Every child deserves access to vaccination
Disclaimer: MSD has funded and had editorial control over this article.
Vaccination is one of the most effective public health interventions in human history – second only to clean water in preventing disease . In fact, childhood vaccinations alone prevent an estimated 3.5 to 5 million deaths globally each year.
However, the impact goes further: protecting children early helps give them the best possible start in life, making vaccination an important way to tackle health inequalities. In a country where the government has pledged to put prevention at the heart of the NHS and break down barriers to opportunity, ensuring every child has equitable access to routine vaccination must be a national priority. Yet today, too many children are still being left behind.
England's childhood vaccination coverage rates (VCRs) have been declining steadily since 2013/14, with the World Health Organization (WHO) target of 95 per cent coverage not met in any part of the childhood immunisation schedule.
Measles, mumps and rubella (MMR) vaccination – once the symbol of UK immunisation success – has fallen to its lowest level in 15 years, with coverage at age five reaching a new low in 2023/24. This is not an abstract risk. In 2024 alone, there were 2,911 confirmed measles cases in England – the highest annual total since 2012.
The UK briefly regained its WHO measles elimination status during the Covid-19 pandemic, but with case numbers now rising sharply, that status is at serious risk and, according to the UK Health Security Agency (UKHSA), it is unlikely to be sustained.
Beneath these national figures lie deeper, structural inequalities. Coverage is not just falling – it is falling unequally. London consistently reports the lowest childhood vaccination rates, and has been the epicentre of recent measles outbreaks. In 2024, research found that socioeconomic inequalities in coverage are widening across the childhood immunisation schedule.
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The introduction of maternal vaccination against respiratory syncytial virus (RSV) has shown similar patterns, with women from black ethnic groups appearing to be particularly underserved, echoing longstanding disparities seen in maternal pertussis vaccination coverage. This puts babies' health at risk from the very beginning of life.
These gaps persist as children grow into adolescence, with variation across regions and demographics observed in meningococcal and human papillomavirus vaccination. These are not isolated issues. They are symptomatic of a system that has not fully adapted to meet the needs of all its communities.
So what now? To achieve the high, equitable vaccination coverage rates needed to protect children from vaccine-preventable disease, programmes must meet the needs of all communities.
The NHS Vaccination Strategy published in 2023 rightly proposed more joined-up and accessible provision, better tailored to population need. As the Government delivers a new 10-Year Health Plan and explores wider NHS structural reform, it has a timely opportunity to turn that ambition into action.
First, the NHS must expand vaccination capacity across the system. Community pharmacy has underpinned Covid-19 and flu vaccination in recent years, and in parts of London, supported pneumococcal vaccination for older adults too. The pharmacy sector has shown appetite to take on a greater role in the delivery of routine adult vaccination – harnessing its trusted position in the heart of local communities to make vaccination more accessible and understandable, while freeing up GP time to focus on routine childhood appointments.
But expanding capacity is only one piece of the puzzle. Vaccination services must be redesigned in partnership with local authorities, voluntary organisations and community leaders to reach those who are persistently underserved.
That means understanding the local barriers to vaccination – from mistrust around vaccination to inconvenient appointment times and locations – and tackling them head-on with tailored, data-driven interventions.
Second, we must address vaccination hesitancy and misinformation with fresh urgency and nuance, recognising that not all communities with low coverage are hesitant.
For many, the challenge is one of information, communication and confidence. For example, in socially disadvantaged groups including ethnic minority populations and migrants, historic distrust in healthcare systems and lower health literacy have been identified as barriers to vaccination.
We should learn from the Covid-19 pandemic, where community champions helped deliver trusted, culturally appropriate messages and built confidence in the vaccination offer. That model should be revived and embedded for routine childhood immunisations.
Third, we must stay responsive to new evidence and be ready to act on innovation. When the Joint Committee on Vaccination and Immunisation (JCVI) recommends the introduction of new vaccination programmes, implementation must be timely, equitable, and adequately resourced. If the government is serious about a prevention-first NHS, recovering childhood vaccination must be a top priority. This is not just about preventing disease today. It is about building the health, resilience and opportunity of tomorrow.
As MSD's UK Public Health Lead, I hear from local system leaders, clinicians and community partners about the growing urgency to act and the frustration of knowing what works but not yet seeing it consistently delivered. For every child who misses out on vaccination, the cost is more than clinical – it is generational. Reversing the decline in childhood vaccination is not just a public health imperative, but a test of our commitment to a fairer, prevention-first NHS. With reform on the horizon, now is the moment to act: to understand the factors driving variation, to evolve service provision accordingly, and ensure every child gets the protection they deserve.
Footnotes
Job bag: GB-NON-11624
Date of preparation: July 2025
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