Cumbria: How we pulled together to deliver flu and COVID-19 vaccines in schools

Cumbria organised the flu and COVID-19 jabs as two separate schemes resulting in nurses on the school immunisation service focussing on the nasal flu delivery, while the clinical leads working to deliver the COVID-19 vaccination campaign. 


The demands placed on school immunisation services in the autumn of 2021 have been huge. Not only have they been asked to vaccinate four extra school years against flu, but the COVID-19 vaccination programme for children aged 12 to 15 was introduced shortly after the start of term. 

In Cumbria the 15 nurses on the school immunisation service focussed on the nasal flu delivery, while the clinical leads in the team worked closely with the public health nurses, local GPs and community pharmacists to deliver the COVID-19 vaccination campaign. 

Why we split flu and COVID-19 jabs

Cumbria is a large rural county with more than 316 schools. There is an NHS immunisation service as well as a public health nursing service, which is commissioned by the council.

The public health nursing service is different from the traditional school nursing service in that it does not provide one-to-one support to pupils, apart from through an e-school nurse service. The seven public health nurses support on things such as health reviews and initiatives such as obesity work.

It also includes a team of six school screeners who are in charge of vision screening and weighing and measuring under the National Child Measurement Programme. Both are run by North Cumbria Integrated Care NHS Trust. 

When it was announced that there would both an extended flu campaign and a COVID-19 vaccination programme, Cumbria decided it was important to run the two schemes separately. But doing that would require a joint effort by both services as well as the wider health system. 

North Cumbria Integrated Care NHS Trust 0-19 Clinical Service Manager Louise Willis said: “We have really good uptake of flu vaccines in previous years – last year it was around three-quarters of children who got the nasal flu vaccination.

We wanted to protect that, but there was a concern that if we offered them both together it could damage uptake of the flu vaccination given the unknown public feeling that exists over the COVID-19 vaccine in children.

“So we felt it was important to run them separately. That, of course, was a huge logistical challenge. The autumn term is always the busiest in terms of vaccination for children and we always have to bring in extra bank staff to help the immunisation team with the flu campaign. 

“We did that again this time, but there was no way we could do the COVID-19 programme on top of that.”  

‘It was a real team effort’

Instead, GPs and pharmacists were brought in to deliver the COVID-19 jabs and were supported by the public health nursing service. Public health nurses and school screeners attended each school clinic to help organise the sessions and manage queues and monitor children afterwards.  Schools also helped out, taking charge of sending out the consent forms and collecting them in ahead of the day of vaccination.

Ms Willis said: “Pharmacists and GPs are not used to going into schools, but the public health nursing service knows them well. They helped to facilitate the clinics, calming children ahead of the vaccination. It worked really well.

“In fact, because the pharmacists and GPs work under a different contract they had a bit more flexibility in that they could have someone preparing the vaccines, someone doing the questions and another giving the vaccine.  

“They ended up getting through it very quickly – doing whole schools in a day. But it did mean the public health nursing service has had to drop other things. We completed the mainstream schools it in an eight-week window so the redeployment of the public health team has only been for a limited period of time. It was a real team effort.” 

The team is now reviewing uptake levels. The high infection rates seen in schools means there will have been a number of children who were not eligible for the COVID-19 vaccine when the teams came in. 

One option would be to go back into low uptake schools a second time or run pop-up clinics in community venues. “Parents also have the option of booking their children into a community venue via the national booking system. We will have to look at what demand there is and where the gaps in uptake are and see what is the best option for our children” added Ms Willis. 

Approach has paid off

The decision to separate the two vaccination programme appears to have paid off with more than 40 per cent of eligible children coming forward for the COVID-19 jab, which is higher than the regional average.

Meanwhile, the flu programme is on track to see above 70 per cent uptake with slightly higher figures being registered in primaries than secondaries.

To help ensure good uptake of the flu jab, the team ran a social media campaign, promoting catch-up clinics which have been run at weekends. The aim is to get the flu programme finished by Christmas.

Contact details

Louise Willis
Clinical Services Manager Universal 0-19
North Cumbria Integrated Care NHS Foundation Trust

louise.willis@ncic.nhs.uk