Dr Anthony Hill MBE provides his insights into why the Welsh vaccination campaign is the envy of the world.
Back in December at the very start of the vaccination programme, amidst a dramatic rise in Covid cases and, unbeknown to us all, another lockdown ahead of us, I wrote in an article for the IWA; “A vaccine programme on this scale, to be conducted with the necessary speed, is a titanic administrative and logistical undertaking.”
But six months on, Wales is leading the four UK nations when it comes to vaccine rollout; with approximately 85% of the adult population having received the first dose of the vaccine, and 36% fully vaccinated at time of writing.
As a result Wales finds itself, along with other UK nations, amongst the likes of Israel, U.A.E, Bahrain and the US, in the ranks of the world’s most vaccinated nations.
It has been a real privilege to witness the epic undertaking of the vaccine strategy and roll-out take shape in Wales, and it has been a deeply emotional time for individuals and families after a prolonged period of isolation and loss.
First doses of the vaccine also provided a much-needed injection of optimism and hope, that many may not have felt since the early months of 2020.
“It has been interesting to see that incumbent Government parties… have all seen a continuation of support in recent devolved Parliament and local council elections.”
But what has led to Wales’ success? What factors have placed Wales among the world’s leading nations for vaccine roll out?
In my piece for the IWA in December, I identified the key elements that would be crucial to success – all of which would only be possible with the urgent coordination of various complex systems and bodies, all of whom would need to be operating at peak performance, and for a prolonged period of time.
Firstly, we needed a robust and innovative health infrastructure, incorporating meticulous internal communications, precision supply chain management, sufficient and sustainable financing, and ultimately, high-quality dispensing facilities and procedures.
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This would need to be backed up with fool-proof administrative support, creating and scheduling appointments in order to cascade the vaccine down through the population, in order of priority groups.
Secondly, a strong political will and strength of leadership would need to be demonstrated, and it has been interesting to see that incumbent Government parties – i.e. those responsible for delivering the vaccine roll out – have all seen a continuation of support in recent devolved Parliament and local council elections, with the Welsh and Scottish Governments increasing their seats, and the Conservatives making significant gains across England’s councils.
Thirdly, efficient external communication and common consistent messaging would be key – tackling misinformation about vaccines and encouraging public confidence.
And finally, audience identification and segmentation would be crucial, particularly for groups like the elderly, vulnerable and healthcare workers, but also for audience groups who viewed vaccines with concern, suspicion or even hostility.
“Countries with fragmented, or non-existent universal healthcare, have naturally struggled.”
In all of the areas I identified as the key to success, Wales has performed impressively, thanks to the collaborative efforts of the Welsh Government, Welsh NHS and their delivery partners, who built from scratch the infrastructure to deliver a mass vaccination programme, which will very soon have vaccinated the entire adult population of Wales.
Make no mistake, a public health operation on this scale is truly unprecedented, and I’m sure will be unique in many of our lifetimes.
It’s also important to note that as well as what has been outlined above, there have also been other factors at play which have contributed to Wales’ vaccine success to date.
First, and perhaps foremost, Wales’ position within the UK is a significant factor. As a country of just 3.1 million people, belonging to the union of the UK, and being part of a four-nation approach, has elevated Wales’ position, with combined purchasing power giving access to an ample supply of vaccines, alongside shared expertise and joint decision making by the various administrations.
Another significant factor was the creation of the Welsh Immunisation System (WIS), a digital system created by Digital Health and Care Wales, designed specifically for the needs of people living in Wales. The system was ready for service on 2nd December to support the delivery of any approved vaccinations in Wales.
The WIS uses information on patient demographics, occupation groups and agreed priority levels for receiving the vaccination, to allow healthcare professionals to schedule appointments, creating appointment slots, sends out letters and recording details about each vaccine administered in Wales.
The system also automatically schedules follow up appointments for second doses, which will be an important factor in coming months, and is already doing an excellent job.
An integrated administrative system like this, which supports roll-out through centralising and digitising records effectively, is similar to systems in other highly vaccinated nations like Israel, where the existence of universal healthcare systems have truly come into their own during the pandemic. Whereas countries with fragmented, or non-existent universal healthcare, have naturally struggled.
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We’re also fortunate in Wales that national sentiment towards the vaccine has been positive, which cannot be undervalued as a factor of success.
And this attitude towards the vaccine has improved throughout rollout, with the Guardian reporting a trend in people taking up the vaccine after initially intending to refuse it.
NHS efforts to address vaccine uncertainty alongside public health campaigns will have had an impact, not to mention seeing friends, family and peers successfully vaccinated.
This has been a much more significant challenge for countries like France, where their traditional vaccine scepticism has been further fuelled by misinformation.
Weeks away from the midpoint of the year – a year that started with soaring Covid-19 rates, and an incredibly challenging lockdown – it really is important to pause and take stock of the significant progress that has been made in Wales, and tribute must be paid to the healthcare workers, public servants and volunteers that have been administering vaccinations.
But, while we can feel cautiously optimistic, the pandemic is not over yet and continued vigilance is crucial to achieving our end goal.
As a public health professional for many years, and also a teacher of the discipline, my students and I have noted how the pandemic has truly highlighted the importance of the role of public health in modern society.
“Uptake of the second dose is fundamental to continuing immunity and keeping transmission rates, and hospitals admissions, low.”
We know that viruses and pandemics are likely to have an ever-present position in our increasingly global world, so this provides an important opportunity to learn lessons for the future.
There are also two remaining steps that will be critical for maintaining the success of our vaccine rollout in coming months.
Firstly, that younger generations take up their vaccine offer. The Guardian report found that while most who were initially vaccine hesitant in December had changed their minds, younger groups were the most likely to still turn down the vaccine.
But vaccines are equally crucial to the younger generation – not only to protect themselves, but to strengthen broader public immunity, to reduce infections, and to try and stop new variants emerging.
Variants which could potentially pose a higher risk to younger people – although it is important to note that our vaccines work against all known variants to date.
Secondly and finally, uptake of the second dose is fundamental to continuing immunity and keeping transmission rates, and hospitals admissions, low. We must not let over-confidence or complacency hamper efforts, and every individual has a role to play in keeping the virus at bay.
The next few months will still be instrumental, but we’ve come a long way and we should all be incredibly proud of how we have overcome and adapted to the monumental challenges of the last year.
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