TopicsImmunisation & IllnessDramatic drop in childhood vaccinations

Dramatic drop in childhood vaccinations

After two major measles outbreaks in England led to the declaration of a national incident, journalist Jo Waters asks how this happened and how it can be speedily remedied.

Childhood vaccination rates have generally been falling for a decade in the UK (rates have varied between countries), but the consequences are only beginning to make headlines. Earlier this year, major measles outbreaks in Birmingham and London received widespread media coverage.

According to the latest figures, only 92.5% of children in England had received the first of two MMR (measles, mumps and rubella) vaccinations (MMR 1) by the age of five – the lowest rate since 2010-11 (NHS Digital, 2023a). Only 84.5% of those in the relevant age group – it’s normally given around the age of five – received a second dose (MMR 2), again the lowest level since 2010-11. (For UK-wide figures, see Snapshot of MMR vaccination rates in the UK, below).

It’s not just the uptake of the MMR vaccination that has fallen – statistics from all four UK nations reveal a pattern of successive annual drops for most vaccinations over more than a decade (BMJ, 2022).


‘The general direction of vaccine uptake has been downwards in the UK and has been decreasing year on year since 2013-14,’ says Helen Bedford, professor of child health at University College London.

‘The decreases have been tiny, sometimes as little as 0.1 to 1.2% annually, but year on year they have had a big impact. We have seen little upswings and then downswings, but over 10 years the downward trend is significant.

‘There are now some pockets of inner London, such as the borough of Hackney, where uptake of MMR 2 by five years is down to 56%, which is extremely worrying as measles is extremely infectious and has spread like wildfire in the West Midlands.’

In England, childhood vaccination coverage decreased for 12 of the 14 vaccine measures reported in 2022-23, and no vaccine programmes met the target of 95% coverage. In fact, all coverage measures had decreased among children at the age of five (NHS Digital, 2023a).

The ‘5-in-1’ coverage at five years had the biggest year-on-year decrease in 2022-23, falling to 93.2% – the lowest level since 2008-09. (Children born post-August 2017 who had the ‘6-in-1’ vaccine will have received the 5-in-1 component). The Hib/Men C vaccine, also had its largest year-on-year decrease in 2022-23, falling to 90.4% – the lowest level since 2011-12. And rotavirus vaccine coverage is now at its lowest level since data became available in 2016-17 (NHS Digital, 2023b).

While the rates of HPV vaccination showed some improvement in 2022-23, they are still below pre-pandemic levels (UKHSA, 2024a).

At Public Health Wales, Dr Chris Johnson, who heads the country’s Vaccine Preventable Disease Programme, says MMR rates are stable at just below 90% uptake at the age of five. However, while Wales is not seeing the very low levels recorded in some parts London, for example, vaccine uptake is more challenging among children in the older age bracket. There were nine confirmed cases of measles in Wales last year.

‘The older children have the lower uptake. One of the main drivers for high uptake is good accessibility. Mums of eight-week-old babies are usually on maternity leave so can get to clinic appointments more easily than if they are back at work,’ says Chris.

Though the uptake of the HPV vaccine in Wales is good, it could be better. ‘Uptake for the HPV vaccine by school year 10 in 2021-22 was high at 83.1% and 72.7% at the second dose,’ reveals Chris. ‘This is because of significant efforts by our vaccination teams after uptake in this age group was affected by the Covid pandemic.’ He adds: ‘However, we recognise there is room for improvement, and we will be doing more to improve take-up of the HPV vaccine across Wales.’

The only vaccine in Wales to reach the 95% target in 2023 was the PCV primary dose by age one (Public Health Wales, 2023).

Meanwhile Scotland has witnessed long-term declines in the uptake of all primary and booster childhood vaccinations, a spokesperson for Public Health Scotland says. Brief increases during the early Covid-19 pandemic years were followed by recent declines in MMR, both the 5-in-1 and 6-in-1, rotavirus, MenB, PCV [pneumococcal], and Hib/MenC. For MMR 2 by age five, only two regions (Angus and East Dunbartonshire) hit the 95% uptake target and the lowest uptake was in Aberdeen with 83.1%. Two (unrelated) cases of measles were reported last year, in October.

In Northern Ireland, a 2023 report said there had been a 10-year downward trend in all but one of the 14 childhood vaccinations (Northern Ireland Audit Office, 2023). The latest figures for the three months ending in September 2023 show MMR 2 rates at age five stood at 85.4%, down from 91% in 2011. Meanwhile, uptake rates for the 4-in-1 vaccine were 85.9%, from 91% in 2011 (Public Health Agency, 2023). At the time of writing, a spokeswoman said a vaccination push was planned for February.


Attitudinal tracking studies show that vaccine confidence levels have generally been improving, despite the gradual decline in vaccine coverage (UK Health Security Agency (UKHSA), 2023a). ‘Although some communities have concerns about vaccination, there is no evidence that the decline in childhood vaccine uptake is being driven by this,’ says a UKHSA spokesperson.

‘The declining rates is a combination of some people perceiving diseases like polio and measles as no longer being a real threat,’ the UKHSA spokesperson continues. ‘But largely it’s about people’s busy lifestyles and the pressure of work [and] finding time to ensure your baby or child attends their appointment when offered and gets their vaccines. Especially if you’re working during the day when GP surgeries and clinics are open.’

Professor Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, agrees the reason for the decline in vaccine uptake is multifactorial. ‘Usually when vaccine acceptance or confidence declines it’s rarely for just one reason. Sometimes people lose confidence in the system as they try to get the vaccine and can’t, and then they give up,’ says Heidi.

‘We also can’t ignore the effect of the Andrew Wakefield research, which wrongly suggested a link between the MMR and autism,’ Heidi notes: ‘It hasn’t gone away.’ The initial response to the Wakefield findings [published in 1998] has abated to some extent, helped by a wealth of evidence countering his assertions. ‘But there’s still a group of parents who don’t trust it and are anxious about it,’ Heidi explains.

It’s also about the impact of the ‘digital world’, she points out. ‘At the same time there’s a very toxic social media environment. This is a new challenge and has certainly contributed to undermining confidence in vaccines. At the end of the day, the system hasn’t caught up with the pace of change in the communications and information environment,’ says Heidi.

‘Before Covid, most people took vaccines for granted and thought they were safe enough and would trust what they were told at the clinic and do it. But when Covid began, everyone was online looking for information about vaccines. The people who beforehand had no clue about all the negative stuff and questioning of vaccines were then exposed to it during the pandemic.’

Heidi says that some ethnic communities can harbour concerns about the measles vaccine. Some Somali communities, for example, associate MMR with autism and this can also be a barrier.


In September 2017, the UK received a World Health Organization (WHO) ‘certificate of elimination’ for eradicating measles (UKHSA, 2023b). Having lost that status in 2019, the country regained its measles-free status in 2021 after transmission rates fell because of the Covid-19 restrictions (UKHSA, 2023b).

Fast forward to 2023, and England now has 3.4 million children with no protection from the world’s most contagious respiratory disease (NHS England, 2024). Just 85% of children starting school in September 2023 had received both MMR jabs (Roxby, 2023). Measles-free status is unlikely to be sustained (UKHSA, 2024b).

Professor Bedford said that experts issued warnings about the dangers of low uptake for many years. ‘I hate to say this, but until you actually start getting measles cases coming through again people don’t see it as an urgent health problem,’ says Professor Bedford. ‘You almost need the impetus of a build-up of cases to get people to take it seriously.’

The drop in MMR vaccinations is by no means confined to the UK, however. At the end of last year, WHO reported a 30-fold increase in measles cases since 2022, with 30,000 cases occurring in 40 of the region’s 53 states from January-October last year (WHO, 2023). The increases have been largely attributed to ‘backsliding’ in vaccination coverage in the region from 2020-22 during the Covid pandemic (WHO, 2023).

Janet Taylor, CPHVA Executive chair and a public health nursing manager in Northern Ireland says having fewer health visitors shouldering higher caseloads is clearly contributing to the drop. ‘It’s a variety of reasons,’ says Janet. ‘But certainly, I think HVs promote vaccination, and… if you have fewer HVs, there are less visits and less opportunities to keep the message going about the importance of vaccines. So, I think staff shortages are a big factor, particularly in England where there only five mandatory contacts between HVs and families, compared to nine in Northern Ireland.’

Janet says access may also be an issue and that clinics must go to where the people are. ‘I don’t think most people are anti-vaccines, very often it’s just that they are working and busy and can’t get their child to the clinic. We have to make it easier.

‘Complacency also creeps in,’ she adds. ‘With high vaccination rates until relatively recently we just haven’t seen many measles cases, so people think it’s nothing to worry about and take their foot off the pedal.’

Covid was undoubtedly a factor too, with home visits being curtailed in many places. ‘There wasn’t the same opportunity to talk through the benefits of vaccinations,’ explains Janet. ‘If you did see a parent face to face, they wanted you [the practitioner] to visit in a timely manner.’


NHS (England)
Vaccination Strategy
Uptake of Infant and Preschool
in Scotland
and England during Covid
McQuaid et al, 2022
NICE Guideline NG218
Vaccine Uptake in the General
aims to
increase uptake
See the UK Figures
Northern Ireland

Professor Larson says vaccinations need to be made more accessible, both in terms of locations, time of day offered and the ease of booking appointments. ‘We need to make it as easy as possible,’ she says. ‘We also need to make use of waiting rooms and other spaces where you have a captive audience and even, perhaps, make use of volunteers who can be there for people who have questions – a bit like a help desk. One of the things we hear from a lot of parents is that they just want to talk to someone who is not going to judge them for their questions or humiliate them.’

Professor Bedford is adamant HVs can help to boost vaccine uptake rates. ‘But I think their focus should be on the children with additional needs, or who have problems accessing services,’ she says.

‘The big thing is we would have to ask HVs if they want to take on more of this work. They do tend to get landed with everything, so we need to be careful. It would also require a change to commissioning. We should also think about giving vaccinations opportunistically when children go to hospital and make it part of routine assessments.’

Janet stresses that while HVs and school nurses are trusted health professionals, they could encounter ‘an element of vaccine fatigue’. She says: ‘If you sit people down face-to-face with a health professional to discuss it and give them the evidence and reassure them, you can help people who are teetering on the edge of not getting vaccinated to go ahead. But we need the time and resources to be able to do this.’

Professor Larson concludes: ‘At the end of the day we can’t just do business as usual: we really need to address this, and it doesn’t come free. It needs a conscious and planned investment in people, time, and resources, otherwise we are going to see other diseases such as diphtheria making a comeback too.’


BMJ. (2022) UK childhood vaccination rates fell last year in almost all programmes, figures show. See: (accessed 21 February 2024). 

McQuaid F et al. (2022) Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic: An observational study of routinely collected data. See: (accessed 21 February 2024). 

NHS Digital. (2023a) Childhood Vaccination Coverage Statistics, England, 2022-23. Overview. See: (accessed 20 February 2024). 

NHS Digital. (2023b) Childhood Vaccination Coverage Statistics, England 2022-23. Coverage Statistics 2022-23. See: (accessed 21 February 2024). 

NHS England. (2024) NHS launches catch up campaign for missed MMR vaccines. See: (accessed 21 February 2024). 

Northern Ireland Audit Office. (2023) Pre-School Vaccinations in Northern Ireland. See: (accessed 21 February 2024). 

Public Health Agency. (2023) Vaccination Coverage Statistics for Children in Northern  Ireland. See: (accessed 22 February 2024). 

Public Health Scotland. (2023) Childhood immunisation statistics Scotland: Quarter ending 30 September 2023. See: (accessed 22 February 2024). 

Public Health Wales. (2023) COVER – National childhood immunisation uptake data: Uptake of scheduled childhood vaccination. See: (accessed 22 February 2024). 

Roxby P. (2023) Measles vaccine campaign targets unprotected millions. See: (accessed 21 February 2024). 

UKHSA. (2024a) Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2022 to 2023. See: (accessed 11 March 2024).  

UKHSA. (2024b) National measles guidelines. See: (accessed 11 March 2024). 

UKHSA. (2023a) Immunisation survey 2023 findings. See: (accessed 21 February 2024). 

UK Health Security Agency. (2023b) UK measles and rubella elimination indicators and status. See: (accessed 21 February 2024). 

WHO. (2023) A 30-fold rise of measles cases in 2023 in the WHO European Region warrants urgent action. See: (accessed 21 February 2024). 

Image | Freepik


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