TIP implementation in the United Kingdom

TIP in the Charedi community in north London, United Kingdom

Northeast London is home to the largest Charedi community in Europe, with over 25 000 people. The Charedi are strictly observant Orthodox Jews. A high birth rate is leading to rapid expansion of the community with a high proportion of children, placing an increased demand on health services. Immunization coverage is known to be suboptimal to ensure herd immunity for several vaccine-preventable infectious diseases, including measles. As such, recurrent outbreaks of measles have caused preventable ill health and increased pressure on health services.

In an attempt to better understand reasons for current suboptimal coverage of children’s immunizations within this community, Public Health England (PHE) in partnership with the community, immunization service commissioners – National Health Service (NHS) England – and health providers conducted a WHO tailoring immunization programmes (TIP) project during 2014–2016. The project aimed to provide evidence-informed recommendations to immunization commissioners and providers to enable services to be better tailored to the needs of the community.

Diagnose supply- and demand-side barriers and motivators to vaccination

Several steps were taken to help define the research problem:

• a mapping of current immunization service support within the community
• a literature review
• examination of relevant surveillance and outbreak data
• 2 stakeholder meetings.

This resulted in a situation analysis, defining potential barriers to immunization in the community. These were further explored in the formative research phase of the project, which included further analysis of surveillance and outbreak data; a questionnaire survey of Charedi parents; and in-depth interviews with parents and key informants.

The research revealed barriers to immunization uptake, which were analysed to explore behavioural patterns and grouped as environmental, social/community or individual. Parents were grouped according to their beliefs/behaviours to ensure solutions can be tailored to meet the needs of different sections of the community.

Community members, a senior rabbi, NHS commissioners and providers, general practice staff, PHE, WHO and the Government met to discuss findings and provide feedback. Participants were asked to suggest and prioritize possible solutions.

Identify target populations

Based on the behavioural pattern analysis and feedback from the meeting, 4 broad categories of parents were identified:

• the concerned mother
• the culturally and religiously adherent mother
• the busy mother
• the mother who is sceptical of health authorities.

Recommend evidence-informed responses to sustain vaccination

As a result of this process, a report with clear recommendations to further tailor and protect commissioning and provision of children’s immunization and health protection services for the community was developed.

Rabbi Abraham Pinter from the London Charedi community says: “We recognize the importance of childhood immunization to protect children in our community from preventable, and potentially serious, illness. It is really great to see Public Health England engaging with our community to try to understand the reasons for the low level of immunization coverage and to work in partnership to see levels increase.”