Knowsley Council: Flu Superheroes - tackling low vaccination uptake in early years

Rates of flu vaccination uptake in Knowsley are the lowest in Cheshire and Merseyside across all eligible groups, and among the lowest in the country for 2-year-olds. A Flu Superhero campaign was developed by Knowsley Council with the aim of increasing the uptake of flu nasal spray vaccination amongst 2-year-olds. A range of resources were created based on insight from relevant partners, which were then distributed across the borough to primary care settings, Health Visitors, Early Years settings and community settings including libraries and leisure centres. The resources were accompanied by conversations with partners which shared best practice in supporting and encouraging local families to have their child vaccinated against flu. The campaign was well-received by professionals and local families, and data suggest that rates of vaccination by 2-year-old children increased by a fifth compared with the previous flu season.

Flu vaccination is the most effective public health measure for preventing seasonal flu. In the borough of Knowsley, in the Liverpool City Region, uptake of flu vaccination across all eligible cohorts is the lowest within the nine local authorities of the Cheshire and Merseyside ICB, and uptake by 2-year-olds in Knowsley is amongst the lowest in the country. Flu infections can result in severe illness – particularly in vulnerable people – and hospital admissions, placing a significant burden on health care services during the winter period. 

For the 2025/26 flu season, a targeted approach was taken with a focus on 2-year-olds in order to improve coverage and address inequalities in vaccination uptake. The decision was made to focus on the 2-year-old cohort following declines in uptake of flu vaccination by this group in recent years, and with the aim of building confidence for families not just in relation to flu vaccination but also in terms of the routine childhood immunisation programme.

The objectives of the Flu Superhero campaign were as follows:

• to increase uptake of the flu vaccination amongst 2-year-olds
• to raise awareness of flu vaccination among parents, carers, and professionals
• to embed vaccination conversations within existing child and family contacts (e.g. Health Visitor reviews)
• to promote a consistent, borough-wide approach to vaccination messaging.

Sharing best practice across primary care

Prior to the 2025/26 flu season, the public health team reviewed flu vaccination uptake data for each GP practice from the previous three flu seasons to identify practices which showed improving, or consistently higher than average, uptake of the flu vaccine amongst 2-year-olds. Four settings were highlighted as ‘local best practice’. The Practice Managers (or flu vaccination programme co-ordinators) of each of these four GP practices took part in an individual discussion with a member of the public health team about their approach to enabling vaccination uptake. One of the lowest performing practices in the borough was also asked to take part in a discussion about the challenges experienced. 

From the insight gathered, a list of recommendations for primary care was collated. These included: regular calls to parents/carers (until vaccination was booked or declined) using specific wording (such as ‘Dr Smith has asked us to call you’); additional appointments to answer any questions prior to the vaccination appointment; evening and weekend clinics; decorations for the setting and stickers; a nominated flu vaccination programme co-ordinator; sending self-book links via text message; and social media messaging. These recommendations were shared with the practice managers of every GP practice, PCN managers, and the NHS Knowsley Place vaccination lead.

Flu Superhero campaign

Flu Superhero is a local campaign to promote vaccination in 2-year old children which was developed by the Knowsley Council public health and communications teams in 2023 after gathering insight from local parents. The campaign was strengthened for the 2025/26 flu season with the creation of a wider variety of resource options, refreshing the colour scheme, and emphasising that the vaccination consists of a nasal spray which is quick and painless. 

Every GP practice except one opted to receive Flu Superhero resources to promote the flu vaccination offer to parents and carers. These included A5 flyers, pull up banners, stickers, bunting and balloons, and were provided to GP practices prior to the commencement of childhood flu vaccination delivery on 1 September 2025 (see Appendix 1 for the display in one GP surgery). Community pharmacies which had opted to deliver nasal flu vaccination to 2- and 3-year-olds were also provided with Flu Superhero materials to display in their setting.

Health Visitor engagement

Flu Superhero resources were distributed to Health Visitors to support conversations with parents and carers about flu vaccination, particularly during the two-year child developmental reviews. Health Visiting teams were provided with a supply of ‘flu bears’ — small teddy bears wearing t-shirts featuring the Flu Superhero design — alongside Flu Superhero information flyers (Appendix 2). These materials were intended to engage children and to support communication with families in an accessible and appealing way. The superhero flyers included frequently asked questions addressing common concerns, such as potential side effects, the safety of the nasal flu vaccine, and the importance of vaccination for children. 

Flu Superhero information flyers and pull up banners were also displayed in a number of community venues including libraries, early years settings, leisure centres and Private, Voluntary and independent (PVI) nurseries.

The latest published data from February 2026 showed an uptake of flu vaccination among 2-year-olds in Knowsley of 24.3 per cent for the 2025/26 flu season. While this remains significantly below the national average of 43.5 per cent, it represents an increase of 4.1 percentage points from 20.2 per cent in 2024/25. It is likely that the Flu Superhero campaign underpinned this improvement, particularly as the same increase in uptake was not seen across the other age cohorts for flu vaccination in Knowsley. This progress reflects a strengthened collaborative approach with partner services. Feedback from Health Visiting colleagues indicated that the resources provided were a valuable tool, enabling staff to initiate conversations about vaccination with families more easily and with greater confidence.

Early preparation proved to be critical for delivering an effective seasonal vaccination campaign. Timing of both resource development and stakeholder engagement was key to ensuring readiness ahead of the flu season. The importance of localised communications was evident, particularly when supported by trusted professionals and services. Embedding vaccination messages within existing contacts and relationships with families was shown to enhance engagement.   

Early feedback from Health Visiting colleagues suggests that some parents and carers are unaware that flu vaccination is required annually, which may be contributing to lower uptake.

• The Flu Superhero campaign will be expanded to 3-year-olds, and behavioural insight will be used to explore why flu vaccination uptake amongst this cohort has declined in recent years
• Partnership working will continue to be developed, and resources will be provided to relevant colleagues again for the 2026/27 flu season, in order to sustain a consistent and effective approach.
• A complementary pregnancy campaign will also be developed in order to encourage conversations around vaccinations during antenatal care, raising awareness of the importance of flu vaccination for pregnant women.

For further details please contact [email protected]

Example of a Flu Superhero display at a GP practice 

Health Visiting teams were provided with a supply of ‘flu bears’ alongside Flu Superhero information flyers: