Over the past decade, England has witnessed a worrying decline in vaccination uptake across nearly every major programme, with significant variation across the country. From childhood immunisations to seasonal flu and HPV coverage, the numbers paint a stark picture. With another challenging winter on the horizon, coupled with the resurgence of measles (a previously eliminated disease) the urgency to address this issue has never been greater.
Since the 2021/2022 flu season, uptake among those aged 65 and over, as well as clinically at-risk under-65s, has fallen year on year. HPV vaccination rates remain below pre-pandemic levels. Childhood immunisation coverage has been in steady decline for a decade, and none of the routine childhood vaccinations have met the World Health Organisation’s 95 per cent coverage target since 2021.
The consequences are far-reaching. Without adequate coverage, outbreaks of vaccine-preventable diseases can lead to long-term illness, hospitalisation and devastatingly for some it can be life-threatening. High vaccination rates play an important role in protecting vulnerable individuals, preventing the spread of diseases and freeing up NHS resources to support other patients. The government has responded with campaigns promoting vaccination programmes, but messaging alone cannot overcome the structural and behavioural barriers at play.
The NHS Confederation has taken a proactive approach to analysing the root causes of low uptake. Through engagement with members across primary care and Integrated Care Boards (ICBs), several systemic issues have emerged. These include fragmented contracting and procurement processes that create siloed working between providers, limiting service integration and outreach. Inconsistent funding streams hinder the development of tailored, community-based vaccination services. Inadequate population-level data restricts workforce planning and targeted delivery. Language, trust, health literacy, and accessibility issues disproportionately affect underserved populations. The rise of online disinformation continues to erode public confidence in vaccines.
These challenges are not insurmountable - but they require coordinated, locally informed solutions from NHS England as part of the vaccination strategy. To address these barriers, the NHS Confederation has launched a new online resource hub, supported by the Association of the British Pharmaceutical Industry. It offers healthcare leaders access to case studies, a checklist of barriers and enablers, and practical guidance for improving delivery of vaccination programmes and campaigns across the country.
Drawing from real-world examples across England, we have identified critical success factors that can help health systems improve access, stimulate demand, target outreach to underserved populations, and deliver a joined-up prevention and vaccination offer.
These insights are especially timely as ICBs prepare to take on commissioning responsibilities for vaccination services by April 2027. This is a core component of the Vaccination Strategy, which aims to reduce morbidity and mortality from vaccine-preventable diseases by increasing uptake and coverage, particularly in underserved populations.
A renewed focus on the local delivery of vaccination services is both timely and strategic. As healthcare systems prepare to commission and implement their own programmes, this shift aligns closely with the Ten-Year Health Plan, where prevention is one of the three key shifts.
The plan outlines several commitments, including increasing HPV vaccine uptake among young people, improving childhood vaccination rates, expanding the vaccination workforce and delivery settings, and enhancing access through the NHS app by making it easier to book appointments and check vaccination status.
However, these ambitions will only be realised if local systems are truly empowered to lead. Success depends on giving communities the autonomy and resources to tailor vaccination efforts to local needs.
Where this has worked well includes the South East Coast Ambulance Service NHS Foundation Trust, which boosted flu vaccination uptake among frontline healthcare workers to nearly 75 per cent by deploying peer vaccinators across 14 sites, offering flexible access, incentives, real-time tracking, and tailored communications. This locally managed, multi-site approach overcame logistical barriers and hesitancy, outperforming the national average of 37.8 per cent for frontline healthcare workers.
Alliance for Better Care (a GP federation supporting 77 practices across Surrey and Sussex) also delivered over one million vaccinations via more than 6,000 community clinics, targeting underserved groups with mobile units, health checks, and culturally sensitive outreach. Their trust-based model improved access, built community confidence, and aligned with NHS strategy - proving scalable, inclusive delivery can reduce health inequalities and boost uptake.
As England braces for another winter, the stakes are high. But with the right tools, leadership, and commitment to local delivery, the NHS can turn the tide on vaccine uptake - and protect the health of its workforce and the public alike.