Immunization in the UK: policy review and future economic options

Vaccination is one of the most effective health promotion activities, but specific targets have been difficult and costly to achieve, and have frequently fallen short of the desired aims, leaving some vulnerable groups unprotected. Policy in the UK has differed for the childhood diseases and in some cases, for example diphtheria and poliomyelitis, has been successful in almost eliminating the disease. In other cases, such as that of pertussis, there has been public opposition, and for other diseases, for example, measles, sufficient numbers of the susceptible population have only recently been reached. Although the World Health Organization target of 90% uptake for the childhood diseases has been reached for all except pertussis, the figures conceal lower uptake rates in some areas, particularly the inner cities. The introduction of target payments to general practitioners appears to have had some effect in increasing uptake rates, particularly in some inner city areas, although the change in immunization schedules may also have had an impact. Target payments fail to take account of the difficulties faced by inner city GPs and, in effect, favour those who need to make least effort, since, in some areas, high uptake rates may already have been achieved before targets were introduced. It is suggested that there is a case for special local development programmes in inner city areas which will provide help with improving record keeping and recall systems for immunization. An alternative policy, which might be more difficult to implement, would be to have targets which could be set at different levels in different areas so that uptake rates could be progressively improved.(ABSTRACT TRUNCATED AT 250 WORDS)