County Durham launched a three year flu vaccination pilot in 2022 to address declining uptake among two to three-year-olds and widening inequalities across the county. Building on learning from the COVID 19 vaccination programme, the pilot introduced nursery based and community based vaccination clinics to complement traditional GP delivery. The aim was to improve accessibility, reduce barriers and gather insights from parents and carers.
The challenge
Influenza remains a significant public health concern, especially for vulnerable groups such as young children as evidence shows that children under five experience high rates of infection, complications, and hospital admissions. Influenza in children leads to increased GP visits, secondary infections, and substantial healthcare costs, while also positioning children as key transmitters of the virus to older and high risk groups, amplifying its impact across the wider community.
Uptake of the flu vaccination for this group in County Durham ranged from 39 to 44 per cent between 2014 – 2019. During the COVID-19 pandemic the uptake rates peaked at 65 per cent and therefore the challenge was to maintain vaccination levels above pre-pandemic rates.
County Durham faced several challenges in improving flu vaccination uptake among two to three-year-olds. There were inequitable uptake levels across GP practice areas, with some communities consistently falling behind others. Vaccination rates in two to three-year-olds year olds were also lower than those seen in primary school aged children and adults over 65, highlighting a specific gap in early years protection. Families additionally experienced accessibility barriers, particularly those who struggled to attend GP appointments due to work, transport, or childcare constraints.
These issues highlighted that the GP model also needed support from a more flexible, community centred delivery model.
Delivery
The pilot was delivered over three seasons (2022/23–2024/25) through a partnership between Durham County Council, the ICB, Durham Dales Health Federation, IntraHealth the School Aged Immunisation Service, nurseries, Family Hubs, and GP practices.
The programme was delivered through a targeted and flexible model that evolved over the three years. Each year, GP practices with the lowest uptake were identified using practice level data, ensuring resources were focused where they were most needed. Vaccination teams delivered clinics directly in nursery settings in low uptake geographical areas, making use of trusted relationships between parents and early years staff, while community clinics—initially pop up buses in 2022/23 and later Family Hubs in 2023/24 and 2024/25—provided additional accessible venues. The model was refined annually based on evaluation findings, parent feedback, and operational learning, allowing the programme to become increasingly efficient and responsive. In 2024/25, Intrahealth integrated delivery within school linked nurseries alongside their school immunisation programme, reducing duplication and improving coordination.
The nursery settings were fundamental to the success of the clinics. They were extremely supportive on the build up and on the day, they raised awareness about the importance of the flu vaccination and shared all of the information about the vaccination clinics.
Throughout the pilot, targeted communications campaigns such as “Protectasaurus” and “Be Wise, Immunise” were shared through nurseries, GP practices, and Family Hubs, helping to raise awareness and encourage uptake across the county.
Across the three years, the pilot programme supported the delivery of 1,035 vaccinations.
Outcome
The pilot programme delivered strong, measurable improvements in uptake, accessibility, and equity.
The 2024/25 programme vaccinated children from 56 of 61 GP practices, demonstrating broad reach beyond the original target areas. For some practices, up to 36 per cent of all vaccinations were delivered through the pilot. While England and the North East returned to pre 2018 coverage levels, County Durham maintained higher performance, demonstrating the effectiveness of the flexible delivery model.
Parents’ and carers’ perceptions of the flu vaccination programme for two to three-year-olds, found that although flu is generally viewed as a mild illness with low perceived risk, there is strong intention to vaccinate, driven largely by a desire to protect others rather than just the child. However, a clear gap exists between intention and actual uptake, influenced by practical and psychological barriers. The nursery-based vaccination model was widely accepted and valued for its convenience, accessibility, and child-friendly environment, helping to reduce barriers such as time constraints. Three key factors affecting uptake were identified: accessibility, environment, and hesitancy, with the latter increasing following the COVID-19 pandemic due to greater scrutiny of vaccine information and trust. Overall, while motivation to vaccinate is high, improving ease of access, delivery settings, and communication is essential to ensure uptake translates into action and to reduce the risk of under-vaccinated populations.
The following quote was from a parent and this shows the importance of flexible delivery models.
Last year my child ended up not getting the vaccine, not because I didn’t want them to, but because I couldn't get the time away from work and it was one of them things. I did mean to get around to doing it, but I didn’t. So yes one of my children didn't actually end up getting the flu vaccine because I just couldn't get the time off work to take them which I felt bad about.”
The programmes outcomes indicated that nursery based and community clinics reached families who would otherwise miss out on the vaccination. Insights from the parents and carers are being used to improve the vaccination programme for children aged 0-5 years.