Award Title: Vaccination in older adults: understanding how to do it better and knowing when to stop
Funder: Department of Health and Social Care

Abstract: We have an aging population in the UK thus there is a need to focus efforts on how to keep older people fit and well, and given NHS pressures, help them avoid attending primary care and hospital. Vaccination is a primary means of disease prevention used by the NHS, but evidence is lacking in several areas used to inform vaccine policy decisions in older adults. This research aims to enhance vaccination policy for older adults in England, through better evidence and stronger decision-making structures, to ultimately improve the health of older people. The objectives are: (1)To assess the heterogeneity in vaccine uptake in the 65+ population (2)To explore knowledge, attitudes and perceptions of routine vaccines for 65+ year olds and of other programmes that could offer this group protection against infectious diseases (3)To estimate social contacts and mixing patterns in older people (50+ population) (4)Valuing the impact of potentially vaccine preventable disease on health and capability to determine potential gains from vaccination in people aged 65+ years (5)To develop a methodological guideline for reassessing, including withdrawing, routine vaccine programmesStatistical analysis of secondary data (primary care records) will be used in objective 1 (completion 07/2020). Focus groups with the public will be used in objective 2 (completion 06/2022). For objective 3 a survey will be administered to the public and data statistically analysed (completion 10/2020). A longitudinal study will be used in objective 4 with data statistically analysed (completion 06/2022). For objective 5 a methodological guideline will be developed through a process of initial scoping of key questions, literature review, gaining evidence from stakeholders, and consultation (completion 11/2022). Patient and Public involvement (PPI) will be embedded throughout the research with four consultation events with a panel of PPI contributors informing study document design, analysis and interpretation of results, and dissemination plans. Two PPI contributors will also be part of the advisory group, which will also seek to include GPs, and individuals with a national/international profile in vaccine policy, guideline development, qualitative research, and health economics.Research summaries will be shared with participants and GP practices and at wider public engagement events. Results will be published in peer-reviewed journals and at conferences (including at a PPI conference for which an abstract will be co-produced with a PPI representative). The methodological guideline will be sent to organisations with an interest in vaccine policy and delivery (all of whom will be invited to be stakeholders in the guideline development) including the Joint Committee on Vaccination and Immunisation, Department of Health, NHS England, Public Health England and patient groups. The findings of the research can be used to improve vaccine uptake and modify vaccine strategies in older adults, reducing ill health (and the requirement of antibiotics to treat infectious disease), pressures on healthcare services and allow scarce resources to be spent in the best possible way. Ultimately the impact of this research will be the improvement of health in older adults through improved decision making around the use of vaccines in this age group.

Lay Abstract: We have an aging population in the UK. This means that we need to focus on preventing disease by keeping older people fit and well, which will also help take pressure off healthcare services. One way of preventing disease is vaccination. Three vaccines are currently offered to people aged 65+ in the UK, against flu, shingles and pneumococcal disease. More vaccines are being developed. Decision making around which vaccines are offered to the public rely on understanding how infections spread and the benefits that could be gained by preventing disease. Policies must also take into account current uses of and attitudes to vaccination. However, better evidence is needed for older adults.This research aims to improve the health of older adults through producing better evidence to influence vaccine decisions and designing a method for reassessing vaccine strategies. The research is divided into five areas of work: (1)We will look at GP records (we will not have access to identifiable information) to find out how many older people choose to be vaccinated and what might affect these rates. (2)We will do 8 focus groups with older people to look at why people get vaccinated or not and find out how they feel about other ways they could be protected by vaccinations (for example other people they meet being vaccinated). (3)We will survey 1000 older adults living in the community, and assisted living, and ask them about who they come into contact with to understand how infection can be spread. (4)We will survey older people who have had a disease that could have been prevented through vaccination and ask them about their health and quality of life over time, so that we can better understand the benefits of vaccination. (5)We will develop a guideline for reassessing, including stopping, vaccine programmes. We will bring together results from the other work packages, decide on an initial list of questions to consider, look at the existing research, gain opinions from people with an interest in vaccines (for example members of the public, Department of Health, Public Health England) and hold a consultation on the guideline.Patients and members of the public have informed the design of the areas of work. Two patient/public members will sit on an advisory committee, meeting 8 times over 4 years. A patient/public panel of 8-10 people will meet four times over the project to help us develop study materials, feedback on findings, advise on other angles to explore and discuss how best to share findings. Support will be given to members of the public who contribute to the study.Findings will be shared in different ways to ensure the research has impact. This will include sending a short report to people taking part in the research and speaking at events where members of the public can discuss research (such as the Pint of Science festival). Results will be shared with clinicians through sending reports to GP practices and seeking to work with the Royal College of General Practitioners. We will share our results with researchers through publications in journals and conference presentations and will seek to work with a member of the public to share our results at a public involvement conference. We will promote our guideline to organisations responsible for vaccination in the UK (for example Department of Health and the Joint Committee on Vaccination and Immunisation) and will produce a short report with PolicyBristol who share these with Parliamentary contacts and senior civil servants.Ultimately this research will affect policy decisions about infectious disease control in older adults to improve the health of older people in England.

Research Activity Codes: 3.4 VACCINES
Health Categories: GENERIC HEALTH RELEVANCE;INFECTION