Luton’s Clinical Commissioning Group (CCG) has banned the use of a safe and effective NHS vaccine against Hepatitis B virus (HBV) putting Luton’s poor ethnic minority at particular risk of contracting the disease. Under pressure from the government to cut costs, the CCG’s decision will not only subject children to more painful injections but also means that the previously free vaccine must now be paid for. The decision has been criticized for seeming to discriminate against the region’s high-risk multicultural population.
The policy, which came into effect in April alongside the hugely expensive reorganisation required by the Health and Social Care Act, says that the CCG will no longer fund the HBV vaccine, which they state is only required for travel purposes. This means that the combined Hepatitis A & B vaccine is no longer available on the NHS. Hepatitis A continues to be funded by the NHS. A spokesperson for Luton CCG said, “Patients have the option of paying for their Hep B for travel from their GP or a private provider. Patients could also pay for the combination Hep A&B, but from a private provider.”
The decision is causing concern amongst health professionals. Despite WHO guidance, the UK is one of a small number of developed countries that still has no universal programme for HBV, on the grounds that the UK’s prevalence is low. However HBV is 100 times more infectious than HIV. Over time, it can progress to advanced liver disease, including life-threatening liver failure and liver cancer. HBV causes 600,000 deaths in the world every year. Though most commonly spread through blood and infected bodily fluids, global travel and crowded living conditions - thought to facilitate transmission via skin scratches amongst children in some inner city communities - means the prevalence of HBV in multicultural areas is increasing.
Given that here is no universal coverage scheme for HBV in the UK, previous NHS policy which recommended that travellers to areas of medium to high prevalence should be vaccinated was the only way of protecting high-risk ethnic minorities.
GPs can privately provide a course of HBV vaccinations and set their own prices - as high as £150 in some surgeries. The majority of travellers seeking vaccinations in inner city Luton are travelling to visit families in sub-Saharan Africa or the Asian subcontinent - areas of high or medium HBV prevalence. Although nursing staff recommend the HBV vaccine, the embargo on free combined vaccinations means that the majority of travellers refuse on the grounds of cost. This decision puts Luton’s poor ethnic minorities - almost half of the city’s population - at risk of HBV.
What is worse is that prior to the CCG decision a child could be vaccinated for life against both Hepatitis A and B with two immunisations delivered six months apart. Under the new regulations five injections are required to provide the same protection - a process which is highly stressful for the child. Likewise, the adult combined Hepatitis A and B vaccine course of three injections provided lifelong protection, compared to the five injections now necessary with the separate courses.
When asked about how this decision was made, Luton CCG said: “NHS organisations have to make a lot of hard decisions on which drugs and treatments should be funded on the NHS. Luton, in common with many other commissioners, did not see that the funding of Hepatitis B for travel was a priority for our NHS services”. It is unclear whether they performed an equalities assessment.
The question is why? Why would a CCG make a decision which endangers almost half their population? Another practice nurse in Luton stated: ‘Many of us have expressed concern at this short-sighted policy. It appears to be underpinned by middle-class values about travel and holidays. Tourists are at a very different level of risk to those returning to communities where HBV may be endemic. It seems unethical and against everything we believe in as nurses. We know that children are at special risk - this shifts the blame to parents emphasising their choice in how they spend their money. It seems ironic that in wealthier areas of Bedfordshire a traveller can still be offered the free combined vaccine, while poorer ethnic minority travellers at greater risk will be denied it.’
By no longer funding the HBV vaccine, Luton CCG exemplifies how the government’s demand for savings on a cash-strapped health service leads to putting business before patients. We have seen this happening already; services such as podiatry and physiotherapy are no longer free. Sadly, it appears that decisions for rationing of this type will hit vulnerable and marginalised groups hardest. It is all well and good for the Coalition to claim that their health reforms have put “power back into the hands of GPs”, but patients will look at this and wonder if that power will ever benefit them.
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