As vaccine uptake continues to drop in England, Nursing Times has spoken to public health specialists about what nurses can do, and already are doing, to reverse this trend.
The most recent annual statistics showed that childhood vaccination coverage declined across the board between 2022-23 and 2023-24, with not a single vaccine meeting the 95% uptake target, continuing a gradual decline in uptake over the past decade.
“The fallout from Wakefield is still apparent”
Deborah Scott
Measles, mumps and rubella (MMR) vaccination uptake, which is sometimes used as a marker for the success of the child vaccination programme in general, plummeted to its lowest in almost 15 years. First-dose coverage at five years fell to 91.9%, and second dose fell to 83.9%, according to the NHS England data.
England, as a result, remains below the World Health Organization target of 95% MMR vaccination coverage, which it deems necessary to achieve and maintain measles elimination.
The impact of the fall in childhood vaccination uptake has come into sharp focus in the past few years.
In 2024, there were 2,911 confirmed cases of measles in England, following outbreaks in the West Midlands, London and elsewhere. Of the cases recorded by the UK Health Security Agency (UKHSA) between July and September 2024, more than 90% were in people who were not vaccinated.
Dr Julie Yates, a registered nurse and UKHSA deputy director for immunisation programmes, said improving access to services and embedding public health in nursing practice was key to getting MMR, and other vaccines, towards the 95% mark.
She acknowledged the impact that the Covid-19 pandemic had in disrupting some vaccination programmes.
“There has been a need to recover those programmes and to ensure people who missed their vaccines still have an opportunity to have them,” Dr Yates said.
Julie Yates
Asked what nurses could do to help, Dr Yates said providing flexible vaccination clinics was one thing.
She said: “Practice nurses are the backbone of our whole immunisation programme… they look at ways they can plan their clinics.
“They have an awful lot to fit in, and one of the issues is that they have lots of other pulls and demands on their time.
“They can ensure that those [clinics] are as flexible as possible… ensuring that people can get to those appointments, making sure there is opportunistic vaccination if people are coming in for something else, identifying that they haven’t had a vaccine and giving it to them.”
“We don’t make our systems easy [for patients],” Dr Yates continued.
“If we could do that – and nurses are really good at that, because they’re really good at making systems work – then I think our uptake would start to increase.”
Nurses could also, Dr Yates said, make further use of data to check groups with low uptake and keep up to date with guidance on immunisation.
Dr Yates acknowledged the importance of tackling vaccine hesitancy and stopping people from falling between the cracks, and said nurses and health visitors had an “absolutely vital role” as professionals who were highly trusted by the public.
“If we’re going to turn this around, we need nurses to feel confident to advocate for vaccines,” she said.
She added that, in her view, nurses in secondary care should grasp any opportunity they had to mention vaccines, including non-childhood vaccines such as for respiratory syncytial virus (RSV), influenza and Covid-19, during contact with patients.
“Public health is something that all nurses should be involved in, and they are, intrinsically,” she said.
“Practice nurses are the backbone of our whole immunisation programme”
Julie Yates
As well as this, Dr Yates said she hoped proposed changes to nursing practice could further improve uptake.
For example, in 2024, the Labour Party published its Child Health Action Plan, which included a pledge to reform the health visiting service to allow routine immunisations to be administered to “vulnerable and at-risk” babies and children as part of visits.
Since Labour won the general election last year, the Institute of Health Visiting has been working with the UKHSA and other parts of the government to implement this.
Dr Yates said health visitors were “trusted first contacts” with mothers and young children, and that they had an important role in tackling misinformation and signposting people towards getting immunised, even without the reforms.
Sarah Muckle
Former nurse and health visitor Sarah Muckle, now director of wellbeing, public health and communities at Essex County Council, agreed that health visitors, as well as school and other public health nurses, were key to improving vaccination uptake.
However, she said better investment in services was needed to give them the capacity and numbers to do so.
“Health visiting and school nursing… are open to all children and families, and that goes a long way in terms of building trust,” she said.
“There isn’t any stigma associated with talking to those professions as there might be in other places. There needs to be more health visitors and school nurses, but there equally needs to be proper investment in those services.”
Ms Muckle agreed that all nurses, regardless of specialty, could use the high trust placed in them to educate people.
She said that, from her past experience, making all contacts with people count to spread the message about vaccinations was important.
The public health official also spoke about the importance of diversity and tackling cultural barriers.
She recalled an outbreak of measles in an area with a high proportion of people from one Eastern European country with lower vaccination rates, which took her team six months to get on top of.
This outbreak, she said, could potentially have been mitigated if there was a better understanding of the languages this ethnic group spoke and read.
Nurses at some trusts have already, in recent years, had success in driving up immunisation numbers in areas of low uptake.
At University College London Hospitals NHS Foundation Trust, between September 2023 and March 2024, nurses piloted a mobile MMR vaccination service, primarily targeting minority ethnic populations in deprived areas of North London with rates as low as 64%.
This scheme saw nurses travelling by bus to children’s centres and other non-clinical settings, allowing critical vaccinations to be administered.
Deborah Scott, a registered nurse and University College London Hospitals’ clinical programme lead for vaccinations, said: “There is definitely an advantage to having the vaccine being taken to people in a safe environment.
“When we were doing MMR, we were taking it to nurseries… they’re surrounded by people they trust.”
Deborah Scott
The mobile service has since been used to help drive uptake in other groups. For example, the team ran a catch-up MMR vaccination drive at local universities to improve vaccination rates in young adults who were not immunised as a child.
Ms Scott said many of the students were part of the “Wakefield cohort” – referring to the now-discredited 1998 study by disgraced former doctor Andrew Wakefield that suggested a link between the MMR vaccine and autism, which caused a sharp decline in uptake.
“We’re ‘mopping up’ those people in different environments. The fallout from Wakefield is still apparent,” she said.
As well as vaccine outreach schemes for childhood immunisation, Ms Scott’s nursing team has collaborated with midwives to boost uptake of vaccines, such as Covid-19, flu and RSV, in pregnant women.
In a simple tweak to the arrangement of maternity appointments, midwives can now signpost mothers to nurses who are based in the same facility to discuss and organise vaccinations.
Ms Scott said this idea was easily replicable in any setting with both midwives and nurses operating.
“Whether you’re in a role that is specific to vaccines or not, we as nursing staff are all key to having those conversations”
Jessica Turner
“It [took] the pressure off the midwife so they can do everything else, and allowing [a] space to be protected for vaccination,” she said.
The trust has, since this change, seen a 285% increase in Covid-19 vaccination uptake and a roughly 250% increase in flu jab uptake among pregnant women.
Asked what else could support nurses to build uptake rates for all immunisation programmes, Ms Scott said she hoped for improvements in NHS technology and IT systems.
“I think [technology] should be there to support nurses to do our job, not to hinder it,” she said, describing some current systems as “archaic”.
Ms Scott added: “There is a place for digital to make it smoother for us.”
Jessica Turner
She further called for nurses to lead by example, such as ensuring they get vaccinations themselves when offered, and embedding discussions about vaccines in contacts with patients.
Jessica Turner, professional lead for public health at the Royal College of Nursing, said improving coverage was “not about reinventing the wheel”, and instead about improving the systems currently in place, as well as addressing ongoing workforce challenges.
She said nurses should look at innovative ways to make vaccination services more accessible, supporting solutions like mobile clinics, extended hours, public awareness campaigns and other initiatives to tackle misinformation.
In particular, however, Ms Turner said improving the retention and recruitment of staff was vital to any improvement measures: “We’ve got to make sure that we’ve got a core health visiting workforce, that we’ve got a school nursing workforce, that we’ve got practice nurses in place.”
She added: “I also want to [say] to all nursing staff… whether you’re in a role that is specific to vaccines or not, we as nursing staff are all key to having those conversations, and signposting people to the right evidence-based information, and to other health professionals.”
Read our clinical factsheets on childhood diseases
