Resetting the relationship between local and national government. Read our Local Government White Paper

Cheshire West and Chester: Improving MMR vaccination rates in communities with lower uptake

Cheshire West and Chester Council has been working with the NHS and other partners to increase uptake of the MMR (measles, mumps and rubella) vaccine, particularly in the most vulnerable communities.

View allPublic health articles

Introduction

Vaccination rates for MMR (measles, mumps and rubella) show a steady decline across England. The World Health Organization has a target of 95 per cent, the figure required to eliminate measles. Cheshire West and Chester Borough Council has been working with the NHS and other partners to increase uptake of the MMR vaccine, particularly in the most vulnerable communities. 

The challenge

Cheshire West and Chester is a large, predominantly rural borough with a population approaching 400,000. In common with many areas of England, Cheshire West and Chester has seen a fall in childhood immunisation rates, including the MMR vaccination. In the year 2022/23, MMR immunisation rates were: 

  • one dose by two years: 93.8 per cent 
  • one dose by five years: 94.6 per cent 
  • two doses by five years: 89.9 per cent.  

In the light of rising cases of measles across England, Cheshire West and Chester Borough Council’s public health team set out to better understand how MMR uptake varied across the borough and within different community groups. 

This knowledge would be used to inform a conversation with partners from the voluntary sector, community representatives and service providers to consider how these community groups could be better protected against measles and other infections. 

In preparation for engagement of local stakeholders, the public health team examined several data sources to gain an accurate picture of MMR uptake. Data was also sought from primary care and the local NHS provider of early years services. 

Data providers were asked to help identify the actual number of children and young people who needed one or two doses of the MMR vaccine. This would enable every partner to understand the scale of the challenge to reach the 95 per cent target and would provide a realistic picture of the resources required to do this. 

Without taking into account missed vaccinations from previous years, the extra MMR vaccinations that would have been required to reach 95 per cent coverage in 2022/23 were: 

  • one dose at two years – 42 people 
  • one dose at five years – 17 people 
  • two doses at five years – 203 people. 

The data analysis exercise identified that vaccination rates were lower in communities with higher levels of deprivation and in ethnic minority communities.

Community-focused workshops

Two workshops were held in order to better understand vaccine inequalities across the borough and identify proactive solutions to improve uptake. The first workshop gathered insights from community and voluntary sector stakeholders who work with families, parents, children and typically under-vaccinated groups in the borough. 

This included an educational component focusing on measles, MMR, the importance of vaccination and signposting to resources. The public health team then facilitated discussions to gain insights into the knowledge and perceptions of vaccination in the represented communities. They asked about barriers to vaccination and discussed specific local solutions that could help to address access issues and vaccine hesitancy.   

The knowledge and experience gathered at this first workshop fed into a second workshop with local service providers and system partners responsible for vaccine delivery. This format aimed to expose hyper-local issues and move towards solutions that were community and locality specific. It also aimed to encourage networking and build connections between different parts of the local system. 

The solutions identified through the two workshops fell broadly into four categories: 

  • communication and collaboration between organisations 
  • better use of data
  • overcoming access and practicality issues
  • proactive engagement with communities and families. 

A series of recommendations were identified under each theme. These are being used to develop an immunisation framework, initially focused on MMR, which will help to drive improvements in uptake and reduce inequalities. 

Next steps

Cheshire West and Chester Borough Council is continuing to work with the NHS and other partners to ensure fair access to all immunisation programmes. The public health team is establishing an ‘Increasing Immunisations Taskforce’ which will bring local partners together on a quarterly basis to share ideas, collaborate and take this work forward. They are also looking at how to build stronger relationships with community stakeholders and grow community networks. 

The team have visited children’s centres in low-uptake areas to gain further insights from parents and carers and to provide information and signposting. The NHS provider of early years services continues with its outreach programme, which includes Saturday and evening sessions in communities that have lower uptake levels. Communication was identified by some GP surgeries as a key factor, so vaccination promotion material in languages other than English has been shared with stakeholders. 

Plans are in place to meet with service providers and primary care representatives to review the impact of the campaign. This will include focussed discussion with the GP surgeries that have the lowest uptake to identify whether they need further support. The evaluation will look to identify whether particular community groups still have lower levels of vaccination and, if so, what the barriers are for them. 

Contact

Dr Kate Appleton, Specialty Registrar in Public Health: [email protected]