Detailed Analysis: The Influenza Program for Infants in the UK

This report examines the influenza immunization program for infants in the UK. It details the program's rationale, including the vulnerability of young children to influenza and the inclusion of the vaccine in the National Immunization Program. The report discusses program delivery, highlighting the phased implementation, stakeholder involvement, and staffing. It also evaluates the program's strengths, such as its use of existing structures and digital data management, and weaknesses, including reliance on temporary staff. The monitoring and evaluation strategies, including data management systems and team leader reports, are analyzed. The report presents the program's outcomes, such as uptake rates and the reduction in flu-related illnesses and hospital admissions, and discusses future considerations for program improvement, like enhanced stakeholder collaboration and communication.

Running Head: THE INFLUENZA PROGRAM FOR INFANTS 1
THE INFLUENZA PROGRAM FOR INFANTS
Name
Institutional Affiliation

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Introduction
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 rationale for inclusion of the vaccine on NIP
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

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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,

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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;
Local childhood immunization teams
Vaccine providers
National Departments of Health in each country
Directors of Children Services
Directors of Education Services
Local councils and education authorities
Community 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

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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.
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.

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Monitoring program outcomes and impacts
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.

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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.
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

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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.
Future consideration for the program
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).

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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.
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 pa

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