Summer has just started but it will not be long before the first older patients arrive in the surgery asking about their annual influenza vaccination. In UK general practice, the autumn seasonal flu vaccination for over 65s is a well-established routine, as widely-accepted as the free bus pass. In 2009/2010, uptake was 77% in Northern Ireland, 75% in Scotland, 72% in England, and 64% in Wales.1 Although one of the three papers on influenza vaccination in this issue of the BJGP reports that some social inequality in vaccine uptake persists — despite introduction of the Quality and Outcomes Framework, which boosted overall uptake and reduced variation between practices — even in the most socioeconomically deprived category, two-thirds (67%) of older patients in Scotland were vaccinated in 2006/2007.2
In contrast, research by Sampson et al found that influenza vaccine was given to only one in four of the at-risk children for whom seasonal influenza vaccination is recommended by UK national guidelines.3 For some parents, getting to the clinic for the offered appointment was an issue. Others intended to take their children but didn't get around to it, and a substantial number are unconvinced that their children would benefit from the vaccination.3 Some of this scepticism may reflect media-amplified concern about vaccine side effects and a suspicion that multiple vaccinations are harmful. It also appears that many parents think either that influenza vaccine is not effective, or that their children are not at ‘high risk’. The authors highlight that a number of parents had discussed the issue with GPs and nursing staff who had supported their negative views, expressing similar ambivalence about the benefits of vaccination.
This negative attitude to seasonal influenza vaccination may partly explain why vaccine uptake was also low when offered to children age 6 months to 5 years during the 2009 H1N1 pandemic: research by Varma and Murray in this issue of the BJGP showed an uptake of 34% in one Welsh general practice.4 Uptake of the pandemic vaccine in this study was not related to social deprivation, and the parental reasons for non-acceptance echo those of parents of at-risk children offered the seasonal vaccine. The most common concerns were about safety (31.0%) and side effects (10.3%), again with many parents (15.5%) saying they thought vaccination was unnecessary for their child.4 Negative parental views may have been reinforced by those clinicians who felt that the national response was an over-reaction and were concerned about the safety of the arrangements.5