Spotlight on… Joanna Lowry

In the first of our Spotlight on series, we meet Joanna Lowry, an Immunisation Specialist Nurse and Educator from Hampshire. We discuss how she came to be so passionate about immunisation, some of the challenges she has faced over the years, and what she believes it takes to successfully implement immunisation programmes in a busy practice.

Joanna, could you tell us a bit about your current role and how you came to be involved in immunisation?

It was an interest in tropical infections which ignited my passion for immunisation. Knowing there is an effective way of preventing a disease is hugely reassuring, and that led to travel health and routine vaccines. I have been an Immunisation Nurse Specialist in an independent school and more recently in primary care and general practice.

I also administer vaccines as a sexual health nurse and enjoy the contrast alongside the occupational health and TB Specialist Nurse vaccine experience I’ve gained over the years. So, I’ve ended up covering lots of clinical care where vaccines are given, and they are all different and interesting. This has helped me understand the importance of education for effective and efficient vaccine delivery.

This passion led me to want to support other clinicians and colleagues. I’ve created and delivered an introduction to immunisation training course to a range of healthcare professionals, helping to provide the latest evidence-based practice and protocols. Immunisation training offers the opportunity to engage in interdisciplinary learning, which I thoroughly enjoy.

Can you tell us a bit about the role of the Immunisation Lead in your experience?

Although the title ‘Immunisation Lead’ may not be used in every practice, all practices should have an individual who coordinates vaccinations and improves standards. In my experience, Immunisation Leads will participate in specialist training and learning, implement best standards, and monitor for updates to immunisation programmes. Their role is to disseminate knowledge and national recommendations among the whole practice and the rest of the staff. As an Immunisation Lead, I’ll offer a vaccine preference if there is a choice for a given disease.

The practice manager will be looking at the statistics and the uptake, but the person who does the ordering is often a member of the admin team and many of the vaccines may now be given by a healthcare support worker (HCSW) or healthcare assistant (HCA).

It's important to ensure immunisation care is consistent nationally. Therefore, it’s recommended that anyone who will be giving vaccines participates in a 2-day introductory course and completes competencies with a mentor in practice, in line with the national minimum standards.¹

What are some of the key challenges you've faced being an Immunisation Lead?

Reaching some communities can be tricky. During COVID-19, I was redeployed four times, one of which was as a clinical lead in a mass vaccination centre. During another redeployment, I was asked to set up a mobile vaccination clinic to help provide access to immunisation for our harder-to-reach communities.

We worked in a little bus, travelling around to public places such as football matches, supermarkets, and rural locations, as well as being welcomed into our local traveller communities and the homeless community. We did our best to build relationships with local groups and be responsive to their questions and concerns, while also offering a convenient location for vaccines.

Other challenges we face include compliance, with patients needing to book and remember their appointments, especially if they need to return for a second dose of a vaccine.

We need to remember that people lead busy lives and even if they are aware they may be eligible for a vaccine, they may not remember to attend. One tip is to give little stickers with the date on that the patient can put in their calendar as a reminder. That physical reminder can be really helpful, especially in your patients who are over 65 years of age and are eligible for a number of different vaccines. They often appreciate that.

How aware and prepared do you think practices are for the upcoming changes to the Shingles National Immunisation Programme, such as eligibility criteria changes?

I think there are some clinicians who are as fascinated by vaccines as I am, that have been reading a lot to keep up to date on vaccines which may be introduced to the routine programme. Now that the National Immunisation Programme – Information for Healthcare Professionals has been published,² they’ll be able to share the details of the changes that take place from 1st September with their colleagues, to make sure they are prepared to act as soon as the guidance comes into force. We have been eagerly awaiting its publication, ready for the rollout in September.

With that in mind, do you think there will be a staggered approach to implementing the changes to the Shingles National Immunisation Programme?

No, I think the complete opposite. I think it’s such a well-oiled machine now. We’re so used to doing this, and following national guidance, that we will be able to implement the changes on 1st September. It will happen and it will happen really slickly. I have absolute faith in every GP practice in the country adapting and changing. To make this as easy as possible, it’s important practices have in place the right leadership, understanding of the guidance, and education for their teams.

The guidance has clearly identified which ages are to be offered the shingles vaccine, which will include 65-year-olds and continue inviting 70-year-olds, as well as some immunosuppressed individuals.

However, it is a busy time because flu season will be getting underway, so I do urge everyone to prepare for the changes as much as possible, and consider the impact of the changes to the National Immunisation Programme on their practice.

What can we do to overcome the resistance around vaccinations?

One part of the national minimum standards update training is to encourage increased vaccine uptake and engagement. However, I think some patients are put off because they don’t want to book an appointment if they are not 100% sure they want the vaccine, or have a niggling doubt from something they read on social media. In their mind, if they come in and are given information but do not want the vaccination, they feel that they are wasting an appointment or have to receive a vaccine despite not wanting to.

However, this is absolutely not the case. As a healthcare professional, I want to ensure the patient feels comfortable and has all the information they need to make an informed, educated choice.

Therefore, one of the things that I always advise clinicians is to provide an opportunity to answer questions in advance. I try and encourage surgeries to have a call-in system or a drop-in box, or some way for patients to ask questions and get the answers and reassurance they need, before booking an appointment to have the recommended immunisation.

Do you have any other advice on how we can improve vaccine uptake?

With regards to shingles, many people don’t necessarily know what it is or have a misunderstanding, such as thinking you can ‘catch’ it. So, when I see an eligible patient, I try to simply explain to them what shingles is and which type of symptoms the vaccination will protect them against.

Many people are unaware of post-herpetic neuralgia and how long the pain can last. Understanding what a vaccine can help protect against, often helps reassure patients during a shared decision-making process.

The other thing I would say is to consider opportunistic vaccinations as a bonus. If someone comes in for an alternative appointment and they also get vaccinated, fantastic, but that’s not just what we are aiming for. The ideal is to offer the vaccine to people when they become eligible and proactively invite them in to ensure they are vaccinated and protected as quickly as possible.