With 145 measles cases reported in England since early July and childhood vaccination uptake at a decade low, the challenge for ICB leaders is immediate and urgent. This resurgence of a preventable disease creates a public health risk that must be addressed before the long-term vision of the NHS 10-Year Plan - shifting from treatment to prevention - can be realised. For ICBs, tackling this decline is not only essential for protecting vulnerable populations but also for meeting performance targets and reducing the significant burden that outbreaks place on NHS resources.
The World Health Organisation (WHO) recommends a 95% uptake rate for routine immunisations like MMR to maintain herd immunity. England's rates have fallen below this threshold, with a worrying decline across all vaccination programmes. This has created the resurgence in diseases like measles, with the highest increase in suspected outbreaks in the most deprived communities. The preventative model also extends beyond childhood immunisation. Robust call and recall programmes for adult vaccinations against conditions like shingles or seasonal influenza can significantly reduce hospitalisations.
While the COVID-19 pandemic brought vaccination to the forefront, it also contributed to a complex public health landscape. A recent poll of healthcare professionals identified vaccine hesitancy as the single greatest challenge in meeting vaccination targets, cited by 57% of respondents. However, it is a misconception that this is driven solely by a committed anti-vaccination stance. The reality is that many people sit in the middle, finding it difficult to make a decision. They have concerns, don’t feel they have reliable information and default to inaction.
These individuals and families are not necessarily against vaccination; instead, they are often caught in a state of indecision, worried about making the wrong choice for their child. GP practices are tasked with improving uptake but are often under-resourced, with the administrative capacity to do little more than send a standard text message. They lack the time for the detailed, sensitive conversations needed to address the concerns of hesitant parents, conversations that can take between 10 and 40 minutes per family.
To effectively address hesitancy, there needs to be a shift in approach from simple, informational messaging to empathetic, person-centred conversation. The goal is not to pressure individuals, but to create a supportive environment where they can explore their thoughts and make a positive, informed choice. This can often require an understanding of thespecific cultural beliefs and behaviours at play. For example, when speakingwith some South Asian communities, discussing the link between mumps andpotential fertility issues can resonate more strongly than focusing on the broaderbenefits of vaccinations, highlighting the importance of a tailored approach.
This is where specialist training can make a tangible difference. Equipping staff with the skills to have better conversations can generate a measurable impact. Using a specific training programme called Chat, delivered by ICE Creates Ltd, participants report a 4–5-point increase in their confidence to discuss vaccination on a 10-point scale. By upskilling trusted voices across the system, from clinical staff to community champions, it is possible to build confidence and drive positive choices.
An innovative programme commissioned by a pioneering ICB in the Midlands provides a practical model for how these principles can be successfully applied. Serving a diverse and deprived population of 1.26 million people, this ICB partnered with CHASE to design and deliver an enhanced patient identification and recall service focused on childhood immunisations.
The service is delivered by a dedicated team of remote Primary Care Immunisation Facilitators (PCIFs). A key benefit for practices is that this skilled resource is funded by the ICB and the team works entirely remotely, taking up no physical space or administrative time within the practice itself. Through secure honorary contracts and smart card access, the PCIFs can log into the practice's clinical system (EMIS or SystmOne) to run searches that identify children who are overdue for vaccinations.
Once identified, the PCIFs begin the engagement process. The goal of the initial phone call is not always to book an appointment immediately. Instead, it is to open a supportive dialogue and move the parent or guardian along a decision-making pathway. This may involve arranging for them to speak with a practice nurse or GP for more detailed clinical advice. It is this sensitive, step-by-step personal engagement that makes the difference in building trust and increasing uptake rates. A 10-15% uplift in vaccination rates, as seen in this programme so far, can be enough to help a practice meet its crucial Quality and Outcomes Framework (QOF) targets and maximise Item of Service (IOS) payments.
The framework established by this immunisationprogramme offers a cost-effective model that can be applied to other areas ofpreventative healthcare. A key factor in its success is the use of highlytrained Band 4 staff, who specialise solely in patient recall, making it anefficient use of resources.
This system-wide, collaborative approach can beeffectively deployed for a range of other screening and recall initiativeswhere proactive patient contact is beneficial. The model is directly applicableto many of the NHS's key priorities, including:
Maintaining the status quo on vaccination is not a neutral position; it carries significant and predictable risks for both public health and the NHS. With childhood vaccination rates at their lowest in over a decade, and with as many as one in six children not fully protected against MMR, the potential for large-scale outbreaks of preventable diseases is a serious concern. Studies have shown this decline is not uniform, with inequalities in vaccine uptake widening, particularly in more deprived areas. A failure to reverse this trend will inevitably lead to a resurgence of illnesses like measles, mumps, and rubella, which can cause severe complications, including pneumonia, meningitis, blindness, and death. For the NHS, this would mean a significant increase in hospital admissions and a greater strain on already stretched paediatric and emergency services, directly undermining the preventative goals of the 10-Year Plan and incurring substantial costs associated with managing outbreaks.
This strategic challenge is also highly relevant to the pharmaceutical, biotech and medical technology industries. Pharmaceutical and biotech companies invest heavily in the research, development, and manufacturing of innovative vaccines. However, the value of these medical advances is only realised when they reach the patient. Falling uptake rates represent a critical failure in the "last mile" of the healthcare journey. The med tech sector provides essential infrastructure for this journey, from developing the devices used for vaccine administration to the digital health and cold chain management systems that ensure doses are delivered safely and efficiently. Programmes like the one detailed in the case study are therefore crucial for industry partners, as they create an effective and scalable pathway to ensure that the population can access and benefit from the preventative health technologies they have developed. Collaborative NHS-Industry Partnerships focused on improving these recall systems can ensure that the investment in vaccine innovation translates directly into improved public health outcomes.
By adopting innovative and person-centric models as described above, ICBs and GP Federations can have a real impact on reducing the risk to population health inherent in declining vaccination rates. The approach provides a scalable solution to not only reverse this decline but also to build a more proactive and sustainable healthcare service for the future.
For more details on the ICB childhood immunisation programme, watch our webinar or read the full case study.
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