This indicator was published in March 2020.

In May 2021 we updated our graphs and charts where new data had been published, and we reviewed our policy recommendations by nation.

Background

• Immunisation is a safe and highly effective way to protect children and young people against serious and potentially fatal diseases.¹The UK national childhood immunisation schedule includes a number of different vaccinations. While it is critical to scrutinise the uptake of all routine childhood (and indeed adolescent and maternal) immunisations, this indicator focuses on only two of the vaccines offered in early childhood.
  • The 5-in-1 vaccination protects against five diseases: diphtheria, tetanus, whooping cough (pertussis), polio and Haemophilus influenzae type b (Hib); a single injection administered on three separate occasions at 8, 12 and 16 weeks of age. In Autumn 2017, this was replaced with a 6-in-1 vaccination which additionally includes a vaccine that protects against hepatitis B (HepB).²
  • The MMR vaccine protects against measles, mumps and rubella. This vaccine is single injection administered at 1 year of age and at 3 years 4 months of age or soon after.³
• High vaccination rates provide increased probability of immunity throughout the population (herd immunity), which is particularly important for protecting individuals who cannot be vaccinated, and can also lead to the elimination of some diseases. Even when a disease is no longer common in the UK, without sustained high rates of vaccination it is possible for these diseases to return⁴ as demonstrated by recent measles outbreaks.^5,6

Key findings

• From 2005 to 2014, uptake of vaccinations has generally improved. Signs of decline are evident from 2014 to 2018, however, for both the 6 in 1 and the MMR vaccinations:
  • In 2018, uptake rates in the UK for the 6 in 1 vaccination varied from 92.1% in England,⁸ 95.4% in Wales,¹⁰ to 95.9% in Scotland¹¹ and 94.8% Northern Ireland.⁹
• In 2017, all four UK nations fall short of the 95% WHO target for the 2nd dose of MMR.⁷ In 2018, uptake rates in the UK for the second dose of MMR varied from 86.4% in England,⁸ 92.2% in Wales,¹⁰ 91.2% in Scotland¹¹ and 91.8% in Northern Ireland.⁹
• Vaccine uptake rates for both the 6-in-1 vaccine and MMR vaccine are considerably lower in England in comparison to Northern Ireland, Scotland and Wales.

What does good look like?

An effective vaccination programme be taken up by 95% of the population, to ensure the greatest number of children and young people are protected.¹² Vaccine coverage should be increased from early childhood to adolescence, with a particular focus on groups where uptake rates are known to be lower. Targeted public health messaging should take causes of inequalities in vaccine uptake into account; for example, ethnicity, deprivation, geography and religious belief.^13,14,15 Additionally, there are other groups including unregistered children, younger children from large families, children with learning difficulties, looked after children and those from non-English speaking families that are more likely to not be fully immunised.^16,17,18

Improved understanding of why immunisation rates aren’t improving. There is currently no compelling evidence to suggest anti-vaccine groups and social media messaging have had a major impact on parental confidence. Although health professionals should by no means be complacent about this in the face of rising cases of misinformation, research suggests that only about 1-2% of parents refuse all vaccinations, and parents and carers seem in general to have confidence in national immunisation programmes.¹⁹ In fact, the reasons for under immunisation are more complex²⁰ and include practical issues such as lack of easy access to services, cost of travel to services and competing demands on parents’ time as well as parents having questions or concerns about the vaccines.²¹ Call-recall systems have been shown to increase uptake of vaccines and form an essential part of immunisation programmes.²²

A whole system approach to improve vaccine uptake. An effective immunisation programme needs to consider the important role of services, such as health visiting and school nursing, who are ideally placed to contribute to a “whole system” approach to improving immunisation uptake. Youth services, schools and primary care should also be included.

Policy recommendations

What can health professionals do about this?

• Explore ‘Vaccines in Practice’ eLearning, which has been developed by the RCPCH and mapped to the GP curriculum. It aims to develop trainees’ skills in communicating the benefits of vaccines and is available online.²² Immunisation eLearning is also available online from eLearning for Healthcare.²³
• Making every contact count. Practitioners should take every opportunity to enquire about vaccination history, and to counsel families and carers, or young people, of the importance of vaccination. Practitioners should direct them to immunisation services for routine or catch-up immunisations, particularly for children and young people at risk of low vaccine uptake. Where possible, vaccinations should be offered during consultations. Where this is not possible, there should be clear communication to document the need for vaccination.
• Address concerns over immunisations. Parents and/or carers, and young people themselves when it comes to vaccinations in adolescence, should be offered the opportunity to discuss their concerns. Professionals should sensitively but directly address any concerns about the safety and efficacy of routine immunisations.²⁴
  • Guidance for professionals on communicating with parents and/or carers on vaccines is available from: NICE,²⁵ UK Health Security Agency,²⁶ and the European Centre for Disease Prevention and Control.²⁷
  • Parents and/or carers can be signposted to further sources of information, such as the NHS²⁸ and the Oxford Vaccine Knowledge project.²⁹
• Dispel common misconceptions over contraindications to vaccination. Egg allergy is commonly considered to contraindicate the MMR vaccination, but this is no longer correct (see advice on Measles from UK Health Security Agency Green Book).³⁰ When seeing children and young people with allergies, it should be made clear that allergies rarely interfere with vaccines.
• Role-modelling. Health professionals should ensure that they themselves are vaccinated in line with guidance provided by UK Health Security Agency and the other public health agencies across the UK.

Contributing authors

• Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
• Rachael McKeown, RCPCH State of Child Health Project Manager
• Vicki Osmond, RCPCH Policy & External Affairs Division
• Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor