Tag: Vaccination

Increasing measles, mumps, and rubella (MMR) vaccine uptake in primary care

Measles cases in the UK have increased recently; putting at risk the health of children who are unvaccinated.[1] What can primary care teams do to boost measles (MMR) vaccine uptake? I discuss some actions that general practices can take in a recent comment in the British Medical Journal.

Implementing an effective vaccination programme within a general practice requires a multifaceted approach; combining clear leadership, comprehensive staff training, patient education, and meticulous record-keeping. The collective effort of the entire practice team is essential for its success. Assigning a dedicated team member to lead the vaccination programme ensures focused oversight. It is crucial that all staff are well-informed about the vaccination programme, including eligibility criteria and the benefits of vaccination for individuals, families, the NHS, and society. This knowledge can be enhanced through free online training.[2]

Developing a set of Frequently Asked Questions based on official sources like NHS England and the UKHSA, and training staff in effective communication strategies, are key steps in addressing patient concerns and misinformation. Accuracy of medical records is essential, especially in urban areas with high population mobility, to avoid unnecessary vaccination reminders. Regular audits and updating vaccine status during patient registration can help maintain record accuracy.[3]

Effective patient communication about the MMR vaccine’s benefits requires using multiple channels, including text messages, emails, and social media, as well as during consultations, to ensure impact. Practices should also consider the cultural and linguistic diversity of their patients, using appropriate materials and partnering with community organisations to enhance outreach.

Accessible clinics are also essential. Vaccination should be offered during routine appointments and through additional channels like mobile clinics or community centres. Monitoring vaccine uptake and actively following up unvaccinated patients through reminders can significantly improve vaccination rates.[4]

For patients vaccinated outside the practice, it is important to verify and record their vaccination status. Motivating staff with incentives to meet vaccination targets and collaborating with community groups can further improve vaccine uptake.


1. Bedford H, Elliman D. Measles rates are rising again. BMJ 2024; 384 :q259 doi:10.1136/bmj.q259

2. NHS England Immunisation e-learning programme. https://www.e-lfh.org.uk/programmes/immunisation/

3. Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Farah Y, Goldsmith LP, Wurie F, Ciftci Y, Majeed A, Hargreaves S. “We don’t routinely check vaccination background in adults”: a national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care. BMJ Open. 2022 Oct 10;12(10):e062894. doi: 10.1136/bmjopen-2022-062894.

4. Williams N, Woodward H, Majeed A, Saxena S. Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review. JRSM Short Rep. 2011 Oct;2(10):81. doi: 10.1258/shorts.2011.011112.

Improving measles (MMR) vaccine uptake in primary care

The UKHSA has warned that the UK is seeing a surge in measles cases; putting at risk the health of children and others who are unvaccinated. What can primary care teams do to boost measles vaccine uptake in their patients and help bring the number of measles cases down?

In this post, I list some of the key steps in implementing measles (MMR) vaccination in your practice and raising vaccine uptake. This guidance can also be used by primary care providers in other countries.

1. Give one member of the practice team responsibility for leading the vaccination programme, supported by the wider practice team.

2. Ensure that all staff are informed about the programme; including who is eligible; and the benefits of vaccination for the individual patient, their family, the NHS and society. There are many free online programmes on vaccination and addressing vaccine hesitancy for health professionals. Ensure that vaccination is discussed regularly at team meetings to review progress and address challenges.

3. Prepare FAQs to common questions from patients. These are usually available on government websites such as those published by NHS England and the UKHSA. Ensure staff know where to look for these FAQs, which are essential in countering misinformation about MMR vaccination. Specific training is available in effective communication strategies to address vaccine hesitancy and misinformation during patient interactions.

4. Ensure medical records are as accurate as possible so that patients are not called for vaccination inappropriately. This is particularly important in large urban areas where population mobility is high and vaccine records may not always be up to date. Regular audits of medical records can help identify gaps in the recording of vaccine status.

5. A key time to record vaccine status and offer MMR vaccination is when patients register with a practice. Ensure that vaccine records are entered on the medical record correctly (including vaccines given overseas) and offer MMR vaccine to patients who are unvaccinated or unsure of their vaccine status.

6. Prime patients with information about MMR vaccination, including who is eligible; and the benefits of vaccination for the individual, their family and society.

7. Use multi-channel communication to inform patients. Consider using a variety of media to inform patients as well as direct contact through text messages, phone calls, emails and letters: posters, leaflets, social media, and the practice’s website. Different people prefer different methods of communication. Partnering with local schools, colleges and universities can also help in contacting patients.

8. Be culturally sensitive, particularly if your practice is located in a diverse area. Use materials that are linguistically and culturally appropriate to cater to diverse populations, especially those who may not be fluent in English or are from different cultural backgrounds. Collaborations with community organisations and voluntary groups can help practices to better reach and communicate with diverse groups of patients; including those least likely to be vaccinated.

9. Provide accessible clinics for MMR vaccination and also offer opportunistic vaccination to patients when they attend appointments at the practice for other reasons. To make it easier for working adults, consider extending clinic hours for vaccinations. Some areas may also offer mobile clinics or clinics in community centres that can further improve access to vaccination.

10. Monitor uptake in each target group. Contact those who have not come forwards for vaccination by text, email or telephone. Discuss the need for vaccination with patients in clinics. Implementing an automated system for sending reminders for upcoming vaccination appointments can be efficient and lead to increased attendance.

11. Some patients will receive MMR vaccines elsewhere in the NHS or overseas. Details of vaccinations at NHS sites should be sent to the practice automatically but this may not always be the case. Contact patients to check their vaccination status by text or email and enter vaccinations on their medical record if given elsewhere. This will improve the data the NHS uses to monitor vaccine uptake and also ensures that patients are not sent unnecessary reminders.

12. Incentivise staff to achieve targets; and work with the patient participation group and other local community groups to increase awareness of the benefits of vaccination and improve vaccine uptake.

13. Develop a way for patients to provide feedback about their vaccination experience. This could be a short survey sent by email or available at the clinic. The feedback can provide valuable insights for improving the programme in the future. Also consider a post-campaign evaluation to understand what worked well and what didn’t. This information can be also help for planning future campaigns.

14.The same principles can be applied to maximise uptake of other vaccination programmes delivered by the practice for both children and adults.

Boosting Vaccine Uptake in Pregnancy: What Works and What Doesn’t

Pregnancy is a time of anticipation and preparation. But it’s also a time when expectant mothers must be vigilant about their health — not just for themselves but for their unborn children as well. Vaccinations against COVID-19, influenza, and pertussis are vital during this period, yet many pregnant women hesitate to get these lifesaving shots. Let’s delve into recent research that sheds light on effective strategies to increase vaccine uptake among pregnant women.

Our study published in the Journal of Travel Medicine reviewed studies from January 2012 to December 2022, following the gold-standard PRISMA guidelines, to identify interventions that successfully increase vaccine uptake in pregnant women. The meta-analysis focused on three key diseases: COVID-19, influenza, and pertussis — all of which pose significant risks to both mother and child.

Key Findings

Out of 2,681 articles, 39 studies were relevant, comprising over 168,000 participants from nine different countries. Interestingly, while 15 of these were randomized controlled trials, the quality of evidence was strong in only 18% of the studies. Here’s what we found:

– For influenza, interventions modestly increased vaccine uptake, but the overall effect was small.

– For pertussis, the data showed no clear benefit from the interventions.

– There were no randomized controlled trials available for COVID-19 vaccine interventions during pregnancy.

The ‘Three Ps’ Approach

The interventions that were examined fell into three categories — patient, provider, and policy-level strategies.

Patient-Level: The most effective strategies at this level involved healthcare professionals giving clear recommendations, supplemented by text reminders and written information. Personalized face-to-face discussions that addressed concerns, debunked myths, and emphasized benefits were particularly effective.

Provider-Level: Educating healthcare professionals about the vaccines’ safety and importance, along with reminders to offer them as part of routine care, made a significant difference.

Policy-Level: Financial incentives, mandatory recording of vaccination data, and ensuring vaccines are readily available were key policy interventions that showed promise.


Our study indicates that while there’s some success in increasing influenza vaccinations, the overall impact of interventions is modest. Pertussis vaccine interventions didn’t show a clear benefit, and data on COVID-19 interventions is lacking.

What’s clear is the pivotal role of healthcare providers in educating and encouraging pregnant women to get vaccinated. There’s also untapped potential in mobile health technologies that could further promote vaccination during pregnancy.

The takeaway message is that a concerted effort combining clear communication, education, and policy support is essential to protect both mothers and their babies from vaccine-preventable diseases. As the medical community continues to explore and implement these interventions, the hope is to see a significant rise in vaccine uptake, ensuring safer pregnancies and healthier babies.

The Next Steps

For healthcare providers, the message is to continue the dialogue with expectant mothers, ensuring they have all the information they need to make informed decisions about vaccinations. For policymakers, the challenge is to create an environment where vaccinations are not just available but are actively and consistently promoted as part of prenatal care. And for expectant mothers, our study underscores the importance of discussing vaccinations with healthcare providers to ensure the healthiest possible start for their children.

Closing Thoughts

Vaccinations during pregnancy aren’t just a personal choice; they’re a public health priority. Our study provides a roadmap for increasing vaccine uptake — a mission that, if successful, could mean the difference between life and death for the most vulnerable among us.

Chickenpox vaccination in the UK

The Joint Committee on Vaccination and Immunisation (JCVI) recommending the inclusion of the chickenpox (varicella) vaccine in the UK’s childhood immunisation schedule is a significant step for public health. This decision aligns the UK with many other countries that have already integrated the chickenpox (varicella) vaccine into their routine childhood immunisation programmes.

The implementation of the chickenpox vaccine on a national scale offers several benefits:

1. Reduction in cases: Widespread vaccination among children has the potential over time to significantly reduce the incidence of chickenpox, a highly contagious disease, among children and the wider community.

2. Prevention of complications: While chickenpox is often mild, it can lead to serious complications such as secondary bacterial infections, pneumonia and encephalitis; and can be particularly severe in immunocompromised individuals. Vaccination will help reduce the risk of these complications.

3. Healthcare burden: By reducing the number of chickenpox cases, the NHS can lower the associated healthcare burden, saving resources, GP consultations, urgent care capacity and hospital beds for other important healthcare needs.

4. Economic impact: Fewer chickenpox cases mean less time off from school for children and work for parents, positively affecting the economy and individual productivity, as well as educational outcomes for children and quality of life for families.

5. Herd immunity: Vaccination contributes to herd immunity, protecting those who are not  vaccinated or at higher risk of complications from chickenpox.

6. Health equity: Bringing the UK’s vaccination programme in line with other countries ensures that children in the UK benefit from the same level of healthcare protection.

The JCVI’s recommendation is based on evidence of the vaccine’s safety and effectiveness, making it a positive addition to the UK’s public health strategy. This decision underscores a commitment to safeguarding children’s health and reducing the impact of preventable diseases through immunisation once the governments in the UK and devolved nations accept the decision and start to implement the recommended vaccination programme.

Digital Tools for Enhancing Infectious Disease Screening in Migrants

The European Centre for Disease Control (ECDC) has highlighted a stark reality: migrants in Europe are disproportionately affected by undiagnosed infections, including tuberculosis, blood-borne viruses, and parasitic infections. Many migrants also fall into the category of being under-immunised. The call to action is clear — innovative strategies must be developed to deliver integrated multi-disease screening within primary care settings. Despite this call, the United Kingdom’s response remains fragmented. Our recent in-depth qualitative study published in the Journal of Migration and Health delves into the current practices, barriers, and potential solutions to this pressing public health issue.

Primary healthcare professionals from across the UK participated in two phases of this qualitative study through semi-structured telephone interviews. The first phase focused on clinical staff, including general practitioners, nurses, healthcare assistants, and pharmacists. The second phase targeted administrative staff, such as practice managers and receptionists. Through these interviews, a complex picture emerged, revealing a primary care system capable of effective screening but hamstrung by inconsistency and lack of standardized approaches. Many practices lack a systematic screening process, resulting in migrant patients not consistently receiving care based on established NICE/ECDC/UKHSA guidelines.

The barriers to effective infectious disease screening are multifaceted, stemming from patient, staff, and systemic levels. Clinicians and administrative staff pinpointed the stumbling blocks: overly complex care pathways, a lack of financial and expert support, and the need for significant administrative and clinical time investments. Solutions proposed by respondents include appointing infectious disease champions among patients and staff, providing targeted training and specialist support, simplifying care pathways, and introducing financial incentives.

Enter Health Catch-UP!., a collaboratively developed digital clinical decision-making tool designed to support multi-infection screening for migrant patients. The primary care professionals involved in the study responded enthusiastically to this digital innovation. They recognized its potential to systematize data integration and support clinical decision-making, thereby increasing knowledge, reducing missed screening opportunities, and normalizing infectious disease screening for migrants in primary care.

The conclusion is unequivocal: current implementation of infectious disease screening in migrant populations within UK primary care is suboptimal. Yet, there is hope. Digital tools like Health Catch-UP! could revolutionize disease detection and the effective implementation of screening guidance. However, for such digital innovations to succeed, they must be robustly tested and adequately resourced. It’s not just about having the right tools but also ensuring the entire healthcare system is aligned to support their deployment. With the right commitment, we can ensure that migrants receive the care they need and deserve, safeguarding both their individual health as well as public health in the UK.

Impact of vaccination on Covid-19 hospital admissions in England

Our new article in the Journal of the Royal Society of Medicine examines the impact of vaccination on hospital admissions for Covid-19 in England during 2021. Covid-19 vaccination substantially reduced the risk of hospital admission, particularly in people who received three doses.  We used data over a whole calendar year covering multiple variants of SARS-CoV-2, variable case rates and changing vaccine uptake.

This provides a population-level overview of the impact of vaccination that is not possible from studies over a shorter period. Using primary diagnosis of Covid-19 as the inclusion criteria increases the specificity of our study by excluding those co-incidentally Covid-19 positive but admitted for another reason. We excluded “ghost patients” that can bias the estimates of vaccine effectiveness.

We report a dose-dependent effect of vaccination, as well as waning of the effectiveness of each vaccination dose, highlighting the value of booster vaccinations. Our analysis supports an ongoing programme of booster vaccinations, especially in the elderly and risk groups.

Uptake of influenza vaccination in pregnancy

Our study published today in the British Journal of General Practice shows how the uptake of flu vaccination in pregnancy varies with age, ethnicity and socio-economic deprivation.

Pregnant women are at an increased risk from influenza (flu), yet uptake of  Seasonal influenza vaccination (SIV) during pregnancy remains low, despite increases since 2010.

Getting the flu vaccine when pregnant is important, because it reduces the risk of severe disease, complications and adverse outcomes for both mother and child such as pre-term birth. However, uptake was lower among women living in more deprived areas, women who were younger or older than average, Black women and those with undocumented ethnicity.

Although the flu vaccine is safe and recommended for pregnant women, misconceptions about safety play a role in pregnant women not being vaccinated and flu vaccination levels among pregnant women are suboptimal worldwide.

In the UK, since 2010, the Joint Committee on Vaccination and Immunisation (JCVI) has recommended that pregnant women get the flu vaccine to provide protection during the winter flu season. Despite these recommendations, data from Public Health England (now the YK Health Security Agency) showed that in 2020-21, fewer than half of pregnant women were vaccinated.

Previous studies of influenza vaccine uptake during pregnancy have either used data from a single care provider, or from surveys. Our retrospective cohort study looked at 450,000 pregnancies among 260,000 women in North West London, over a ten year period. By applying statistical models to data on women’s age, ethnicity, health conditions and socio-economic deprivation, we were able to identify groups with lower uptake of the flu vaccine.

Misconceptions about the safety and efficacy of antenatal vaccinations play a role in pregnant women being unvaccinated, while recommendation by health professionals improves uptake. To ensure access to vaccines, for high uptake among pregnant women, strong primary care systems are needed and targeted approaches are recommended to reducing inequalities in access to vaccination and should focus on women of Black ethnicity, younger and older women, and women living in deprived areas.

Why shingles vaccine is important for people in their 70s

Much of the discussion about vaccination in the UK is on Covid-19 and flu vaccines or vaccines for children. But there are also other important vaccines for adults – such as for shingles – where there is scope to increase uptake and improve health outcomes for older people and the immunocompromised.

Shingles is caused by the reactivation of latent varicella zoster virus (VZV); sometimes decades after the primary chickenpox infection. For some people – particularly the elderly and the immunocompromised – shingles can be a very unpleasant illness with significant complications.

In the UK, two vaccines are licensed for shingles:

– Zostavax which contains live, attenuated virus and which is given as a single dose.

– Shingrix which is a recombinant vaccine and which his given in two doses.

The main target group for shingles vaccination in the UK is people aged 70-79 years. Most people in this group will receive the Zostavax vaccine. People in this age group who are immunocompromised should receive the Shingrix vaccine. The rationale for vaccinating the elderly is because complication rates are much higher in this group. For example, hospital admission rates for shingles (zoster) are around 20 times higher in people aged 75 and over than those aged 15-59.

When people turn 70, they should receive an invitation for shingles vaccination from their GP. If they didn’t take up the offer of a vaccination at that time, they can still get a shingles vaccination until they are 79. Once they turn 80, you will no longer be eligible for shingles vaccination. Shingles is a disease that has many complications in the elderly. It can result in considerable pain and discomfort and reduce your mobility. In more severe cases, it may require hospital treatment as an outpatient or inpatient. Vaccination reduces these risks substantially.

Implementation of covid-19 vaccination in the United Kingdom

Our new paper in the British Medical Journal reviews the implementation of the UK’s Covid-19 vaccination programme. The programme is essential in keeping down the number of serious cases, hospitalisations and deaths from Covid-19 and allowing society to function more normally. Overall the programme performed well. But it’s important to address some common misconceptions about the programme. Firstly, the rapid implementation of the Covid-19 in vaccination in the UK was not due to Brexit. When the programme started, the UK had not finalised Brexit. Secondly, the vaccination programme was good and all those who supported the programme are to be congratulated for their efforts but it was not “world-leading” as some politicians have claimed. Many other countries have outperformed the UK in areas such as vaccine uptake.

One limitation of current vaccines is that although they are very successful in reducing the number of serious cases of covid-19, they are less effective in preventing infection from SARS-CoV-2, which means that vaccinated people can still become infected and infect others. Early in the vaccination programme, this was often not communicated well to the public, leading to unrealistic expectations about how well vaccines would suppress the risk of infection, particularly with the emergence of new variants that reduced vaccine efficacy.

The UK became the first country in Europe to grant emergency use authorisation for a covid-19 vaccine when the MHRA gave approval for use of the Pfizer-BioNTech vaccine in adults on 2 December 2020. This decision took place when the UK was still operating under EU law. Overall, the policy for prioritising people for vaccination was fair but was criticised for not including ethnic minority groups or key occupational groups other than health and care workers, such as people working in public transport or teaching. The pandemic had major effects on the education of children, for example, and it could be argued that staff working in schools should have been prioritised in the same way as NHS staff to reduce the disruption caused by the pandemic to children’s education.

Shortly after the start of the vaccination programme in the UK, the government decided to prioritise delivery of the first dose of vaccine over the second dose, based on advice from the JCVI. This meant a delay in giving the second dose of vaccine from 3-4 weeks after the first dose to 12 weeks. The immunisation programme was disrupted by this decision, with many people having their appointments for their second doses cancelled. A key question for the Covid-19 Inquiry is why the JCVI did not consider a delayed second dose policy before the programme started. The Inquiry also needs to look at what plans were in place for evaluating the effects of the delayed second dose on clinical outcomes such as infection, hospital admission and case fatality rates and on the delivery of the vaccine programme.

Although the UK was an early adopter of covid-19 vaccines for use in adults, it was slower than many other countries to implement vaccination for 16-17 year olds, then for 12-15 year olds, and finally for 5-11 year olds. This also needs careful review by the Covid-19 Inquiry. Additional problems arose after the decision to give some immunocompromised people a third primary dose of vaccine. The rationale was that immunocompromised people often had a poor response to two doses of vaccine and that a third dose would give improved protection. The third dose programme was rolled out with little central or local planning, resulting in considerable confusion among both the public and NHS staff and leading to delays in many eligible people getting their third primary vaccine dose. Key lessons from this component of the vaccination programme were the need to give the NHS adequate time to plan and to ensure that NHS staff are fully briefed in advance of any public announcement or media briefing about vaccination policy. It’s also essential to look at the method of vaccine delivery. In England, there is now a very fragmented system. In the longer term, we need to look to integrate Covid-19 vaccination with other vaccine programmes in primary care and schools.

One area in which the UK excelled internationally was using data from the NHS, covid-19 testing, and national mortality records to monitor vaccine uptake, safety, and effectiveness. Congratulation to PHE and then to the UKHSA who set up this work.

The UK is currently very reliant on overseas manufactured vaccines. We must plan consider how we ensure that the UK can develop, test, and manufacture vaccines for the current and any future pandemics at the speed and quantity needed.

The feedback on our article from patients emphasised the importance of clear, positive messages about vaccination for the public; and personalised support for people who were vaccine hesitant or who had concerns about vaccination to help increase vaccine uptake. Access to vaccination at a local site was also important, particularly for older people or those with limited mobility. Finally, there are many questions about vaccination that the UK’s Covid-19 Inquiry will need to consider. Some of these are summarised below.

Questions for the UK’s Covid-19 Inquiry

  1. What should we be doing to secure the legacy of the covid-19 vaccine research and delivery strategy for vaccine science, vaccine manufacturing, public health, and pandemic preparedness?
  2. Why hasn’t the UK established a pipeline for the rapid development of RNA vaccines?
  3. Why did the UK lag behind many other countries in recommending covid-19 vaccines for children?
  4. How would we respond to a future pandemic causing high levels of morbidity and mortality in children?
  5. Was sufficient attention paid to targeting groups who were likely to be vaccine hesitant?
  6. What can be done to build on the JCVI’s communications and operations—particularly around public and patient involvement and engagement and its position on equality, diversity, and inclusion?
  7. Why did the JCVI not recommend a delayed second dose strategy in its initial recommendations to the government in 2020? What impact did this have?
  8. What is the best method of covid-19 vaccine delivery in the future?
  9. Should staff working in schools also have been included in the initial occupational groups targeted for vaccination (such as health and care workers) reduce the effect of the pandemic on schools, given the many adverse effects of the pandemic on the education, social development, and the physical and mental health of children?
  10. Did the UK government take the correct decisions about vaccine procurement? Was the UK correct to work alone on procurement or should there have been greater collaboration with the EU?
  11. What impact did the over-procurement of vaccines by developed countries such as the UK have on vaccine equity and on the supply of vaccines for lower income countries early in the pandemic?

Why you should get your flu vaccination

The NHS is now starting to rollout flu vaccinations for eligible people. Although the public health focus since early 2020 has been very much on Covid-19, flu remains a major threat to vulnerable individuals and the NHS in the UK.

We have been fortunate that in the last few years, flu rates have been very low in the UK. However, there are signs from Australia that we may see much higher rates of flu in the UK this winter. Australia has seen its highest flu rates since the start of the Covid-19 pandemic and this may be a predictor of what the UK may face during our own winter.

Because flu rates have been low in recent years, this means that people will have less immunity from a previous infection. The end of Covid-19 control measures – such as face masks and social distancing – combined with the return of normal social activities also increase the likelihood of a large flu outbreak this winter.

This makes flu vaccination essential – particularly for the elderly, the clinically vulnerable, and people who work in health and social care. You can get your flu vaccine at a range of sites such as your GP surgery or a local pharmacy. Getting the flu vaccine reduces your risk of being infected and of suffering a more severe illness that may result in hospital admission or death. By getting vaccinated, you are also helping to reduce pressures on the NHS at a time when it is facing unpresented demands for care.

So don’t delay. Get your flu vaccine if you are eligible to protect yourself and to protect the NHS.