Immunisation

Vaccination stands as one of the most powerful tools for saving lives and safeguarding public health. It is second only to clean water in its effectiveness as a public health intervention to prevent disease. Through vaccination and immunisation, diseases that were once widespread are now rare, protecting millions of people each year from severe illness and death.

Historically, England has excelled in both life-course and seasonal vaccinations and has effectively responded to outbreaks of vaccine-preventable diseases. However, over the past decade, there has been in decline in vaccine uptake performance, with significant variations in uptake and coverage across different communities, often reflecting broader health inequalities. (Source: NHS Vaccination Strategy)

An infectious disease is an illness, due to a pathogen (an organism that causes disease) or its toxic product, which arises through transmission from an infected person, an infected animal, or a contaminated, inanimate object, to a susceptible host.

Immunisation is the process of making you immune or resistant to an infectious disease, typically via vaccination.

Vaccination stimulates your immune system to protect you against infection, disease and/or death and is one of the most cost-effective health interventions available, saving millions of people from illness, disability and death each year. Childhood vaccinations help to prevent disease and promote child health from infancy, creating opportunities for children to thrive and get the best start in life.

Immunity is the ability of the human body to protect itself from infectious diseases. Immunity can be innate and present from birth, e.g. physical barriers such as intact skin or chemical barriers such as gastric acid. Immunity can be passive (protection provided from the transfer of antibodies from immune individuals) or active (resulting from exposure to a pathogen that triggers the immune system to produce antibodies to that disease). Active immunity can naturally occur or can be delivered via the administration of a vaccine (vaccine acquired immunity).

Herd immunity occurs when a large proportion of a population are immune to a pathogen. A vaccinated population makes it unlikely for an infection to spread as only a few individuals, dispersed through a population, are potentially vulnerable.  This important outcome provides protection for vulnerable groups, such as newborns.  The percentage of a population required to be immune to achieve herd immunity varies for each disease/pathogen. For example, herd immunity against measles requires approximately 95% of a population to be vaccinated, whereas for polio the threshold is 80%.

In the UK, the year 2025/26 marks a significant transition period for Integrated Care Boards (ICBs) as functions and powers begin to be delegated from NHS England (NHSE). To guide this transition, NHSE published the National NHS Vaccination Strategy in December 2023. This strategy emphasises the importance of focussing on outcomes, specifically reducing morbidity and mortality by increasing vaccination uptake and coverage at a local level.

To achieve this goal, every system in the country needs vaccination services that:

• are high quality, convenient to access and tailored to the needs of local people,
• are supplemented by targeted outreach to increase uptake in underserved populations,
• are delivered collaboratively by integrated teams, working across the NHS and other organisations, to enhance patient experience and deliver value for money.

The National Vaccination Strategy offers valuable insights from across England on enhancing vaccination services and provides local systems with guidance on improving vaccination uptake. While this serves as a solid foundation, each Integrated Care System (ICS) must develop its own local strategy to address the unique issues and challenges specific to their population. The Lincolnshire vaccination strategy identifies key priority areas to tackle the decline in uptake, focusing on overcoming barriers for underserved communities and ensuring that vaccination provision is safe, effective, timely and efficient. This local strategy builds on the recommendations from the National Strategy, presenting a localised core offer supplemented by comprehensive and locally appropriate outreach initiatives.

 Other policy documents which influence this topic area include:

• The Joint Committee on Vaccination and Immunisation (JCVI) advises the Secretary of State for Health in England, and Welsh ministers on matters relating to the provision of vaccination and immunisation programmes. Advice is scientific and evidence based and used by Government to inform, develop and construct policy.
• The current national immunisation schedule sets out the national immunisation programme, with changes to the schedule planned in 2025/26 .
• Nationally commissioned immunisation programme specifications are available from: NHS Service Specifications for Immunisation Programmes..
• UKHSA (2025) published a Health Inequalities in Health Protection report, which highlights inequalities across England of infectious diseases.
• NICE has produced supporting guidance and shared learning documents on Immunisations. Of particular relevance is Flu Vaccination: increasing uptake [NG103] and Immunisations: reducing differences in uptake in under 19s [PH21].
• The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

The Infectious diseases impacting England: 2025 report highlights an increase in both endemic disease and vaccine-preventable infections. These diseases accounted for over 20% of hospital bed usage, costing nearly £6bn in the 2023 to 2024 period, a trend also observed in Lincolnshire.

There is evidence of inequality in the reach of immunisation programmes across a range of characteristics including age, geography, socioeconomic status (deprivation, employment, income/occupation, education), ethnicity, religion, disability and health status (learning disability, physical disability, chronic physical illness), underserved and hard to reach (travellers, migrants, prisoners, children in care) and parental factors (lone parents, large families, parental age). Data specific to Lincolnshire is not currently available.

Overall, there appears to be a relationship in vaccine uptake between the most and least deprived in society. Small populations of some ethnic groups can skew numbers in some cases. This has most recently been observed with the pre-school vaccination programme in Lincolnshire. Local data from this programme has also shown the inequality to be most pronounced in those of “White – Other” ethnicity and, more noticeable still, in those from the most deprived communities. Research continues to be undertaken to understand the barriers and hesitancy related to vaccination uptake amongst all age groups from deprived communities and from certain ethnic backgrounds in Lincolnshire. Inequalities have a profound impact on healthy life expectancy, and significant inequalities remain in Lincolnshire for vaccination uptake, with MMR uptake rates at 12 months ranging from 99% to 75%, when comparing uptake at a GP Practice level (Source: Local Datasets).

Influenza is frequently linked to winter deaths due to complications such as bronchitis and pneumonia, especially in vulnerable groups such as the elderly. Respiratory diseases cause the majority of excess winter deaths however, these include a range of diseases and not solely influenza (Source: DHSC). ‘Uptake of flu vaccinations amongst 2-3 year olds in Lincolnshire is comparable to the rest of the country, and uptake amongst older people (aged 65 and over), individuals at risk and primary school aged children is better than the regional and national uptake’ (Source: UKHSA).

For immunisation programmes for pre-school aged children, there is a current plateauing trend regarding levels of vaccination. This includes MMR, Hip/Men C, Dtap/IPV/Hib vaccinations. The full schedule is found here.  Uptake of Human papillomavirus (HPV) vaccinations for males and females in Lincolnshire is comparable to regional and national levels and is showing signs of improving given the intense system wide effort for this programme.

Maternal vaccinations have shown a marked improvement this year, with the pertussis uptake improving significantly in the last 18 months.

NHS England (NHSE) is responsible for commissioning national immunisation programmes, directly supported by the UK Health Security Agency (UKHSA) which has the specialist knowledge needed to ensure this complex area is commissioned and managed safely. The Director of Public Health (DPH) provides independent scrutiny and challenge to the plans of NHSE, UKHSA and providers; this assurance function is a statutory function of the DPH.

The complete routine immunisation schedule includes programmes for childhood immunisation, populations at particular risk, older people and, the seasonal flu programme.

In Lincolnshire, most immunisations are provided through GP practices.  The Lincolnshire School Aged Immunisation Service (SAIS) provider is commissioned to deliver the school-aged/childhood seasonal flu programme, teenage booster and HPV.  SAIS also offer opportunistic HPV vaccinations via local sexual health clinics. This offer includes electively home educated children. United Lincolnshire Teaching Hospital (ULTH) delivers neonatal hepatitis B, pertussis and BCG vaccines.

The Lincolnshire Immunisation Programme Board includes stakeholders involved in delivering, commissioning and assuring immunisation programmes, and provides a mechanism to explore and address issues around the delivery, outcomes and outputs of programmes in Lincolnshire.  The Lincolnshire Health Protection Board provides additional oversight.

In collaboration with regional NHSE, the Local ICB, local GP practices, and the Local Authority Public Health team, the Lincolnshire Immunisation Board have developed local strategies to improve the quality of immunisation uptake data and increase vaccination rates, while addressing inequalities. A comprehensive improvement plan for childhood immunisations is now in place, presented as a delivery plan for the Lincolnshire Immunisation Strategy.  This strategy employs a multi-agency approach to boost vaccination uptake across Lincolnshire, with targeted interventions for areas with the lowest uptake.

A continuous programme is being conducted in collaboration with schools to educate about the availability and importance of immunisation. The team is also actively promoting seasonal vaccine uptake among eligible individuals, with a particular focus on health and social care frontline staff and contracted providers.

Innovative approaches to improve all vaccination programme uptake in Lincolnshire include:

• Offering pre-school vaccinations in school settings in the most deprived and underserved areas.
• Developing outreach models to take seasonal vaccinations to underserved communities and core frontline services.
• Expand the maternity vaccination offer into community hospitals.
• Offering catch-up programmes in local community settings, i.e. HPV catch-up in college settings and MMR in schools.
• Develop local communications and engagement in simple and multiple languages.
• Having a rolling engagement approach to continually receive feedback across multiple forums.

The Lincolnshire Immunisation System supports the three strategic health and care shifts by:

• Reducing morbidity and long-term poor health, directly driving down hospital care needs.
• Working with NHSE and regional services to develop an enhanced digital offer, improving access and providing timely information and guidance to local populations.
• Delivering core preventive services which reduce the need for longer term treatment.

Key partner organisations and services in this field include NHSE, UKSHA, ICBs, GPs, schools, Lincolnshire Community Health Services NHS Trust (LCHS), the 0-19 Service, LCHS Child Health Information System, LCC Children’s Services, childcare providers, universities, carer organisations, residential/social/nursing care providers and healthcare trusts.

Using the National Strategy as a basis, all providers of vaccination services were asked to feedback their experiences. This engagement along with feedback from patient and public engagement is being used in the ongoing development and updates of the Lincolnshire strategy and associated action plans.

Parents Feedback

A survey was carried out within the local population regarding their experience of childhood vaccinations. The responses were predominantly from those who had chosen to vaccinate their child(ren). The majority expressed that they were offered a range of appointments, however the use of other venues for clinics, such as children’s centres and drop-in clinics were popular choices when asked how this could be improved. Weekend appointments are also popular for Lincolnshire parents.  Mass vaccinations in school were also suggested (like the MMR case study). Whilst access to vaccinations is satisfactory this should continue to be improved to include other venues and increase convenience for parents, ideally this would be a consistent offer across the county, particularly in the areas with the poorest uptake.

Most parents are accessing information from trusted sources which is a positive outcome, however there is evidence that parents are regularly seeing negative messages regarding vaccines. Positive messaging must continue to counteract this and should be local and accessible for all. Whilst social media/online is a popular option for spreading health messages the survey found that many parents don’t trust these mediums for accurate vaccine information. Whilst many parents are looking to health professionals for their information, we must ensure a consistent approach from all health care sectors in the information given. This should be supported with literature in the appropriate language, and healthcare training where needed.

Over half (52%) of respondents confirmed that they had been exposed to negative messages about vaccines at least 1-3 times per week. Information gained for those who had confirmed that they had declined a vaccine (14%) or were reluctant to book them (11%), the following themes were recurring in the responses:

• The Covid jabs are scams, do not trust or respect the science, or is all lies
• They are unnecessary and not needed if the child is already healthy
• Cause more harm than good or are full of poison
• Lack of time and not accessible
• Worries about side effects
• Myths and conspiracy theories

In conclusion responses highlighted a need for:

• Clear understandable information and communication regarding vaccinations
• Being well informed prior to appointments and
• Information being provided by health and care professionals from different parts of the system was also highlighted as a high priority.

A recurring theme was to ensure that information given by associated health professionals is consistent and accurate, improving public confidence and take up.

Wider Stakeholder Feedback

Improving immunisation uptake rates requires input from all system partners, currently individual vaccination programmes are commissioned to be given in specific defined settings. Engagement with teams that currently provide vaccination services highlighted that the current model is seen as prohibitive and there is agreement that introducing more flexibility in where and how vaccinations take place is a big step in improving uptake rates.

During engagement sessions providers fed back that patients are now more interested in vaccinations and want to know more information about the vaccines that they are eligible for before agreeing to have them, this is something that they say has occurred since the start of the Covid vaccination programme. Understanding how best to share this information and educate patients will be a key focus.

The overall feedback from the wider stakeholder engagement is that changes and innovation are required if we are to improve uptake in line with the WHO targets.

Addressing gaps and unmet needs in immunisation coverage is crucial for ensuring the health and well-being of all community members. The following points highlight specific areas where improvements are needed to enhance immunisation uptake and effectiveness:

• Caravan dwellers and transient communities: These groups may be registered with GPs outside Lincolnshire or not registered at all, leading to their absence from local GP data.
• Ethnicity-Related Needs: There is a gap in understanding the needs related to ethnicity. Insights from research on COVID-19 vaccine hesitancy could be applied to other immunisation programmes, involving collaboration with community champions, groups and faith leaders to ensure culturally appropriate messaging.
• High-Risk Homes: While immunisation programmes are effective, data on the number of children living in high-risk homes is unavailable.
• Preschool children: Nurseries, Children’s Centres and similar environments could be pivotal for immunisation activities/promotion.
• Childhood Immunisation Uptake: Efforts are underway to improve the uptake of childhood immunisations, including exploring alternative delivery locations, such as children’s centres.
• Flu Vaccine Uptake: Uptake among frontline health and care staff is low due to access issues and hesitancy.
• Opportunistic Vaccination: There is potential to explore opportunistic vaccination across health and social care settings.

Work will continue to improve uptake around all vaccination and immunisations. The local health and care system, overseen by the Immunisation Board will:

• Look at ways to address inequalities of access e.g. those living in areas of high deprivation, traveller communities/transient populations.
• Improve links with communities to maximise opportunities to promote uptake of national programmes e.g. provide more information to Children’s Centres, nurseries etc.
• Work with practices on their call and recall systems, e.g. the timing of invites, to try and improve uptake/coverage.
• Assist the LCHS team to help schools deliver direct education on the availability and importance of childhood immunisations.
• Continue to develop and deliver an improvement plan for uptake in childhood immunisations.