Flu.

Our IMS Call Centre carried out a programme of scheduled calls to parents of unvaccinated children to understand the reasons for their vaccination hesitancy.

Analysis of parental responses to these calls highlighted firstly that most parents from the Muslim community did not accept the offer of a Flu vaccination for their children due to the porcine and gelatine ingredients. Further investigation showed that they were unaware of the alternative injectable version and would have been more likely to bring their child had they had this information. Secondly, several parents did not think the Flu vaccination was important for their child but admitted to not fully understanding its benefits.

Informed by our analysis and the insight it provided, the Lancashire and South Cumbria Screening and Immunisation team decided to focus on uptake improvement initiative on 3 BwD PCNs – East, North and West.

The initiative:

A localised invitation letter and information leaflet addressing key concerns identified from parental responses captured by the IMS Call Centre were produced for GP practices to use. All participating GP practices were supplied with:

• a letter template to be signed by the practice GP including easy-read diagrams to understand the benefits of Flu vaccination – versions available in specific languages including Urdu, Hindi and Arabic, which strongly emphasise the option of an injectable version of the vaccine to counter concerns about ingredients in the nasal spray
• locally developed translated factsheet to include with the letter answering several key questions raised by the community identified from the recall centre insight
• a participation form for the GP practice to complete to obtain payment

1290 local invitation letters for Flu vaccinations were sent to families across 9 GP practices and 210 Flu vaccinations were given following the invitation date which equates to 16% of those who received one.

Of those 210 vaccinations, 137 were given to 3-year-olds who had not received a Flu vaccination in the previous Flu season.

The table below shows the positive impact of the local letter pilot, a 10% difference in uptake between GP practices in the ICS which did take part and those who did not in the same period after the local letter date. All participating GP practices achieved a higher Flu vaccination uptake than for the previous Flu season with increased uptake in Muslim communities.

Proving to be a success in Blackburn, an additional budget for the 2022/23 Flu season was allocated to extend it into Liverpool, Knowsley and potentially deprived areas of Greater Manchester.