4 - Guest EditorialDr George Kassianos, RCGP Immunisation Lead and President of the British Global & Travel Health Association, documents recent ambitious changes to our immunisation programme and warns that, once again, GPs will be shouldering the main burden.

2013 will go down in history as the year that saw successive additions and sweeping changes to the UK’s national immunisation programme. Not since 2006, when we saw a radical change in the childhood vaccination schedule, has there been a year of so much flux.

In June, we dropped the second priming dose of MenC at four months and replaced it with a booster in adolescence. July saw the introduction of the rotavirus vaccine for our infants at two and three months. Primary care was given some brief annual leave until September, when the shingles vaccine is to be introduced for people aged 70 years, with a catch-up programme for those aged 79 years. And the programme of pertussis immunisation of pregnant women from the 28th week of pregnancy has been extended to next year.

But the most ambitious move of all will soon follow with the introduction of the childhood inuenza vaccination programme for children aged 2 to under 17 years. GPs are asked to immunise against influenza all children aged two and three years, while the next two years will see an increase in the target population to all those under 17 years. Geographical pilots will take place this year for four- to ten year olds (up to and including pupils in school Year 6).

The success of this new programme, when fully rolled out, will rely heavily on the co-operation of parents and schools. Not only is the number of children to be vaccinated huge (about 9 million), but also the vaccinations need to be completed within six to eight weeks of the start of the programme – every year. This will be a logistical nightmare for Public Health.

An even greater difficulty will be persuading parents their children do need to be vaccinated against influenza for their own protection – not just to protect other vulnerable people such as the elderly, the immunosupressed and patients with chronic diseases. What is beyond any doubt is that children fare very badly when infected with the influenza virus. The vaccine, to be painlessly delivered to their noses, is primarily to protect them from this dreadful vaccine-preventable infection. And if we vaccinate suf?cient numbers of children – the most “effective” spreaders of the ’u virus – we can lower inuenza transmission from children to other children, adults and those in the clinical risk groups of any age. A successful national inuenza immunisation campaign is expected to significantly reduce influenza-related illness, GP consultations, A&E attendance, hospital admissions and deaths.

Most important for the success of the campaign this year is the GP practice team. The Government relies almost entirely on general practice to deliver; what they may not be appreciating is that GP consultations are steadily rising year on year, and that patients’ medical problems have become more complex due to the increasing inability of secondary care to deal comprehensively, holistically and in a timely manner with patients’ problems. There is a tendency to transfer to GPs anything that is possible, because GPs “can do anything”.

In addition, we are witnessing a steady disinvestment in primary care. When the Department of Health spends half a billion pounds “spare”, it is secondary care that gets the benefit of investment, as we have recently heard. General practice is struggling to keep on providing care in an environment of increasing demand, and our numbers are decreasing with the steady departure abroad of well trained and experienced doctors.

It is in this climate that that UK’s immunisation programme is taking on so many changes and new vaccines.

The minimum Public Health can do is to go out with sustained advertising campaigns to raise awareness among the vulnerable population of the merits and the need for inuenza vaccination. The rest can be left to GPs. They have always delivered.