Childhood and adolescent vaccination uptake rates are mostly declining in the UK, but what’s really behind the drop, and what can be done to truly get back on track? Journalist Jo Waters reports.
It was reported in autumn 2025 that almost one in five (18.6%) children starting school in England had missed their 4-in-1 preschool booster vaccination (for polio, whooping cough, tetanus and diphtheria) (UKHSA, 2025a). This is the lowest uptake since 2010/11. Although uptake was slightly higher in the other three UK nations, the overall trend is down, and uptake is also decreasing for most childhood and adolescence vaccines in the UK, including the HPV vaccine for young people.
In fact, vaccination rates have fallen further below the WHO 95% coverage yet again for the majority of childhood and adolescence vaccines across the UK, according to latest figures (UKHSA,2025b). There are only some limited signs of recovery after the falls in uptake seen during the pandemic.
‘Recently, we have sadly seen the impact of this, with large outbreaks of measles and pertussis [in 2024], which also tragically caused some infant deaths in this country [England],’ says Dr Mary Ramsay, director of immunisation at UK Health Security Agency (UKHSA). It means there’s also been a decline in the uptake for vital vaccines given to pregnant women to protect babies.
On childhood and adolescence vaccines, Dr Ramsay has warned: ‘Measles, being the most infectious disease, is the “canary in the coalmine” and a wake-up call that urgent action is needed to stop the very real risk of other diseases re-emerging.’ She also highlights that the decline in uptake rates for the three doses of the 6-in-1 vaccine may be ‘stabilising’ (UKHSA, 2025c), though this appears to be a limited example of stabilisation.
‘2024 WAS A PEAK YEAR FOR MEASLES NOTIFICATIONS IN ENGLAND AND WALES, WITH ALMOST 3000 CASES RECORDED, THE HIGHEST NUMBER FOR DECADES’
THE MMR PICTURE
Overall, uptake rates across the UK are failing to reach pre-pandemic levels or the WHO targets. There are some exceptions to poor MMR uptake, including in Scotland and Wales, where coverage for the first dose aged five years has exceeded the 95% WHO target. However, Helen Bedford, professor of child health at University College London and a former health visitor, describes the latest vaccination figures overall as ‘worrying.’
‘Although there’s a little bit of movement upwards in some areas (such as the 6-in-1 vaccination up by 0.2%in England and Wales), we still have a situation where, in some London districts, only 58% of five-year-olds starting school have had two doses of MMR. The lowest uptake in the country is in Hackney.’
In England, MMR1 rates remained stable and MMR2 rates decreased by 0.2% on the previous year, to 83.7% (10 years ago it was 88.2 %) – though, if London is taken out of the equation, the overall MMR2 uptake figure is 86.6% (UKHSA, 2025d).Professor Bedford puts this all into context: ‘The year 2024 was a peak period for measles notifications in England and Wales, with almost 3000 cases recorded, the highest number for decades.
‘As of 20 November 2025, there were 847 confirmed measles cases in England (UKHSA, 2025e). That might not sound many, but there were virtually none 10 years ago. Half of the cases have been in London and 13% of them in Hackney. And a child in Liverpool died in 2025 from measles,’ (Whittingham and Gawne, 2025).
WHICH WAY NOW?
UK coverage compared with the previous year 5-year-olds:
6-in-1 vaccine coverage increased by 0.1 percentage points to 93.2%
dTaP/IPV (4-in-1) booster decreased by 1.2 percentage points to 82.4%
MMR1 remained stable at 92.3%
MMR2 decreased by 0.1 percentage points to 84.4%
Hib/MenC booster decreased by 0.5 percentage points to 89.6%
1-year-olds:
PCV vaccine coverage decreased by 0.1 percentage points to 91.7%
Rotavirus vaccine increased by 0.2 percentage points to 89.1%
MenB vaccine increased by 0.3 percentage points to 91.3%
UKHSA, 2025d
Click for more detail
UPTAKE AMONG YOUNG PEOPLE
HPV vaccine uptake has declined across the four UK nations, although there are signs this may be improving with the introduction of the single-dose vaccine (UKHSA, 2025f; NHE, 2025). See online for a round-up.
Dr Ramsay highlights that uptake of the vaccine programmes for secondary school students (which includes HPV, MenACWY and the 3-in-1 teenage booster) fell when schools were disrupted by the pandemic. This means some young people remain unprotected against meningitis and cancer caused by HPV, adds Dr Ramsay.
She says there are positives, too: MenC and MenW, ‘two bugs that were killing young people in the past, have been almost eliminated and cervical cancers have fallen by more than 90% in the vaccinated cohort’.
Elaine Baptiste, a member of the CPHVA Executive, currently working as a bank HV in north-east London, says there needs to be better education for young people about HPV to improve rates.
UK VARIATIONS IN PRESCHOOL UPTAKE
ENGLAND
● Overall, preschool booster 4-in-1 coverage was 81.4%
● Local authority areas in the North consistently performed better than other areas
● Highest preschool booster 4-in-1 rates were: Cumbria 94.3%, County Durham and East Riding of Yorkshire 93.7%, Barnsley 92.8%, Northumberland 92.3%
● Childhood vaccination coverage is lowest for all the uptake indicators in London.
Scotland, Wales and Northern Ireland
● Coverage in children aged 5 years was more than 93% for all vaccines except the dTaP/IPV (4-in-1) booster andMMR2 vaccine
● dTaP/IPV (4-in-1) booster and the MMR2 vaccine were above 89% coverage in Scotland and Wales, and above 86% coverage in Northern Ireland.
UKHSA, 2025d
MISINFORMATION, MISTRUST AND HESITANCY
How are these things linked and is the situation getting worse? Research from 2019 found that 55% of UK adults agreed with, or were not sure about, the statement ‘Vaccines are not needed for diseases that are not common any more’ (Opel and Larson, 2022).
UKHSA research from August 2025 (UKHSA, 2025g), meanwhile, found that just less than half of parents (47%) who said they had seen information that made them concerned or worried about their child having vaccines had seen this information on social media.
‘Despite this, our parental attitudes survey continues to show an overall improvement in vaccine confidence, and high levels of trust in healthcare professionals in the NHS,’ says Dr Ramsay.
Professor Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, highlights the dangers of misinformed influences. ‘Although parents say they trust information given to them by health professionals, if they then run into friends who tell them something awful about vaccines, or they hear the president of the US saying it in the media, they may start to sway.’ Professor Larson adds: ‘It must be really tough as a young mum with no experience of vaccines or the diseases they protect against.’
Meanwhile, in September 2025, an adviser to US health secretary Robert F Kennedy Jr caused controversy in the UK when he told Reform UK’s party conference that one of Britain’s most eminent oncologists ‘thinks it’s highly likely that the Covid vaccines have been a significant factor in the cancers in the royal family’ (Mason, 2025).
‘It’s really disturbing, as it’s obviously not evidence-based,’ says Professor Bedford. ‘Who knows what damage this denuding of expert opinion is doing to public confidence in vaccines?’
Dr David Elliman, a childhood immunisation expert at the Institute of Child Health in London and a former community paediatrician, predicts these pronouncements are going to have an impact on vaccination rates. ‘There is a danger that vaccination may become as politicised as it did in the US during the Covid pandemic… I wonder if we are beginning to see this here now, with what happened at the Reform party conference.’
President Trump’s comments, in autumn 2025, on Tylenol (paracetamol) taken in pregnancy and autism (Halpert and Yousif, 2025 ‘emboldens’ people who are already questioning the causes of autism, says Professor Larson, who also authored Stuck: How Vaccine Rumours Start and Why They Don’t Go Away (Oxford Univerity Press, 2020).
‘I think it’s a concern for the effect these types of statements will have on those who are already hesitant, but if these messages keep on being repeated, it also puts it in the minds of people who are good vaccinators, too.’
BEYOND HESITANCY
Whatever the impact of misinformed statements, it’s important to note that there are a number of factors affecting vaccination uptake – it’s hardly ever just one thing, say experts.
Access issues
Dr Ramsay says most parents want to do what is best for their child, and have confidence and trust in childhood vaccinations, but she recognises it can be hard when juggling busy lives and work to find time to book and get to GP appointments. ‘This gets more difficult as
children get older and when there may be younger children in the household.’
‘Sometimes, parents want to get their children vaccinated, but have tried and failed,’ adds Professor Larson. ‘They might not have been able to get an appointment, or have missed an appointment for some reason, such as lack of childcare for their other children or the cost of a bus fare.’
Consent
A review from late 2024 (Karakusevic and Foss) of 152 publications related to HPV vaccination identified several barriers to uptake, including difficulties in obtaining consent forms back from parents and poor communication from school services about HPV. Other barriers included parents expressing concerns about vaccinations promoting promiscuity, misinformation on the internet and fears over vaccine safety.
Cultural beliefs
Another issue could be a lack of cultural sensitivity to the beliefs and customs of particular ethnic groups, says Dr Elliman. ‘What I’ve learned is that someone like me – an elderly, white, bearded male – isn’t necessarily the appropriate person to tell a young Afro Caribbean woman why her baby needs a vaccine.’
Complacency and fatigue
[It’s] another reason why parents might not get their children vaccinated – they haven’t seen how serious diseases such as measles and whooping cough can be,’ says CPHVA Executive chair Janet Taylor. ‘Historically when we had large outbreaks, children would be hospitalised and some would be left with permanent effects – but because we’ve had so few cases until recently, parents don’t realise this now.’
The addition of the new chicken pox vaccine – MMR and varicella (Department of Health and Social Care, 2025) in January 2026, as part of routine infant vaccinations, could also possibly meet with resistance from a minority of parents who complain about vaccine fatigue and their babies having too many vaccines at once. This is despite the varicella vaccine being used safely in the US, Canada, Australia and Germany for decades.
Health professionals overloaded
Often, uptake of vaccines comes down to health professionals just not having enough time to answer questions from parents, says Dr Elliman.
‘Most nurses only get 10 minutes to answer questions, write up the records and administer the injection. In the majority of cases that will be enough, but there will be someone who will have read something, or knows someone who thinks their child had a reaction to a vaccine, and that will take longer to talk about – particularly if it’s a vaccine that’s new to the parent that their child hasn’t had before.’
HV Elaine Baptiste adds: ‘The decline in HVs and school nursing staff numbers, and the increased skill mix [using less- skilled and lower-grade staff] has had a huge impact on the health-promotion agenda, leading to poorer and declining vaccine uptake.’
How exactly? ‘Less-skilled workers do not have the knowledge to impart accurate information and promotion of confidence on vaccination to worried parents and children. If there is continued loss of skilled workers, the decline in vaccine uptake will continue,’ she says.
‘WE SHOULD HAVE VACCINES AVAILABLE AT PLAY AREAS AND SHOPPING CENTRES, TO MAKE IT AS EASY AS POSSIBLE FOR PARENTS’
REACHING EVERYONE
So, what do experts say is the answer to improving vaccine uptake for children and young people?
Real help for parents
‘Making it as easy as possible for children to get vaccinated is important, by sending reminders and trying to make every contact count,’ says Dr Ramsay. Professor Larson also highlights that more outreach work is needed to take the vaccination programmes to
where the people are. ‘We should have vaccines available at play areas and shopping centres, to make it as easy as possible for parents to get the vaccines for their children.’
Professor Bedford reveals a HV initiative that could support parents: ‘There’s now a piece of work about to start looking at training HV teams to offer vaccinations to under-vaccinated groups. That could be done in the home or in children’s centres, or wherever is appropriate for that family. This will be trialled in several areas and, if it’s shown to be effective, could be introduced nationally.’
Another initiative that may improve MMR uptake is bringing the date of the second dose of MMR forward, adds Professor Bedford. ‘Families will, from January 2026, be offered the second MMR dose when their child is aged 18 months, rather than three years four months, as research has shown that this improves uptake. They will also be offered a fourth dose of the 6-in-1 vaccine at the same time.’
Community matters
‘You need to enrol people from the community who are more their peers, and who understand the nuances of that community,’ says Dr Elliman. ‘We saw this happening successfully during Covid, when vaccinations were being done in mosques and community centres. These vaccination campaigns were seen as part of the community and not a government initiative.’
Janet Taylor, who is also a HV service manager in Northern Ireland, says HVs there have run special sessions in Catholic secondary schools to answer parents’ concerns about giving the HPV vaccine to young girls and boys. ‘Some parents had concerns that the HPV would encourage children to start having sex, and we were able to explain this is not the case and the purpose of the vaccine is to protect against cancer,’ says Janet.
‘HVs AND SNs HAVE LIMITED CAPACITY TO DO THE VERY IMPORTANT HEALTH- PROMOTION WORK FOR WHICH THEY WERE TRAINED’
Getting the message across
‘HVs also need regular training to keep up to date with vaccinations,’ highlights Professor Bedford. ‘It’s a rapidly changing field and you have to have real in-depth, fundamental knowledge of vaccination to be able to answer all the difficult questions.
‘Some people suggest giving HVs and SNs a list of frequently asked questions with the answers, but that isn’t enough, because if the conversation goes off piste, and a question is not on the crib sheet, you’re stuck. Also, importantly, it’s often the
way the conversation is conducted that is so vital: listening to concerns, showing empathy and understanding, and providing tailored information with the aim of creating trust.’
Professor Bedford says it isn’t always easy for HVs to access training, but it needs to be made a priority. ‘HVs, SNs and teachers need to go as local as possible to get the benefits of vaccinations across,’ adds Professor Larson.
Government communication
When the low pre-booster vaccine uptake was revealed, health minister Stephen Kinnock said: ‘We know parents want to do right by their children and we’re working with the NHS to make it easier for all families to access these life-saving vaccines’ (UKHSA, 2025h). He also spoke
about an overall 10-year decline in vaccine uptake and that among the reasons was vaccine hesitancy post-pandemic and social media conspiracy theories. He revealed that the government is targeting this with a combination of localised drives in low-uptake areas and a national campaign on the benefits of vaccinations (Sky News, 2025).
Elaine adds: ‘HVs and SNs are stressed and burnt out, and have limited capacity to do the very important health-promotion work for which they were trained. The government is shortsighted in that it lacks awareness of how one affects the other.’
MORE INVESTMENT IN HVs AND SNs
Janet says higher vaccine uptake in Northern Ireland and Scotland could be related to the greater number of mandatory HV visits both countries have. ‘In England, they only have five mandatory HV visits and even then, not all will be completed by a HV; we’re increasing that to 11 visits in Northern Ireland, and Scotland does 11.’
Wales has nine mandatory contacts up to 3.5 years (Welsh Government, 2025).‘There’s a whole opportunity to have those pertinent conversations about immunisations if you have more visits, which is being missed in England because they’re firefighting,’ continues Janet.
‘In England, we know the bulk of a HV’s workload is being taken up with safeguarding, and they don’t have enough time for the other work they’d love to do on public health. To me, immunisations are one of the casualties of this.’
What’s the answer? ‘We keep saying it, but we need more investment in the expertise of HVs and SNs, and public health nursing generally,’ reiterates Janet. ‘They are trusted health professionals, and part of their role is to educate the public and help them make informed decisions about their health. They should be given enough time and a caseload where they have the time to do this.’
She adds: ‘In England, HVs could have upwards of 300 families on their caseload, and their workload is mainly taken up with safeguarding. I think the answer is very simple. If we want to improve immunisation rates, we need to increase the amount of contact HVs have with families – and that requires more staff.’
RESOURCES
- Vaccination coverage, up to 5-year-olds (October, 2025)
- Updated public health data, including measles outbreaks – England
- Childhood schedule changes
England
Wales
Scotland
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