The rationale for inclusion of the vaccine on NIP

The influenza program for infants is an immunization program that is run by the government with the aim of preventing flu among children. The flu vaccine for children is offered once every year in the form of nasal spray. The immunization program mostly targets children between age 2 and five. The program also targets older children with long-term health conditions. In some parts of the country, primary school kids will be immunized against influenza. Children between the age of 6 months and two years who are at high risk from flu are offered the annual flu jab. The program is mainly carried out in school where announcements are made, and parents are advised on the dates the vaccine would be offered. The vaccine is given as a single spray which is squirted on each nostril and hence its needle-free. The program for the year 2018/2019 aims at achieving uptake of 78% and therefore ensure a reduction in transmission of flu ( Shoenfeld & Agmon-Levin, 2015). The report identifies the policies that support this program. The report also discusses the feasibility of the program and the goals of the program. The strengths, limitations and the implementation strategy of the program are also discussed. The report also discusses the outcomes of the program and the impact of the program since it started.

The influenza vaccine was included in the National Immunization Program because of the vulnerability of small children to getting flu. In the UK, more than 90 % of children between the age of two and fifteen are at risk of contracting flu if they are not immunized with the influenza vaccine. Interest in prevention and control of seasonal influenza has increased in the wake of the A (H1N1) pandemic (Compans & Oldstone, M. B. A. 2014). The World Health Organization through its Global Action Plan for Influenza vaccines has increased campaigns for the use of influenza vaccine especially among children (World Health Organization, 2010). The influenza vaccine for infants was added to the National Immunization Programme based on estimates of the burden of disease by age both in groups with high risk clinical conditions and those without Research indicates that for children below the age of 6 months, there are 84.5 incidences out of 1000 and there are 11 deaths out of those. Of all the age groups, this age group had the highest fatality rate per admissions with 0.4. For children between the age of 6 months and four years, the fatality rate was 0.2 and incidence of the disease was 33.6 for every 1000 children (World Health Organization, 2010). This, therefore, justifies the need for inclusion of the influenza vaccine in the National Immunization Programme. .Some of the factors that contribute to high prevalence in the UK is the cold weather, especially during winter. Infants also do not have a fully developed immune system, and therefore they need to get the vaccine to avoid getting flu. In the year 2012, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the national immunization program(NIP) be extended to cover healthy children and adolescents aged between 2-17 years. This was done to reduce the high pediatric burden of influenza by reducing the number of cases among children. 

Program delivery

The influenza immunization program has been ongoing in the UK for a very long period. However, in the year 2012, the JCVI recommended that influenza immunization program is extended to include children between the age of 2-17 years (Khot & Polmear, 2011). The extension of this program began in October 2013. During this period the program targeted children between the age of 2 to 3 years in primary care. The program also includes several pilot programs in schools in England, Scotland, Wales and Northern England. The success of the program was pinned around involving many other stakeholders. This would help in improving the supply, storage, and distribution of the vaccine to ensure that it reaches the target group through the United Kingdom. The influenza programme for children targets nine million school children. The program is implemented in phases. The first phase of the programme comprises vaccination of children between the age of 2 and three years in GP settings. At the start of the programme in the year 2013, a board was formed to coordinate the implementation of the programme in the four countries. Some of the issues considered by the project board include vaccine supply, project management, and surveillance of vaccine uptake, training, and protocols.

The following are the stakeholders involved in the implementation of the infant Influenza Immunization program;

lLocal childhood immunization teams

lVaccine providers

lNational Departments of Health in each country

lDirectors of Children Services

lDirectors of Education Services

lLocal councils and education authorities

lCommunity pharmacies

Health Immunization programs used qualified nurses as well as unqualified health support workers. Staffing relied on the general practice structure with a team comprising of a physician, nurse, and administrative clerk. The administrative clerk is in charge of awareness campaigns. At the start of the program, the participants of the programme are trained for two weeks on the objectives of the programme and how to undergo all the activities required in implementing the program (Institute of Medicine (U.S.) & Stratton, 2012). The challenge, in this case, is that most employees are employed on a temporary basis, and therefore training issues arise from time to time. In addition to this, community pharmacies and health centers also played an important role in the delivery of the vaccine. Most of the parents in rural areas took their children to be immunized in the community pharmacies. 

The strengths of the implementation policy are that it depends on avenues such as schools and community health centers. These avenues help in ensuring that the program reaches as all the children in the target group. In addition to this, the program relies on existing structures and hence making it possible to implement the program each year without spending so many resources on training and hiring(Kumar & Danziger-Isakov, 2011). Another strength of the programme is that digital data-management systems were used. This enabled effective and efficient management of patient information and hence improving monitoring and evaluation process. The programme was also strong because it helped in minimizing wastage. The programme heads would order vaccines in stages to avoid wastage. Ordering just enough quantities also helps in reducing refrigeration cost and hence contributes towards reducing the overall costs of the programme.

Stakeholders involved in the implementation of the infant Influenza Immunization program

One of the weaknesses of the programme is that it largely depends on unqualified staff, and hence they require a lot of training. Contracting of many suppliers and pharmacies to help in the administration of the vaccine is also time-consuming and may lead to increased wastage.

Program monitoring is very critical since it ensures that every phase of the project is implemented successfully to achieve the intended objective. Monitoring help in ensuring that everything goes according to the plan and that the implementation process is line with the final objectives for the programme. The immunization program uses a very effective monitoring and evaluation strategy. The first strategy is that data management systems are used to collect timely information on the project. In England, the data management system is connected to the internet and hence enabling live data transmission from pharmacies and other centers used for immunization. In England, a data management system known as ImmForm is used to collect data on the uptake of the vaccine(Thomas & Margulis, 2016). Using this tool, the Department of Health can understand the uptake of the program on a daily and weekly basis and hence measures can be taken to improve the uptake of the vaccine. The other advantage of this method of monitoring is that the data collected is timely and accurate and hence is very useful for decision making. In Scotland, data for the programme is collected every week through the remote extraction of data from General Practice vaccinations using an online application. The data is collected locally and then sent to the NHS headquarters using emails. In addition to this, monitoring of the program was done by the team leaders in each region. The team leaders were required to prepare weekly reports detailing the success of the programme and the challenges experienced during the week. This helps the NHS in determining the progress of the project and making adjustments to ensure further success of the program. The entire immunization process is overseen by the Joint Committee of Vaccination and Immunization. 

The Influenza Immunization program for children has achieved much success since it was launched. The government targeted 60% uptake of the vaccine for children below the age of 2 years. The target for children between the age of 3 and four years is 48%. The programme achieved 62% uptake rate for children below the age of five years in England (Offit & Moser, 2016). For children below two years of age, the uptake rate was 42.6% in England while in Scotland it was higher at 52.5% (In Vesikari & In Van, 2017). This is a clear indication that the project was very successful.  The vaccine was accepted well by both parents and children. Most parents took their children for vaccination in the first few days of the program. Parents also gave permission for children to be vaccinated in schools. A study was carried out at the end of the program in 2014 to evaluate attitudes towards the vaccinations. The results indicated that most of the people were positive towards the programme. Some of the factors that could have contributed to high uptake of the programme are a good communication and the intense awareness campaigns. Some of the initiatives that were undertaken to encourage children to take the vaccine include; sending invitation letters to parents, arranging special clinics for children and infants, and opportunistic vaccinations for children being brought for a checkup or other appointment (Institute of Medicine (U.S.), 2013)s. Most online websites on health also contained information on clinic times and how the vaccine can be assessed.

Strengths and weaknesses of the program

The Influenza immunization programme has had a huge impact in helping the reduce incidences of flu among children below the age of five years. The incidences of flu and related illnesses have reduced by 21% since the childhood influenza vaccination programme began (Compans & Orenstein, 2009). Below the launch of the immunization program, there were very many cases of influenza and other respiratory related illnesses among children below the age of 10 years. These cases were even higher during cold seasons. The programme has also helped to reduce the burden of the disease. Before the programme started, the overall hospital admission rate for children below the age of 5 years was 1.9 for every 100,000 children. After the programme was launched, the admission rate has reduced to 1.7/100,000 n(Atkinson & Centers for Disease Control and Prevention (U.S.), 2009). The cases of fatality for children under the age of 6 months for every 1000 admissions were 0.4. After the start of the program, the cases reduced to 0.3 fatalities for every admission. From the statistics, it is therefore clear the impact that the immunization programme has had on the target population.

The initial programme of immunization of children in the UK has provided many insights which could be useful while undertaking other programmes in the future. One of the things that will be important in the future is taking in more stakeholders and improving collaboration between departments and local entities. School workers and school nurses should be more involved in delivering immunization for school going children. This will help in creating more awareness and improving attitudes of children towards the vaccine. 

Effective communication and education will also be very important in conducting future immunization program. All effective means of communication should be used to create awareness among children and parents to achieve higher uptake of the vaccine and hence achieve the objectives of the programme (In Shoenfeld & In Agmon-Levin, 2015).

The local areas teams and the local childhood immunization teams are important in implementing future programs. This is because the teams have a better understanding of the local health dynamics of society and they have more experience.

Furthermore, it will be important to plan in advance and thoroughly for future programs. This will be important in putting together all the resources required to implement the programme. In addition to this, proper planning will ensure ample time for training the staff to be involved in implementing the project. Wastage should also be reduced as much as possible when the immunization programme will be carried out in the future.

Outcomes of the influenza immunization program for children

Conclusion

This report analyzes and discusses the policies and strategies used in the implementation of the Influenza Immunization program for infants in the UK. The program was included in the NIP because the UK, more than 90 % of children between the age of two and fifteen are at risk of contracting flu if they are not immunized with the influenza vaccine. Interest in prevention and control of seasonal influenza has increased in the wake of the A(H1N1)  pandemic. The World  Health Organization through its Global Action Plan for Influenza vaccines has increased campaigns for the use of influenza vaccine, especially among children. The report discusses the rationale for targeting infants in this campaign and also outlines the stakeholders who will be involved in the project. The strategies used in implementing the programme are also discussed in this report. The results of the program, its impact as well as future considerations for the programme are also discussed in this paper. 

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