Across the UK, a rapid roll rollout of Covid-19 vaccines is underway with remarkable efficiency.

But providing vaccines to ensure a healthy population - at all ages - is nothing new.

There are yearly drives to encourage the take-up of new flu vaccines, and most of us can recall receiving various shots at school to help prevent all manner of nasty diseases.

However, because of the pandemic many of the vaccines usually given to school-aged pupils have been missed and there will be a need to catch-up in this area of school life, too.

But just as everywhere else in the pandemic, healthcare and educational professionals have been working tirelessly to ensure that as many pupils as possible have received their vaccines as usual throughout the past 12 months - and plans to catch up are also taking shape.

The usual vaccines that pupils get at school

To start with, it’s worth outlining the three vaccines that school-aged children usually receive:

12 to 13 years  

• HPV (human papillomavirus) - routinely offered in Year 8 with a second dose six to 24 months later. In the 2019-20 school year, this was being offered to boys for the first time, having been offered to girls since 2008.

14 years

• 3-in-1 teenage booster (technically termed Td/IPV, for tetanus, diphtheria and polio) - usually offered in Year 9
• MenACWY (to protect against meningitis and blood poisoning (septicaemia)) - usually offered to teenagers in Years 9 and 10.

There is no set time frame in which these are usually administered within a school year and, because of this, many schools had not even started their administration of these vaccines during the 2019-20 school year while others had done them all.

Data from Public Health England (PHE) that tracks the HPV vaccine rollout through local authorities, published in October 2020 for the school year September 2019 up until 20 March 2020, shows the following:

• Fully complete in eight out of 150 local authorities.
• Partially complete in 116 out of 150 local authorities.
• Not yet started in 26 out of 150 local authorities.

However, this is not the situation that awaits schools on return.

Covid: New approaches to vaccination

Almost immediately after the pandemic hit, new ways of delivering vaccines were put together to help pupils receive these vaccinations in other ways, as Sharon White, the CEO of the School and Public Health Nurses Association (SAPHNA), explains.

“School nurses and immunisation providers have been working very hard during the pandemic to keep vaccines going,” she tells Tes.

“They have been working in schools to administer them to pupils as normal or those on-site [such as key worker pupils] and running drive-through immunisation centres - often in stadiums - to offer vaccines.”

An example of this was the Derbyshire School Nurses group running a series of outdoor clinics that helped to deliver the HPV vaccine to almost 10,000 school-aged children - see the video below.

Similar work has been carried out by Kent and Medway School and Community Immunisation Service and Bridgewater Community Healthcare NHS Foundation Trust - just two examples found online.

NHS England - which ultimately oversees the administering of the vaccines - acknowledged that this work has been key in helping to maintain levels of vaccination.

“Routine vaccinations provide vital protection against life-threatening diseases and they have continued to be offered during the pandemic, including for school-aged children,” it says.

On the frontline 

And, as mentioned, many schools have been able to continue to allow vaccinations to take place almost as normal - but with the usual social distancing and hygiene measures, of course.

One such school is Cams Hill School in Fareham, Hampshire. The headteacher, Gwennan Harrison-Jones, explains that with the vaccinations schedule already in the calendar before the pandemic began, the decision was made to keep it going throughout lockdown.

“We are all up to date with vaccines as we have continued through lockdown, providing a space each time a scheduled day has come around in the calendar for the vaccinations to happen,” she explains.

“We did roll it round SLT as to whether we should or not, but we deemed it essential and we didn’t want to fall behind on these vaccinations.”

She says there was a fair amount of logistical planning to make this happen and it required work to ensure that pupils could be socially distant when arriving on-site and there was no opportunity for a “mass gathering” to take place.

“I think because we had parents who are happy to drive up and wait, and many pupils live within walking distance, we were confident we could manage this safely,” she adds.

She explains that it didn’t hurt that the chance to administer a vaccine also gave pupils a chance to reconnect with school - however briefly - and re-familiarise themselves with the environment.

Encouraging signs 

Thanks to initiatives such as this across the country, data from Public Health England for the full academic year of 2019-20 shows HPV vaccination levels as follows:

• 64.7 per cent of Year 9 females completed the two-dose HPV vaccination course in 2019-20, compared with 83.9 per cent in 2018-19.

• HPV vaccine coverage for the priming (first) dose in 2019-20 was 59.2 per cent in Year 8 females, compared with 88.0 per cent in 2018-19.
• It was 54.4 per cent in Year 8 males (the first cohort to receive it).

Given the impact of the pandemic, this is a strong achievement - and one that has continued through the 2020-21 academic year, despite it, too, being blighted by a long lockdown.

The latest data for MenACWY and 3-in-1 booster rollouts only goes up to August 31 2019, and so it is not possible to know to what levels these vaccines were issued during the school year that was interrupted by the pandemic - although figures are scheduled to be published soon.

If it is anywhere near the same as the HPV data, that will seem like a good outcome given the circumstances.

Catch-up will be required

However, at the same time, we cannot overlook the fact that HPV vaccination is down by around 20 percentage points on the different metrics.

Clearly, then, some catch-up will be needed for those who missed out - both in the 2019-20 round and those who have still to be vaccinated in the 2020-21 round, given the disruption that the January-March lockdown will have caused, as Dr Andy Preston, from the University of Bath’s Department of Biology and Biochemistry, outlines.

“There will have to be catch-up campaigns because pupils have been out and school nurses and the NHS and PHE have been stretched with everything else going on around dealing with cases of Covid and contact tracing…I do think it will be worth taking stock and having catch-up vaccination plans,” he says.

With the implementation and monitoring of vaccine take-up coordinated at the local authority level - as evidenced by the PHE data cited earlier - this is an issue very much on the radar of the Local Government Association (LGA).

Ian Hudspeth, chairman of the LGA’s Community Wellbeing Board, says there is an awareness of the fact that many pupils would have missed their vaccines and plans are now being put in place to help catch-up on this issue.

“Local immunisations teams are working with schools to plan catch up and recovery programmes, including for those infants and children who have missed their routine immunisations over the last 12 months,” he says, adding that more support for this work would be welcome.

“Due to the ongoing Covid-19 vaccine rollout, the immunisation workforce is already stretched and any additional capacity and resource would be helpful to ensure catch-up programmes can be rolled out as quickly as possible.”

Proactive engagement 

White says SAPHNA is aware of many school leaders proactively contacting the immunisation teams that deliver these vaccinations to get this work back up and running on return.

Dan Morrow, the CEO of Dartmoor Multi-Academy Trust, is one such leader. “It is a significant issue and one we have been thinking about a lot because we have to ensure we are not opening the door to other diseases because we are not getting vaccinations,” he says.

“I have a meeting with the local PHE group soon on how to ensure we have a plan around it and a big part of that is to make sure that children don’t feel completely medicalised with yet more health interventions - I think there is a balance that we need to get right on that.”

While catching up with vaccinations for children who are now back in school should be relatively straightforward - they are all back in one place for a set time - there will, though, be some students who are not able to come back; those that are still at high-risk for Covid and therefore shielding.

At-risk children need focus

Professor Helen Bedford, from University College London, is an expert on child public health issues and childhood immunisation. She says this group must be given special consideration as they are the ones who will be most likely to slip though the net and never receive these vaccinations.

“We know from work on the uptake of HPV that young people who are excluded, not in school or in youth offender institutions are often at risk of not being vaccinated and there will be more now not able to be in school due to health conditions,” she says.

As such, she says there must be awareness across government and in schools of these pupils, and efforts must be made to ensure that they are offered the chance to receive the HPV vaccine: “It doesn’t matter if they are late getting it - so long as they do get it, as people are eligible for HPV up to the age of 25.”

White makes this point, too: “We know a lot of pupils will not return to school and they are the ones that may miss out and that need to be considered.”

Harrison-Jones says her school has kept abreast of those pupils who have still been unable to get the HPV vaccine and will ensure they are protected.

“Any pupils who were self-isolating will get what they missed in the next round at school - we have made a note of who they are, so we know who needs to be prioritised.”

Preston adds that this work at all levels - central and local government, nursing teams and school - will be vital to ensure that other future health crises are not created.

“For example with the MenACWY vaccination….we know how many pupils go on to university these days and so we need to ensure they have had that vaccine to help reduce the risk of meningitis.”

Enough to go around

Of course, in the Covid era any talk of vaccinations raises another issue - availability.

Thankfully, though, even with the extra requirements to include many of the previous cohorts in this year’s round of vaccinations, there is confidence in government and among the pharmaceutical companies that there will be no shortage.

MSD, which supplies the HPV vaccine, said: “MSD are fully committed to supplying the UK HPV programme and do not foresee supply being a barrier to restoring the school-aged immunisation programme after the Covid-19 lockdown,” it says.

“The restoration and catch-up of the HPV schools programme is critical to reducing the number of vaccine-preventable HPV infections and supporting the UK elimination of certain HPV-related cancers, starting with cervical cancer as a first step.”

Meanwhile, Pfizer - which offers one MenACWY vaccination - says: “Pfizer has worked with the Department of Health and Social Care (DHSC) to ensure continuity of supply of Nimenrix (meningococcal groups A, C, W-135 and Y conjugate vaccine) for the MenACWY routine immunisation programme throughout the Covid-19 pandemic.”

Tes also contacted GSK and Sanofi, which supply other vaccines issued. Sanofi had not responded at the time of publication while GSK declined to comment.

The power of vaccines 

However, talking about vaccinations, another issue invariably bubbles up - those who don’t believe in having vaccinations. (This issue specifically is explored in depth in the 12 March issue of Tes with regards to Covid-19 vaccinations - especially if they are, in time, offered to children).

Could there be a concern that with the news dominated by vaccinations, there may be more parents - or even pupils - who are wary of vaccinations and don’t consent to being included in any more scheduled vaccines?

Bedford says she thinks it unlikely that the new awareness among the general population around vaccines will cause any long-term issues on school-age vaccine take-up.

“I would doubt if it had a detrimental effect. We have one of the best vaccine programmes in the world and that is in part because it is given in schools. I suspect those that are already opposed to vaccinations will remain so and hesitant, and may ask more questions, but I don’t think it will affect the overall uptake.”

Preston says it could even be the case that uptake of these vaccines will increase in the future thanks to Covid.

“There’s definitely a window of opportunity, given the success of the Covid-19 vaccines, as awareness has certainly increased. I think people were getting complacent around vaccines because the threat of things like polio [covered in part by the 3-in-1 booster] is seen as so low,” he says.

“It’s low because of the vaccines, but it’s breeding complacency. But the vaccines for Covid, especially arriving when they did in December and January when things were so bad, has been a timely reminder of the power of vaccines.”

Dan Worth is senior editor at Tes