Whooping Cough

Question

Asked by

To ask His Majesty’s Government what recent assessment they have made of the prevalence of whooping cough.

My Lords, data published by the UK Health Security Agency shows provisionally that whooping cough cases are continuing to rise, with 2,793 cases in England between January and March 2024. Tragically, there have also been five infant deaths in England in this period, and our deepest sympathies are with those families. We are urging pregnant women to protect their baby by getting vaccinated and encouraging parents to ensure that young infants receive their vaccinations at the correct time.

My Lords, it is indeed extremely worrying that infants are dying in the biggest whooping cough outbreak in decades, while the UK Health Security Agency also confirms that the lowest vaccination rates are in the 10% most deprived areas, which experts caution should not be dismissed as just vaccine hesitancy. Have the Government assessed the contribution of the cost of living, poor housing and the lack of GP access to disease outbreaks? Is it not time for the Government to show more flexibility and creativity in getting vaccines to those who experience greatest disadvantage?

My Lords, the low uptake of vaccines is typically driven by barriers pertaining to confidence, convenience and complacency. The NHS continues to collaborate with local and regional leaders to deliver tailored communication and flexible vaccination sites and to raise awareness of the benefits of vaccination. The Covid-19 vaccination programme showed that using facilities and services that have familiar and trusted staff, established transport links and convenient access can be highly effective and can inspire trust and confidence in the communities of which they are part. We are also learning lessons from the Covid vaccine programme about the power of real-time specific data to improve uptake, as well as looking at system changes for delivery to make getting vaccinated easier for all, particularly those 10% of the population to which the noble Baroness referred.

My Lords, I am sure my noble friend sees the urgency here, but he will share my alarm that the Joint Committee on Immunisation and Vaccination reports that vaccination levels in pregnant women are currently at less than 60%. What can he say, very precisely, to the House, please? Who is gripping this? What is the plan? How do pregnant women know that this vaccination is available and necessary? How do they know where to get it and who is in charge of delivering it?

On 4 March 2024, the UK Health Security Agency launched a new multimedia marketing campaign across England to remind parents and carers of the risk of their children missing out on protection against serious diseases that are re-emerging in the country, with an urgent call for action to catch up on missed vaccinations. NHS England is implementing best practice, vaccinating pregnant women opportunistically during maternity appointments wherever possible and ensuring that advice on vaccination in pregnancy is being offered across antenatal and primary care settings. I can reassure the noble Baroness, and indeed the House, that NHS England is doing all it can to contact pregnant women to make sure they are vaccinated themselves, which will help the unborn child.

My Lords, the incidence of whooping cough is cyclical; that is well known. In some years, the incidence rises, as it is doing this year not only in the United Kingdom but in several other European countries—countries that have far better health systems that perform far better than our health service. The difference is that the measures they have taken to curtail this and reduce the prevalence are working far better than our own strategy, so we need to re-examine our strategy. So my question is: what other public health measures are we considering to effectively address the rising rate that is occurring in this country, which is now falling in other countries where it was rising?

The noble Lord, as always, makes a very powerful point and he is exactly right. Whooping cough is cyclical. The last time this country experienced an outbreak was 2016 and we were due to have another outbreak in 2021. As noble Lords will know, we suffered from Covid lockdown and because of the isolation, it went down. So we were due one in 2020-21, and the reason that this outbreak is more powerful is because of social distancing during Covid—and the outbreak is the most severe, as the noble Baroness said, in a long time. That is the explanation—it is cyclical, we had lockdown and we are now in the middle of the severe outbreak.

As for the noble Lord comparing our health service to others throughout Europe, he is exactly right. The UK has the most extensive immunisation programme in the world but, as he rightly points out, we have to communicate that to all the population. NHS England works with UKHSA and the regions to continuously review opportunities to improve uptake and coverage of all NHS routine immunisation programmes, sharing and spreading best practice in what has worked. But we can always learn from other countries to make the NHS even better.

My Lords, Education Ministers have been very active recently telling parents to send their children to school with coughs and colds, yet the NHS tells us that the early signs of whooping cough are very similar to those of a cold, and we advise people with this condition to stay home and isolate. Does the Minister recognise the risk of confusion for parents in this messaging? Will he talk to his colleagues at the Department for Education, for example, to tweak that messaging, so it is different where children are unvaccinated or where there are local outbreaks?

The noble Lord is exactly right: communication is critical and, as he well knows, if the message is confusing, it is very unhelpful. But the message is clear that parents and carers have an obligation to immunise their children, not just for whooping cough but for other childhood diseases. Particularly for pregnant mothers, the message is clear: get immunised.

My Lords, my noble friend has already mentioned that the highest incidence was back in 2016 and there has been a steady decline in uptake of the vaccine by pregnant women and young children. Therefore, can my noble friend the Minister say exactly what is done to empower pregnant women, particularly in light of the fact that there are fewer midwives and fewer health visitors and, as a result of Covid-19, perhaps pregnant women and those in deprived communities have not had the appropriate access to their services?

The noble Baroness raises a very powerful question. The department is working with the NHS and the UK Health Security Agency, alongside those most at risk, working to ensure that advice on vaccination in pregnancy is being offered antenatally and that information materials are available across antenatal and primary care settings, so that pregnant mothers understand the risks of whooping cough and are encouraged to come forward for the vaccine. The NHS is implementing best practice, vaccinating pregnant women opportunistically during maternal appointments wherever possible, but it is so important that those hard-to-reach communities, where English is not the first language, are communicated with appropriately. We are looking at those communities through GPs and, as my noble friend said, through midwives, so that the pregnant mums in those communities are encouraged to get vaccinated.

My Lords, antimicrobial-resistant whooping cough has been found in China, North America, South America, Europe and the Middle East. In the epidemic we are now seeing, does the department have any idea how many cases of antimicrobial-resistant whooping cough there are in the UK? Because that makes treatment almost impossible and I am really concerned, as many are, that the public do not take seriously the problem of antimicrobial resistance.

The noble Baroness asks a very detailed question. There is currently a conference going on specifically on that subject. I do not have the information in the pack, but that is ongoing. She is absolutely right. As I said earlier, we had 2,793 cases in England between January and March and it is rising. It is a severe outbreak and we are looking into it.

My Lords, I draw noble Lords’ attention to my interests in the register. To pick up the point of my noble friend Lord Patel, there is a difference in the trajectory with regard to the outcome of disease between the United Kingdom and other European countries. Might that be a manifestation of the fact that there have been changes in the way we address public health measures in our country? Beyond the question of vaccination, we need to look once again at the delivery of public health services in our country.

I am grateful to the noble Lord for that question. He raises a very important point. I have said before at this Dispatch Box, and indeed within the department, that we should always look at other nations’ health services. The NHS is an outstanding institution but it does not have the answer to everything, so we should look at our European neighbours to see what lessons can be learned there.