Strengthening local immunisation services

Immunisation is the clearest example we have of public health saving lives at scale. It is also where the gap between what we know works and what we consistently deliver has widened most visibly in the last decade.

England has not met the World Health Organization’s 95 per cent uptake target for any routine childhood vaccination since 2020–21. In 2026, the UK lost its measles elimination status. Since measles began to resurge following the COVID-19 pandemic, four children have died from a disease that is entirely preventable.

The system for commissioning and delivering immunisation services is undergoing significant and ongoing change, including the integration of NHS England into the Department of Health and Social Care and the planned delegation of Section 7A commissioning responsibilities to Integrated Care Boards from April 2027.

In this context of continued transition, effective governance and oversight are essential. A range of local authority levers play a key role in providing this, including the leadership of elected members, the strategic role of Health and Wellbeing Boards, and the system oversight provided by Directors of Public Health and local authority officers. Health Overview and Scrutiny Committees also provide an important mechanism for democratic accountability, with powers to challenge NHS partners and hold them to account for the accessibility, quality and effectiveness of local vaccination services.

This guide is designed to support all of these roles. The questions are practical rather than theoretical. They are intended to help councillors, officers and system partners test whether children in their area are being protected, whether older residents are being reached, whether the system has a firm grip on the data, and whether those most likely to miss out are being identified and supported.
They also point to something wider: the council’s role is not only to scrutinise, but to lead. That leadership, across communities, services and partners, is essential to improving immunisation coverage and reducing inequalities, and is too often overlooked in discussions of how the system works.

Cllr Wendy Taylor MBE
Chair, LGA Health and Wellbeing Committee

After clean water, immunisation remains the most cost-effective public health intervention available. The UK programme has driven near-elimination of diseases that defined childhood in the nineteenth and twentieth centuries; diphtheria, tetanus, polio, measles, mumps, rubella, Haemophilus influenzae type b, and meningococcal C. 

The Joint Committee on Vaccination and Immunisation (JCVI) advises ministers on the national immunisation schedule, which has expanded substantially over the past twenty years. For pre-school children, rotavirus (2013), MenB (2015), and MMRV (January 2026) have been added; for school-age children, HPV (2008, extended to boys 2019; simplified to a single dose 2023) and MenACWY (2015); for pregnant women, maternal pertussis (2012) and RSV (2024); and for older adults, shingles (2013) and RSV (2024). 

Targeted programmes have also been introduced for at-risk groups, including mpox vaccination for gay and bisexual men at highest risk (2022) and the world-first gonorrhoea vaccine programme through sexual health clinics (2025). Flu vaccination has been extended progressively to primary school children (2013/14) and secondary school children (2021/22). The schedule has also been optimised through the move to a hexavalent (6-in-1) vaccine (2017), pneumococcal dose reductions (2020), and seasonal COVID vaccination for clinical risk groups (2021).

Nonetheless, vaccination programmes are most effective when uptake is high and, unfortunately, for many programmes, uptake has declined.

The picture varies by group. For pre-school children, coverage has fallen gradually and consistently since 2012/13. For school-age children, there was a sharp decline during the pandemic with only partial recovery since. The maternity picture is mixed: pertussis uptake has improved significantly in recent years, RSV is a new programme so trends are not yet established, and flu uptake remains broadly steady. For older adults, coverage is generally high and stable.

The COVER programme (Cover Of Vaccination Evaluated Rapidly), published quarterly by UKHSA, illustrates the scale of the challenge in childhood vaccination. As of October to December 2025, uptake of the 6-in-1 at 12 months sat at around 92.5 per cent, MMR1 at age 5 at around 92.3 per cent, MMR2 at age 5 at 84.4 per cent, and the pre-school 4-in-1 booster at 82.4 per cent, all below the 95 per cent coverage threshold recommended by the World Health Organization (WHO) to prevent outbreaks, and all below the peaks recorded in the previous decade.

The 2024 measles outbreak, with approximately 2,900 cases, was the largest in England in over two decades. London is consistently the lowest-performing region, with some council areas falling below 75 per cent for MMR2 uptake. The most current figures are published quarterly by UKHSA at gov.uk/cover-programme.

These declines are not evenly distributed. The fall in childhood vaccination coverage over the past decade has been driven predominantly by declining uptake in the most deprived communities, while uptake in the least deprived areas has remained comparatively stable. As a result, inequalities in coverage have widened, and the consequences fall hardest on communities already facing significant health disadvantage. Analysis of the 2023/24 measles outbreak in Birmingham, for example, found that 78 per cent of cases occurred in the city's 20 per cent most deprived areas, with infection rates in the Black African ethnic group more than eight times higher than in the White British group.

Deprivation is not the only dimension of inequity. The UKHSA National Immunisation Programme Health Equity Audit 2025 identifies a consistent pattern across programmes: lower uptake among several ethnic minority groups (a pattern largely unchanged since the previous audit in 2019), regional inequalities with London performing consistently below the rest of England, and gaps for inclusion health and at-risk groups where data remains insufficient to fully describe the scale of need. The barriers driving these gaps, limited-service access, logistical and practical obstacles, cultural and linguistic factors, and low confidence in vaccines, are well evidenced and persistent.

The challenge is no longer what to offer, but how effectively the offer reaches those who need it most.

Vaccination is voluntary, and improving uptake depends on ensuring that every eligible person has access to trustworthy information, that their questions are answered with respect, and that practical barriers to accessing services are removed.

Local government has a vital role in supporting and scrutinising vaccination delivery, working across boundaries with the NHS and wider system, understanding local data, and driving action where coverage is lowest. This guide is designed to support councils in doing that effectively.

The guide is accompanied by a collection of case studies submitted by councils across England, illustrating how local authorities are already taking action to improve coverage, address inequalities and reach underserved communities. We are grateful to all the councils who contributed.

The council does not commission the routine NHS immunisation programme. That is currently the function of NHS England, with Section 7A funding flowing from the Secretary of State, and is  expected to transfer to integrated care boards from April 2027, subject to legislation (having been delayed from April 2026). So the case for the council’s role in immunisation does not rest on contracting authority. It rests on something more durable: statutory responsibilities, population reach and democratic accountability. 

The statutory anchors

Three statutory functions place the council at the centre of local immunisation, even where the NHS holds the contracts.

• The Director of Public Health (DPH) has a statutory health protection assurance function. Section 73A of the National Health Service Act 2006 (as amended) places independent professional duties on the DPH, including assuring the local authority that arrangements for protecting the health of the population are robust and effective. Immunisation sits squarely inside that duty.
• The Health and Wellbeing Board is a statutory committee of the council under the Health and Social Care Act 2012. It produces the Joint Strategic Needs Assessment and the Joint Health and Wellbeing Strategy, both of which should treat immunisation coverage as a core population outcome rather than a system-internal performance metric.
• The Health Overview and Scrutiny Committee (HOSC) operates under the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. It has the right to require information, require attendance, be consulted on substantial variations, and make formal reports and recommendations to NHS bodies that must respond. These powers apply to immunisation services as much as to acute reconfiguration.

In addition, many areas have a Health Protection Board, which, while not statutory, provides a standing partnership forum. It brings together the DPH, NHS partners and UKHSA to oversee surveillance, outbreak response and immunisation delivery, and to assure the council on system performance. It is also a natural point of alignment ahead of formal scrutiny or strategic discussion.

Place assets held by local government 

Even without commissioning authority, councils play a central role in whether immunisation programmes reach local populations. This influence is practical and operational: it is the council’s reach into communities and services that determines whether a national programme actually reaches local people.

• Schools and academies: School-aged immunisation services currently deliver HPV, MenACWY, the teenage 3-in-1 booster, catch up vaccinations such as MMR/MMRV and the children’s flu programme through schools. Councils hold key relationships with education settings, particularly outside mainstream provision, including special schools, pupil referral units, alternative provision and children who are home-educated. These relationships are critical to ensuring no groups are missed.
• Early years and family services: Family hubs, health visiting and Healthy Child Programme services sit at the front end of the childhood schedule. Councils commission or oversee these services and can embed immunisation conversations into routine contacts. The updated Family Hub service delivery expectations published in 2026 now include a clear role in supporting vaccination, including embedding discussions at key touchpoints such as antenatal contacts, mandated health visitor reviews and wider family support interactions, providing accessible and trusted information, and supporting families to navigate local vaccination services. This includes signposting, supporting access for those who may have missed vaccinations, and taking a ‘making every contact count’ approach. Councils can also support approaches such as the 2026 pilot enabling health visitors to offer vaccinations directly to families facing barriers to access. 
• Adult social care: Adult social care provides a direct route to flu, COVID, RSV, shingles and pneumococcal vaccination for older adults and care home residents, and to flu vaccination for the social care workforce. As commissioners of care, councils have an important role in driving uptake and addressing consistently low coverage among care home staff.
• Wider council services: Environmental health, housing, registrars, community development and library services collectively reach many of the populations the NHS finds hardest to engage. These services bring regular contact with residents who may be missing routine healthcare and can play a meaningful role both in providing information and raising awareness of vaccination and in helping people navigate and access NHS vaccination services. They should be seen as part of the local immunisation infrastructure.
• Communications and community engagement: Councils and their elected members are well placed to support local vaccination communication. Councillors have trusted relationships in their communities and can help reinforce vaccination messages in ways that national campaigns cannot, reaching residents who may be harder to engage through NHS or central government channels alone. Building public confidence requires understanding local barriers. UKHSA's parental attitudes towards childhood vaccinations and women's attitudes towards maternal vaccination surveys provide useful insight into the barriers and motivations that councils and partners can draw on when designing engagement approaches.

The democratic argument

Vaccination depends on public trust, and trust is not built by national mandates alone; it is built through relationships with people and institutions that residents can see, question and hold to account. 

While Integrated Care Boards were established with a statutory requirement for local authority representation, the Health Bill currently before Parliament proposes to remove that requirement. This is a backwards step. Councils are at the forefront of neighbourhood and place-based delivery, and removing mandatory local authority representation risks weakening the links between NHS commissioning and local priorities, including adult social care, public health and the wider determinants of health, while reducing formal local democratic input into NHS decision-making. 

Replacing local authority representation with strategic mayoral authority representation is not a direct substitute - strategic authorities typically operate across populations of 1.5 million or more, while Health and Wellbeing Boards, rooted in local authorities, generally serve populations of around 250,000-500,000 and are closely connected to neighbourhood footprints, providing place-based intelligence and democratic accountability that cannot be replicated solely through representation at strategic authority level. The LGA is urging MPs and Peers to press for the reinstatement of mandatory local authority representation on ICBs during the passage of the Bill, and is engaging with parliamentarians at every stage of scrutiny to make that case.

This matters particularly for immunisation, where local trust and local knowledge are decisive factors in reaching communities with the lowest uptake. Through elected members, Health and Wellbeing Boards and scrutiny functions, councils provide the democratic oversight needed to connect national programmes with local communities.

A note on boundaries: this guide is not a case for councils taking on clinical responsibilities that sit with the NHS, nor for local government becoming the default solution when NHS commissioning, call-and-recall systems or workforce arrangements fall short. Clinical delivery, patient consent, vaccination records and programme accountability must remain clearly with the NHS. The council's role is one of oversight, leadership and reach, bringing democratic accountability, place-based knowledge and community relationships to bear on a system that cannot succeed without them. Where councils take on additional activity to support immunisation, for example through outreach, communications or embedding vaccination conversations in council-run services, this should be properly resourced and agreed with NHS partners, not assumed as a cost-free addition to existing workloads.

This guide is organised around 10 questions, covering the system end-to-end from national policy through to frontline delivery. The questions are designed to be used flexibly.

• Health Overview and Scrutiny Committees (HOSCs) can use them to structure full reviews, focused inquiries or individual evidence sessions with NHS commissioners, the Director of Public Health (DPH) or service providers.
• Health and Wellbeing Boards (HWBs) can use them to test whether immunisation is being addressed effectively through the JSNA and Joint Health and Wellbeing Strategy.
• Officers can use them to assess system performance, identify gaps and strengthen coordination across partners.
• Elected members can use them to inform local leadership, community engagement and advocacy.

Each question focuses on a specific line of accountability, from national policy through to frontline delivery, and is intended to draw out evidence of impact, coverage trends and inequities in uptake, not just assurances that services are running. This distinction matters: assurances describe activity, while evidence demonstrates whether that activity is reaching the people who need it most.

The guide follows a life course approach, but opens with equity as a cross-cutting theme before moving into population-specific questions. Questions 1 to 3 cover policy and system context, why immunisation matters, who scrutinises it and which vaccines are on the schedule. Question 4 addresses how councils can understand local coverage data. Question 5 covers equity and reaching the unreached, including how to evaluate whether local approaches are working and whether they are being tailored to the communities with the greatest barriers to access. Questions 6 to 8 follow the life course: children aged 0–5, school-aged children and young people, and adults. Questions 9 and 10 cover travel and visiting friends and relatives, and selective and at-risk programmes. A short section on planning for the 2027 transition highlights upcoming system changes that should be reflected in local oversight and planning.

A glossary and references section sit at the end. References are current as of June 2026 and include key national data sources, guidance and policy documents such as the UKHSA dashboard and UKHSA health equity strategy, the Section 7A 2026 to 2027 agreement, the Green Book, OHID Fingertips, JCVI advice and relevant NICE guidance. 

Immunisation is one of the most powerful tools in public health. Globally, vaccines prevent an estimated 4.4 million deaths every year. In England, they have transformed the health of the population,  driving dramatic reductions in diseases that were once common causes of childhood death and disability, including diphtheria, polio, measles, Hib, meningococcal C and rotavirus. The maternal pertussis programme, introduced in 2012, protects newborns from whooping cough in the first weeks of life, before they are old enough to be vaccinated themselves. Evidence shows it is highly effective at preventing infant deaths. The HPV vaccination programme, introduced in 2008, has already delivered a dramatic reduction in cervical cancer rates in vaccinated cohorts and, alongside cervical screening, has the potential to make cervical cancer a disease of the past, NHS England's ambition is elimination by 2040.
These achievements are not inevitable. They depend on sustained high uptake. Where coverage falls, disease returns, as the 2024 measles outbreak demonstrated.

Vaccination policy is informed by the advice and recommendations of the Joint Committee on Vaccination and Immunisation (JCVI), an independent expert committee which advises the Government on matters relating to vaccination and immunisation. JCVI considers evidence on the burden of disease, safety, efficacy and cost-effectiveness. Recent JCVI advice has addressed and resulted in the expanded maternal programme, the expanded RSV programme to those aged over 80 and care home residents, and the introduction of varicella (chicken pox) vaccine with the switch from MMR to MMRV (January 2026).

Delivery sits with the NHS under Section 7A of the NHS Act 2006. The Section 7A agreement is signed annually between the Secretary of State and NHS England. The 2026 to 2027 agreement, published in March 2026, restates that NHS England remains accountable to the Secretary of State and that most Section 7A functions are intended to be delegated to ICBs from April 2027 subject to legislation. UKHSA is responsible for health protection, surveillance and the immunisation function. OHID, within DHSC, is responsible for health improvement and the Public Health Outcomes Framework.

The NICE guideline on immunisation (NG218) provides the core national guidance on how to increase vaccine uptake across all programmes. A separate NICE guideline on flu vaccination (NG103) addresses uptake specifically for flu programmes. Both should inform local planning and commissioning decisions alongside JCVI advice and Green Book guidance.

At local level, UKHSA's Health Protection Teams (HPTs) are a key partner for councils and the NHS. HPTs provide specialist public health advice on health protection, including immunisation, and are the primary point of contact for outbreak management and surveillance. They are an important source of local intelligence and expertise, and councils should ensure that HPTs are engaged as active partners in local immunisation oversight and planning, not just in outbreak response.

Key features of the English system 

• The NHS Constitution gives every person the right to receive the vaccinations recommended by JCVI under the national programme.
• The Green Book (Immunisation Against Infectious Disease) is the core national clinical guidance, updated chapter by chapter on GOV.UK. It is the operational document for everyone delivering vaccination.
• The COVER programme has been the primary surveillance system since 1987. Production transferred from NHS England to UKHSA in August 2025. Annual data is published via the UKHSA dashboard. There are plans to make quarterly data available in the UKHSA dashboard from late summer 2026. 
• ImmForm is a UKHSA website which provides GP-level coverage and uptake data for a range of immunisation programmes, as well as vaccine ordering facilities for the NHS. Vaccine wastage incidents voluntarily reported through ImmForm in 2025 reached £6.4 million on list price, with 84 per cent classified as avoidable.
• Public Health Outcomes Framework indicators on population vaccination coverage are published on DHSC’s Fingertips website and provide the most accessible benchmark for local and regional comparison by councillors and officers.

Questions to ask

• How are JCVI advice, recommendations and Green Book updates communicated to local providers, including through the local UKHSA Health Protection Team, and how do you know they are being acted upon?
• Where does immunisation appear in the JSNA and the Joint Health and Wellbeing Strategy? Is it treated as a population outcome measure with associated actions, or as a contextual statistic?
• Are vaccine incidents and wastage reported, investigated and learned from? 
• Is training and competence assurance for those delivering vaccines in line with the UKHSA National minimum standards and core curriculum for vaccination training, and Quality criteria for an effective immunisation programme?
• Who in the local system is accountable for system coordination across primary care, school-aged services, maternity, pharmacy, community providers and care homes, and how is that accountability exercised in practice?
• Are call and recall systems in place for every age cohort, and how are gaps in registration handled?
• Are records reliably transferred between school-aged immunisation providers, GP practices and the Child Health Information Service, so that children have a coherent lifelong vaccination record?
• Is there a single named system lead for immunisation performance at place level, and how is their accountability exercised?
• Is the local UKHSA Health Protection Team actively engaged in immunisation planning and oversight, not just outbreak response, and are their insights on local coverage and inequities informing system decisions? 
• Is there a named lead and clear governance structure for immunisation equity work specifically, distinct from general immunisation performance oversight?

Those with a role in oversight and leadership, particularly HOSCs, need to be clear who they are holding to account, because the answer changes depending on the year, the programme and the geography.

Roles and responsibilities in 2026

NHS England regional public health commissioning teams currently commission Section 7A immunisation services through general practice, school-aged immunisation services, community pharmacy and maternity services. The Section 7A agreement names NHS England as the accountable commissioner.

Integrated Care Boards are now strategic commissioners for most NHS care and are taking an increasing role in vaccination uptake improvement, particularly through primary care quality and place-based teams. From April 2027, subject to legislation, ICBs are expected to take on most Section 7A functions including commissioning of vaccination services.

UKHSA is responsible for public health leadership and clinical technical expertise, JCVI scientific secretariat, surveillance, analysis and evaluation, the Green Book, COVER data production, outbreak response, the ImmForm website and vaccine and countermeasure procurement nationally. The local UKHSA Health Protection Team is the council's health protection partner, sitting alongside the DPH on the Local Health Resilience Partnership.

The DPH is responsible for statutory health protection assurance for the council. The DPH typically chairs or co-chairs a local health protection board with NHS, UKHSA and provider representation.

Providers include general practice, school-aged immunisation services (commonly a community provider trust), some community pharmacy, and maternity services for whooping cough and RSV in pregnancy. In twelve pilot areas, health visitors are being trained to deliver vaccinations during health visits to underserved communities.

Why this matters now

Accountability for immunisation has become more complex. ICB capacity has reduced significantly in many areas following being asked by Government to make 50% cuts to running costs. NHS England is in the process of merging into DHSC. Local government reorganisation in two-tier areas is moving towards new unitary structures, with consequent disruption to DPH appointments, public health grant flows, JSNAs, HWBs and HOSC arrangements themselves.

Workforce capacity across primary care, school-aged services and community providers is an increasing constraint on delivery, particularly in the context of planned transitions and reduced system running costs.
At the same time, national and local partners are testing new delivery approaches to improve uptake and reduce inequalities, further complicating the accountability landscape.

In this environment, the value of local oversight and scrutiny is not that it solves the problem but that it provides a consistent point of challenge, holding the system together long enough for the problem to be solvable.
Scrutiny should not always be about immunisation in isolation. Children's health and early years reviews should include pre-school vaccinations, the 6-in-1, rotavirus, MenB, pneumococcal, MMRV and the pre-school booster. Maternity reviews should include whooping cough, RSV and flu in pregnancy.

Reviews of older adults' services should include flu, RSV, shingles, pneumococcal disease and COVID. School improvement and inclusion reviews should consider HPV and MenACWY in alternative provision and special schools. This reflects the council's wider place leadership role, rather than a single committee or board examining a narrow service.

Questions to ask about who is responsible for immunisation, and how should councils scrutinise it

• Who exactly is responsible for commissioning each immunisation programme in our area, including the named lead within the ICB, and how is that accountability mapped against the geography of NHS England, the ICB, UKHSA and our council?
• What is the local plan for the proposed delegation of Section 7A functions to ICBs from April 2027, and how will the HOSC be involved in scrutinising the transition?
• How are providers of immunisation services held accountable for performance, and what reporting routes exist into the HOSC, the HWB and the council?
• What systems does the DPH have in place to satisfy the statutory health protection assurance function, and when did the DPH last report formally to the HOSC on this?
• How do ICB strategic commissioning intentions for primary care quality include vaccination coverage, and which programmes are tracked?
• Where local government reorganisation is in train, how will HOSC arrangements, DPH appointments and HWB membership maintain continuity of immunisation oversight through transition?
• What are the key workforce risks across immunisation delivery (including general practice, school-aged services and community providers), and how are these being managed locally?
• Are immunisation pathways included in scrutiny of related topics, particularly maternity, older adults, care-experienced children and special educational needs, and how systematically is this being done?
• What evidence is there that local immunisation initiatives are improving outcomes, not just delivering activity? Are interventions being evaluated against measurable targets, including how many additional people were protected, whether coverage gaps narrowed, and whether improvements were sustained over time?
• How is value for money being assured for council-funded or council-supported immunisation activity, and are findings from evaluation being used to strengthen and focus future approaches?

The schedule below reflects the position from January 2026. You can review the full routine immunisation schedule from UKHSA.

Childhood schedule from January 2026

• Eight weeks: 6-in-1 (diphtheria, tetanus, whooping cough, polio, Hib, hepatitis B), MenB, rotavirus.
• 12 weeks: 6-in-1 (second dose), MenB (second dose, moved from 16 weeks in July 2025), rotavirus (second dose).
• 16 weeks: 6-in-1 (third dose), pneumococcal (PCV13, moved from 12 weeks in July 2025).
• 12 to 13 months: MenB booster, MMRV first dose (replaces MMR1 from January 2026, with MMRV introducing varicella).
• 18 months: MMRV second dose (new contact, brought forward from three years four months from January 2026).
  Three years four months: 4-in-1 preschool booster (diphtheria, tetanus, whooping cough, polio).

Selective childhood programmes

• BCG for tuberculosis, offered to infants in areas with annual incidence of 40 per 100,000 or higher, or with a parent or grandparent born in a country of that incidence.
• Hepatitis B for babies born to hepatitis B positive mothers, in addition to the universal hexavalent schedule. Doses at birth, 4 weeks and 12 months, with serology at 12 months.

Adolescent schedule (school-aged immunisation service)

• Years Reception to 11: annual flu vaccine (live attenuated nasal spray, with inactivated injection where contraindicated).
• Year 8: HPV single dose for boys and girls (since 2023, replacing the previous two-dose schedule). Year 8 is the point of first offer; catch-up remains available through SAIS up to Year 10.
• Year 9: 3-in-1 teenage booster (tetanus, diphtheria, polio) and MenACWY. MenACWY catch-up is available through SAIS up to Year 10.

Adult schedule

• Pregnancy: whooping cough from 16 weeks, RSV from 28 weeks, flu in season.
• Age 65 and over: annual flu, pneumococcal (PCV20), shingles (Shingrix, two doses, currently those turning 65 and 70 are eligible until 80).
• Age 75 and over: RSV, single dose. From April 2026 expanded to all 80-year-olds and over and all older adult care home residents regardless of age.
• Clinical risk groups: flu, pneumococcal, shingles (18 plus for severely immunosuppressed), COVID seasonal.
• Frontline health and social care workers: annual flu, COVID seasonal.
• Specific occupations and exposures: hepatitis B, hepatitis A, BCG and others under occupational health, not Section 7A.

Catch-up programmes

• Children and adults with an unknown or incomplete vaccination history should be identified and offered catch-up vaccinations. Key catch-up routes include:
• MMR and MMRV: catch-up should be offered through the school-aged immunisation service alongside routine adolescent offers where doses have been missed; see measles resources for local government for further guidance (note: this page is in the process of being updated by UKHSA, LGA has reviewed this document). Adults born on or before December 31, 2019, can get fully vaccinated if they missed doses as children, only received one dose, or are unsure of their vaccination status by contacting their GP. 
• HPV: available through SAIS up to Year 10, and through GP practice up to the 25th birthday.
• MenACWY: available through SAIS up to Year 10, and through GP practice up to the 25th birthday.
• Adults who are unsure whether they have received all recommended vaccines, or who have no vaccination history, should be advised to contact their GP practice. GPs can review records, check what has been received and offer any missed vaccines. Adults who have never been vaccinated or have an incomplete history can receive catch-up doses for a range of vaccines including MMR, polio, diphtheria and tetanus. There is no age limit on catching up with missed vaccinations.

Recent and forthcoming changes

• MMRV was introduced January 2026, with a catch-up offer for children born between 1 January 2020 and 31 August 2022 between November 2026 and March 2028.
• Shingles eligibility will change to adults turning 60 and 65 from September 2028, and to a routine 60-year-old offer from September 2033.
• Continued discussion at JCVI on chickenpox-only catch-up routes, and on potential expansion of meningococcal B beyond infancy.
• As of June 2026, a time-limited MenB offer is being made available in summer 2026 for current Year 13 students and those aged less than 25 years who will be attending undergraduate higher education or living in further education accommodation or halls of residence for the first time in autumn 2026 (Eligibility criteria).

Questions to ask: Which vaccines are on the NHS schedule?

• Are providers using the current schedule and the latest Green Book chapters, and how is compliance with schedule changes assured locally?
• Are local communications materials, including translated materials, up to date with the current schedule and accessible to the communities that need them? (UKHSA certified resources)
• How is the transition to MMRV being managed for children midway through the previous MMR schedule, and are all eligible cohorts being actively identified and contacted?
• What catch-up opportunities are available locally in practice for children not in mainstream education, adults not registered with a GP, and those who are unsure of or have no vaccination history, and are there gaps in provision that the council should be scrutinising or raising with NHS partners?
• What specific catch-up activities are in place locally for MMR and MMRV, and how are children being identified and reached, particularly those not in mainstream education settings? 
• When the schedule changes or eligible groups expand, what mechanisms exist to actively call those who become newly eligible, rather than waiting for them to present?
• When new programmes or expansions are introduced, how does the local system assure itself that providers are prepared, that eligible populations are being reached, and that uptake is being monitored?
• How is the council sighted on changes to who delivers immunisation services locally, including any shift towards new provider models, and what is the plan for scrutinising the transition to ICB commissioning?

Understanding vaccination coverage in your area requires knowing where to look, how current the data is, and what it does and does not show. Most coverage data is reported with a lag of several months, and different programmes are reported through different systems. The sources below are the key starting points for local oversight.

Where the data lives

• UKHSA data dashboard for childhood vaccinations, with annual COVER reports broken down by upper-tier local authority and by region. There are plans to make quarterly data available in the UKHSA dashboard from late summer 2026. Quarterly data is also published separately via the COVER quarterly reports on GOV.UK.
• DHSC Fingertips, which holds the Public Health Outcomes Framework indicator 3.03 on population vaccination coverage. This is the most accessible starting point for councillors wanting to compare local coverage against regional and national figures.
• UKHSA monthly RSV maternal coverage reports and older adult RSV coverage reports.
• UKHSA HPV coverage report for school years 8, 9 and 10.
• NHS England flu vaccination statistics throughout the season, covering uptake for adults, pregnant women, children and frontline healthcare staff. 
• UKHSA national flu and COVID-19 surveillance reports, published throughout the season alongside broader respiratory surveillance data.
• Child Health Information Service local data, which is the underlying source for childhood coverage statistics. Council scrutiny should ask whether the local CHIS is fit for purpose, given that data quality issues in London during 2024 and 2025 led to underestimation of coverage in some areas and whether the local CHIS is using the data they have to help drive action to improve uptake.

What the data shows nationally

The national picture provides essential context, but local oversight depends on understanding how your area compares. Councillors and officers should use OHID Fingertips and relevant data sources above to compare coverage in their local authority against statistical neighbours, regional averages and the England average, across each vaccine and age cohort. Where local coverage is lower than comparable areas, that gap requires explanation and a local response. Where it is higher, it is worth understanding what is driving better performance and whether it can be sustained or extended.

The data sources listed above are updated regularly. Officers should ensure that the most current published data is used in any scrutiny or oversight work, rather than relying on figures that may be several quarters old.

Questions to ask: How does the council know what coverage looks like?

• What activities are in place locally to move coverage towards the WHO 95 per cent uptake target, and where is current performance against that target for each childhood vaccine? 
• How does coverage in our area compare with statistical neighbours and with England, by age cohort and by vaccine? 
• Is practice level data fed back to general practices on a regular basis? Do practices know how they compare with peers, and what action is expected and taken from that knowledge? 
• Are there known data quality issues with the local CHIS or in general practice, including list inflation that may be artificially suppressing coverage estimates?
• Are there processes in place to clean GP and CHIS lists, and are unregistered children being accurately accounted for? 
• Are there processes in place to ensure vaccines given abroad are accurately coded and recorded, and are checks made at GP registration and school entry to identify children with incomplete or unknown vaccination histories?
• For school-aged programmes, is provider performance broken down by school, including academies, special schools, alternative provision and pupil referral units? 
• For all vaccination programmes, is uptake data disaggregated by deprivation quintile and ethnic group, not just headline figures, and are identified inequalities being actively addressed? 
• For maternal RSV, whooping cough and flu, are data being received from all relevant maternity and community services, noting that not all maternity units may be commissioned to deliver the vaccine service? 
• How is coverage data being interpreted locally, who is responsible for translating data into action, and are findings being systematically fed back to system improvement teams (SITs) and other relevant partners? Is there evidence that data is driving change rather than just being reported?
• How has uptake changed over the last five years, and what is the trajectory rather than the snapshot, including any periods of significant decline or recovery and the reasons for these trends? 
• Is immunisation data used proactively to identify and recall children in real time, or primarily for retrospective reporting?

Case studies: How does the council know what coverage looks like? 

Leeds City Council used granular local data to identify which communities, practices and programmes required targeted action, and established monitoring arrangements to track whether interventions were making a difference.

Systematic gaps in immunisation coverage between population groups are an avoidable health inequality. The UKHSA National Immunisation Programme Health Equity Audit 2025 provides the clearest evidence yet that immunisation inequity in England is not only persistent but worsening in critical areas. The audit identifies a progressive widening of the gap between the most and least deprived groups in several immunisation programmes since 2016/17, signalling systemic failure to close known gaps.

Across nearly all major vaccination programmes, the audit reaffirms a stark and consistent pattern: lower uptake is strongly correlated with socioeconomic deprivation; several ethnic minority groups continue to show significantly lower uptake, echoing patterns unchanged from the last audit in 2019; and regional inequalities persist, with coverage rates in London consistently lower than in other parts of the country.

The breadth of barriers to uptake is significant and includes limited-service access, practical and logistical obstacles, cultural and linguistic barriers, and mistrust or low confidence in vaccines. These are not new findings, mirroring those reported in 2019, but they have not meaningfully improved despite system-wide recognition. Critically, data gaps persist for some communities, limiting the system's ability to act - without improved data capture, linkage and local intelligence, interventions designed to improve immunisation equity will continue to be poorly targeted and slow to evaluate.

The real-world consequences are stark. Epidemiological analysis of a measles outbreak in Birmingham in 2023/24 showed that 78 per cent of cases occurred in the city's 20 per cent most deprived areas, and that the infection rate per 100,000 was 86.3 in the Black African ethnic group compared to 10.8 in the White British group. Most cases, 89 per cent, were unvaccinated.

The NICE guideline on immunisation (NG218) identifies the same broad groups at higher risk of being unreached: those who have missed earlier doses, looked-after children, children with physical or learning disabilities, children of young or lone parents, those not registered with a GP, younger children in large families, children with chronic illness, children from some minoritised ethnic groups, those from non-English speaking families, and vulnerable groups including children of asylum seekers, Gypsy, Roma and Traveller children, and homeless families. The NICE guideline on flu vaccination (NG103) addresses similar themes for adult programmes.

Rural and coastal areas face a distinct set of barriers that require equally tailored approaches. Travel distance, limited public transport, declining GP and pharmacy coverage, dispersed school populations and the cost of outreach in low-density areas can make vaccination significantly harder to access than in urban settings. These barriers are less visible in aggregate coverage data, which can mask pockets of low uptake in rural areas that would trigger action if they appeared in an urban ward. Councils in rural areas should ensure that equity analysis is sensitive to geography, not just deprivation and ethnicity, and that local plans explicitly address the additional cost and complexity of reaching dispersed populations.

Successfully addressing immunisation inequity requires tailored approaches grounded in local knowledge and the expertise of those with lived experience. The WHO's Tailoring Immunisation Programmes (TIP) methodology, the UKHSA immunisation inequities toolkit and the UKHSA Immunisation Equity Strategy 2025 to 2030 all provide frameworks for local systems to understand and address these gaps in a structured, evidence-based way.

This is the question where the council's place leadership case is most concrete. The NHS does not have direct relationships with most of the groups identified above. Councils do, through schools, early years, housing, environmental health, registrars, libraries, social care and community development. The role of local government is to ensure that this reach is used systematically, with partners aligned around closing coverage gaps rather than operating in parallel or leaving groups unaddressed.

Questions to ask: Equity and reaching the unreached

• Has a local equity audit of immunisation uptake been undertaken, disaggregated by deprivation, ethnic group, geographic area and population group, drawing on the Health Equity Audit 2025 as a baseline for comparison
• Is there a named lead and clear governance structure for immunisation equity work specifically, distinct from general immunisation performance oversight, with dedicated resource and agreed priorities?
• In rural and coastal areas, are access barriers specific to geography, including travel distance, transport availability and declining pharmacy and GP coverage. being explicitly identified and addressed in local immunisation plans, and is funding adequate to meet the additional cost of outreach in dispersed communities?
• Are the communities with the lowest uptake locally understood, and has the system used tools such as the WHO TIP methodology or the UKHSA immunisation inequities toolkit to design tailored approaches with input from communities themselves?
• Are VCSE organisations, community champions and trusted intermediaries actively involved in immunisation planning and outreach, with sustained resource behind them rather than one-off campaign activity?
• How are local GP practices being supported and held accountable to achieve coverage across their registered populations, and where are the underperforming practices?
• How are migrants and refugees being identified, immunisation history checked and brought up to schedule? Are UKHSA certified translated materials and the UKHSA algorithm for individuals with uncertain immunisation status being routinely used?
• Are council communications channels, council-run venues and elected member networks being used to promote vaccination, particularly in communities with the lowest uptake?
• Where there are homeless hostels, Gypsy, Roma and Traveller sites, boating communities, asylum accommodation or refugee resettlement housing in the area, what specific outreach is in place and who is coordinating it?
• How is vaccine confidence and hesitancy understood locally, including differences by population group and geography, and what approaches are in place to address misinformation and build confidence in communities with lower uptake?
• How is the impact of local equity interventions being measured beyond activity and engagement figures? Is there evidence that targeted approaches are translating into measurable reductions in coverage gaps between population groups, and are findings being used to strengthen and focus future approaches?

Case studies: Equity and reaching the unreached

Kirklees Council developed a collaborative system-wide approach to improving vaccination uptake, bringing together NHS, council and community partners around shared priorities and agreed governance arrangements.

Leeds City Council: from misinformation to confidence identified vaccine misinformation as a significant driver of low uptake in specific communities and worked with local partners to develop targeted responses, rebuilding confidence through trusted community relationships.

Wiltshire Council examined vaccination attitudes in an area with generally high coverage, identifying localised pockets of hesitancy and the factors driving them, providing a model for areas where aggregate figures may be masking underlying variation.

Bristol City Council co-produced MMR communications resources with local communities, developing materials that reflected the specific concerns and communication preferences of communities with lower uptake.

Wigan Council improved MMR uptake through targeted community engagement, working with voluntary and community organisations already trusted by families to extend the reach of the vaccination offer beyond standard NHS communications.

London Borough of Lambeth established a Vaccinations in New Spaces service, delivering vaccination in libraries, community centres and other non-clinical settings to reach residents who had not engaged with primary care vaccination routes.

Stoke-on-Trent City Council built the Community First vaccination programme around trusted community relationships, working with local organisations to reach communities where confidence in services was lower and access to primary care more limited.

Wirral Council combined community intelligence with coverage data to build a richer understanding of the barriers to MMR uptake in specific local populations, informing a more targeted and contextually appropriate local response.

The first five years of life carry most of the routine childhood schedule and the bulk of the protection. Coverage at this stage is the strongest predictor of measles outbreak risk and a leading early indicator of system performance more broadly. Falling coverage in this age group has been the principal driver of England losing measles elimination status in 2026.

The schedule is delivered almost entirely in primary care. The mechanics matter. Practices need accurate registers, effective call and recall registers, capacity to offer flexible appointments, time and expertise to talk through the benefits of vaccination, and reliable data flow to and from the Child Health Information Service. Where any of these break down, coverage falls.

But system mechanics alone are not sufficient. Parents and carers need to be aware of the vaccines their children are eligible for, understand the benefits and risks, and be able to access services at a time and place that works for them. Barriers to access, whether practical, cultural, linguistic or related to confidence in vaccines, require active local effort to identify and address. Promotion and outreach are as important as call and recall, particularly for reaching families who may face the greatest barriers to engaging with routine primary care.
In rural areas, the mechanics of delivery face additional constraints. Single-handed practices or practices covering large geographic areas may have limited capacity to offer flexible appointment times, and parents and carers in areas with poor public transport may face significant practical barriers to attending at all. These constraints require active local problem-solving, including consideration of outreach, community venue vaccination and mobile delivery models, rather than an assumption that the standard primary care offer is equally accessible everywhere.

New children arriving in the area, including children of recent migrants and refugees, may have incomplete or uncertain immunisation histories. UKHSA publishes a specific algorithm for vaccination of individuals with uncertain or incomplete immunisation status, which providers should be routinely applying. 

Questions to ask: Children aged 0 to 5

• What governance structure oversees the under-5 immunisation programme locally, and how does it report to the HOSC, HWB and DPH?
• Are CHIS data flows to and from primary care accurate and timely, and how are discrepancies identified, investigated and resolved?
• Who issues call and recall, and is every eligible child being invited at the correct time? Are there any practices with systemic gaps or variation in this process?
• Are any practices operating waiting lists for routine childhood immunisations, and if so, why?
• Do practices offer evening and weekend appointments where parents and carers cannot attend during the working day?
• What is being done locally to promote awareness of the childhood vaccination schedule, including information about the benefits and risks of vaccination, and is this reaching the communities with the lowest uptake?
• Are there barriers to access,  including practical, cultural or linguistic barriers, which are preventing families from attending vaccination appointments, and what is being done to address them?
• Are opportunistic and catch-up vaccinations being delivered, including for children newly registered with a GP and children arriving from other countries?
• How is health visiting being used as a route into the under-5 immunisation conversation, particularly for families who are missing routine appointments, and is the council aware of whether its area is one of the pilot sites enabling health visitors to deliver vaccinations directly?
• How is the January 2026 MMRV transition being managed for children part-way through the schedule? (Note: this is a time-limited question that will become less relevant as the transition is completed.)

Case studies; pre-school vaccination

• Bolton Council used practice-level data to identify significant variation in MMR coverage that headline figures had obscured, and worked with underperforming practices to develop a targeted improvement approach.
• Cornwall Council adapted its flu vaccination offer to reflect the challenges of a dispersed rural and coastal population, using community venues and flexible delivery models to bring vaccination closer to families who would otherwise face significant barriers to access.
• County Durham Council worked with health visitors and early years settings to embed flu vaccination conversations into routine contacts with 2- to 3-year-olds, improving uptake in a group that had proved difficult to reach through standard call and recall.
• Hull City Council mapped MMR coverage by deprivation and ethnicity to identify where gaps were greatest and worked with primary care to redesign the local offer for those communities.
• Knowsley Council developed the Flu Superheroes campaign to increase flu vaccination uptake among young families in early years settings, using creative engagement to make the offer more visible and accessible.

School-aged immunisation in England is delivered by commissioned School Aged Immunisation Services (SAIS), typically community provider trusts. The schedule has been reshaped in recent years by the move to single-dose HPV (2023) for boys and girls, the integration of MenACWY into the year 9 offer alongside the 3-in-1 teenage booster, and the continued annual childhood flu programme.

School-based vaccination offers significant public health value. It delivers vaccines that provide long-term protection or extend protection from vaccines given in the pre-school years, as well as the seasonal flu/influenza vaccine. It offers a key opportunity to check whether children are up to date with other routine vaccinations, including MMR, and helps reduce the risk of cases and outbreaks, contributing to lower absenteeism. The model reaches very large numbers of children efficiently, is convenient for parents and carers, and is viewed positively by a large majority of families. It is also likely the most effective model for reducing inequalities, as it reaches children who may have difficulty accessing health services through other routes, including those who are not registered with a GP.

Coverage across all school-aged programmes remains below pre-pandemic levels, with school-age vaccines seeing the sharpest declines during the pandemic and the slowest recovery since. This includes HPV, MenACWY, the teenage booster and the children's flu programme. The NHS England ambition to eliminate cervical cancer by 2040 depends on closing the gap in HPV coverage, and HPV catch-up to age 25 through general practice is the safety net for school-leavers who missed out. The move to a single-dose HPV schedule in 2023 simplified delivery, though the extent to which this has improved coverage and for which groups is still being understood.

Coverage outside mainstream schools is the structural weakness. Special schools, pupil referral units, alternative provision, home-educated children and looked-after children placed out of area are all groups where SAIS reach is patchy, and in rural areas this challenge is compounded by distance. These are also groups where wider council services hold the relationships.

Questions to ask: School-aged children and young people

• What is the catch-up offer for children who miss school-based immunisation sessions, and how is this communicated to parents, carers and young people? 
• Is the council sighted on how SAIS teams are engaging with local leaders and the local authority, as set out in SAIS service specifications, and is this relationship working effectively in practice? 
• Are there schools where there are particular challenges around access to or support for vaccination sessions, including schools with consistently low uptake, and is there targeted action in place to understand and address this? 
• Are all schools included in the SAIS offer, including academies, free schools, independent schools, special schools, faith schools and alternative provision? Are there examples of good practice from other areas that the council could draw on to improve reach in these settings? 
• Where schools have declined to host immunisation sessions or to share school roll data and parent and carer contact information, what is the local response? DfE has updated its guidance to schools on data sharing, and UKHSA has communications materials and Green Book guidance that can be used to address GDPR concerns. Is the council actively supporting SAIS teams to resolve these issues?
• How are home-educated children, children at pupil referral units, looked-after children placed out of area, and children excluded from school being reached?
• What is HPV coverage by school, and is there targeted action to understand and improve uptake in schools with consistently low rates? 
•  Are catch-up routes through general practice working for school-leavers up to age 25, particularly for HPV and MenACWY? 
•  Are immunisation history checks built into school readiness, admissions, school transfers and school trips, and used as a prompt rather than a barrier? 
• Where are SAIS providers facing workforce pressures, and is the council aware of this through the HWB? 
• How is the council using its school improvement and inclusion functions to support SAIS, particularly in relation to schools with consistently low uptake, rather than treating immunisation as solely the NHS's responsibility?

Case studies: School-aged children and young people

Blackpool Council developed a targeted, community-based MMR catch-up programme in response to low coverage in areas of high deprivation, working through trusted community contacts rather than relying solely on clinical settings.

Bristol City Council, North Somerset Council and South Gloucestershire Council worked directly with young people aged 16 to 24 to co-design communications around the HPV vaccine catch-up offer, producing materials and approaches developed by the target group themselves.

Wolverhampton strengthened school-age immunisation uptake by developing closer working relationships between the council, SAIS providers and schools, improving access and reducing the number of children missed by routine sessions.

Manchester City Council identified students as a group with lower vaccination uptake and gaps in provision between school-age and adult services, and developed a targeted outreach model to reach them through university and further education settings.

Vaccination does not stop at childhood. The adult immunisation schedule covers pregnant women, older adults, clinical risk groups and the social care workforce, and has expanded significantly in recent years since the previous iteration of this guide. The diseases these programmes prevent, including RSV, flu, shingles and whooping cough, carry the greatest burden in older and more vulnerable population groups, where the consequences of infection are most serious.
Population ageing makes this more pressing, not less. ONS principal projections show the population aged 65 and over rising from around 12.7 million in 2025 to over 15 million by 2035, with the number aged 85 and over increasing by around half over the same period. Adult immunisation should be a core part of the council's adult social care strategy, not a side issue.

The structural weakness on the adult side remains the social care workforce. Frontline NHS staff seasonal flu vaccine uptake stood at 45 per cent in 2025/26, an increase following four consecutive seasons of decline, but still well below the levels achieved during the COVID years. Care home staff flu vaccine uptake is consistently lower. Where the council commissions care providers, this is a council issue as much as an NHS one.

The adult programme is also delivered through a more fragmented provider landscape than childhood vaccination, with GP practices, pharmacies, maternity services, care homes and outreach models all playing a role.

Ensuring a consistent and equitable offer across these different routes requires active local oversight.

In rural areas, pharmacy closures and the prevalence of single-handed or small GP practices can leave genuine gaps in coverage that do not exist in urban settings, particularly for shingles, RSV and pneumococcal programmes where the primary care offer is the main delivery route. Where pharmacies have closed or GP practices are under significant pressure, councils should be asking what the alternative delivery model is and who is accountable for reaching residents who can no longer access the standard offer.

Pregnant women 

Pregnant women are offered whooping cough from 16 weeks, RSV from 28 weeks, and flu in season. These vaccines protect both the mother and the infant in the first weeks of life, before the baby is old enough to be vaccinated. A UKHSA evaluation of the first year of the maternal RSV programme found it reduced the risk of baby hospital admissions by up to 85 per cent, making it one of the most effective new programmes introduced in recent years. Uptake varies significantly by ethnic group and by ICB area. Maternity services are not uniformly commissioned to deliver all three vaccines. The programme launched in September 2024, so while inequalities are already visible, there is real scope to address them as the programme matures.

Questions to ask: Adults and the life course

• What are local uptake rates for whooping cough, RSV and flu in pregnant women, and how do these compare with regional and national figures?
• How are local maternity and community services (e.g. primary care) delivering the maternal vaccination offer, and are all three vaccines consistently available across all providers in the area?
• What barriers are pregnant women facing in accessing maternal vaccines, and are outreach or community-based approaches being used to reach those least likely to attend routine appointments?

Older adults

For older adults, the schedule has expanded in recent years to include RSV for those aged 75 and over (extended to all 80-year-olds and care home residents from April 2026), shingles for those turning 65 or 70, and continued flu and COVID seasonal programmes. Despite generally higher uptake than childhood programmes, there are significant gaps. In the 2025/26 season, flu vaccination uptake among care home staff stood at just 11.2 per cent, compared with 65.8 per cent among residents, based on self-reported data from 99 per cent of care home providers as of April 2026.

The UKHSA National Immunisation Programme Health Equity Audit 2025 found that socioeconomic deprivation was significantly associated with lower uptake of influenza, pneumococcal and shingles vaccines among adults aged 65 and over, with larger household size also linked to lower uptake across all three vaccines.

Further questions to ask

• What are local uptake rates for the seasonal influenza vaccine in those aged 65 and over, those in clinical risk groups, carers in receipt of an allowance, and frontline NHS and social care staff?
• What is shingles uptake in those aged 65 and over, and what is being done locally to identify and reach those who remain unvaccinated?
• How is the RSV programme for older adults being delivered locally, including for the expanded cohort of 80-year-olds and care home residents, and what are the early uptake figures and any gaps in provision?
• What is the council doing as a commissioner of adult social care to drive flu, COVID and RSV uptake among care home staff and residents?
• Are care homes being approached as units for vaccination of all eligible residents and staff together, rather than as a series of separate clinical encounters?
•  Across both the core and outreach delivery models for adult vaccination, how is the quality and consistency of the offer being assured, and are there populations being missed by one model who are not being picked up by the other?

Travel for leisure, business and to visit friends and relatives (VFR) remains a source of imported vaccine-preventable disease. Imported measles cases drove domestic outbreaks in 2023 and 2024. Some travel destinations and religious pilgrimages require specific vaccines, including MenACWY for travel to parts of the Middle East and yellow fever vaccination for travel to and from endemic countries.

Most travel vaccines are not commissioned under the NHS. Diphtheria, polio, tetanus, typhoid, hepatitis A and cholera are NHS-funded for travel; others are available privately. The travel vaccination encounter is also a useful opportunity to check routine schedule status, particularly for adults and adolescents who may have missed earlier doses, and to offer catch-up where appropriate.

Travellers visiting friends and relatives are a known higher-risk group for imported infection. They typically stay in private households for longer periods than tourists, with closer contact to local populations, making transmission of vaccine-preventable diseases more likely. Effective community engagement, including with religious and community organisations, is the most effective route to reach this group with travel health and immunisation information.

Questions to ask: Travel and visiting friends and relatives

• Have there been any local initiatives to provide travel health and immunisation information to communities with high VFR travel patterns?
• Are local GP practices actively promoting travel health advice, and are there known gaps in provision across the area?
• Do local pharmacies offer travel vaccination advice, and are pharmacy and primary care offers coordinated to avoid duplication or gaps?
• Are religious and community organisations engaged in travel health communications, particularly those working with communities with high VFR travel patterns or who undertake religious pilgrimages?
• How are imported cases of measles and other vaccine-preventable diseases fed into local public health intelligence, and what is the link to outbreak response planning?
• Is the local UKHSA Health Protection Team providing the council and NHS partners with regular intelligence on travel-related disease trends, and is this informing local communications and outbreak planning?

Several immunisation programmes are not universal but are offered to those at specific risk. Selective programmes typically have lower coverage, more complex referral pathways, and a higher dependence on cross-system coordination. They are a useful test of whether the local system has the operational maturity to handle the next decade of more individualised, risk-stratified vaccination.

BCG for tuberculosis

Selective BCG vaccination continues. BCG is offered to infants from 0 to 12 months living in areas of tuberculosis / TB incidence at or above 40 per 100,000, or with a parent or grandparent born in a country of that incidence. BCG requires a specific intradermal technique and is given by trained staff, often in a small number of designated clinics.

Hepatitis B for babies of infected mothers

Universal hepatitis B has been part of the 6-in-1 schedule since 2017, but babies born to hepatitis B positive mothers require additional doses at birth, 4 weeks and 12 months, with serology at 12 months. Without all four doses and the serology check, the protection is incomplete. This pathway depends on accurate antenatal screening, reliable communication between maternity services, neonatal services, primary care and CHIS, and active follow-up.

Selective hepatitis B and other risk-based programmes

Hepatitis B is offered to a range of clinical and behavioural risk groups beyond infancy, including people who inject drugs, sex workers, men who have sex with men, sexual partners and household contacts of hepatitis B carriers, and prisoners. Provision sits across primary care, sexual health services, drug services and prison service health.

Occupational immunisation

Occupational vaccinations including hepatitis B for healthcare workers, BCG for staff in some clinical settings, and selective programmes for laboratory and environmental health staff are the responsibility of the employer. Council occupational health arrangements should be assured against this.

Questions to ask: Selective and at-risk programmes

• Does the council have sight of local TB incidence data through the UKHSA Health Protection Team, and is the BCG offer reaching all eligible infants?
• Is there a written pathway for babies of hepatitis B positive mothers, covering maternity, neonatal services, primary care, health visiting and CHIS? Who owns each step, and what is the failsafe?
• Are babies of hepatitis B positive mothers receiving all doses and checks as set out in the current routine immunisation schedule, and what proportion are completing the full pathway? 
• What is local MMR catch-up performance for school-aged children, young people and adults? What has been learned from outbreak response and previous catch-up campaigns locally, and how are those lessons being embedded into the core delivery model rather than treated as one-off activity?
• Is selective hepatitis B reaching people who inject drugs, sex workers, prisoners and other clinical risk groups? Who is accountable for measuring coverage in these groups, and is there a reliable mechanism for doing so given the challenges of data collection across multiple providers and settings?
• Is the council, as an employer, ensuring that staff in relevant roles, including environmental health, social care and other frontline services, are offered and receiving the occupational vaccinations to which they are entitled?

The Section 7A 2026 to 2027 agreement makes the policy direction explicit: it is the intention of the Secretary of State that, subject to legislation, most Section 7A functions will be delegated to Integrated Care Boards from April 2027.

NHS England will continue to lead in 2026/27, with regional teams working increasingly closely with ICBs to plan services in collaboration. ICBs are simultaneously merging from 42 into around 26 clusters, with their running costs cut significantly.

This transition has direct implications for councils, including HOSCs, Health and Wellbeing Boards and officers involved in system oversight and delivery. There are several areas that should be considered in local work programmes and planning over the next twelve months.

• A formal session or discussion in 2026 with NHS England regional commissioners and the ICB to map current accountability and the planned transition. There should be a clear answer to the question: who will be responsible for immunisation services from April 2027, and how will continuity of contracts, data flows and provider relationships be assured through the transition, including who is accountable for managing any disruption?
• A review of the local Section 7A delegation plan once published, including the financial settlement, workforce transfer arrangements and the transition risk register. ICBs taking on Section 7A with reduced running costs is a credible operational risk, and assurance should be sought on capacity and delivery plans.
• Where local government reorganisation is in train, explicit consideration should be given to how new unitary structures will maintain DPH appointments, HWB membership, HOSC arrangements, public health grant flows and health protection assurance through the transition. The risk of two simultaneous reorganisations on either side of the system boundary requires active management rather than passive oversight.

Oversight and planning in 2026 will take place in a period of overlapping structural change. Treating this as business as usual is likely to lead to gaps in accountability and delivery.

BCG: Bacille Calmette-Guérin, the vaccine against tuberculosis.

CHIS: Child Health Information Service, the local system that holds children's immunisation records.

COVER: Cover of Vaccination Evaluated Rapidly, the surveillance system for childhood immunisation, produced by UKHSA from 2025.

DPH: Director of Public Health, the statutory officer in each upper-tier local authority with responsibility for the health of the local population including health protection assurance.

DTaP/IPV: Diphtheria, tetanus, acellular whooping cough and inactivated polio vaccine, given as the preschool 4-in-1 booster.

Gillick competence: The principle in medical law that a child under 16 may consent to their own medical treatment without parental knowledge or permission, where they have sufficient understanding of what is proposed.

Green Book: Immunisation Against Infectious Disease, the live national clinical guidance on immunisation, published online by UKHSA and DHSC.

Hib: Haemophilus influenzae type b, a bacterial cause of meningitis and other invasive disease in young children

HOSC: Health Overview and Scrutiny Committee, the committee established by upper-tier local authorities under the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.

HPV: Human papillomavirus, causal agent in cervical cancer and several other cancers. NHS programme since 2008, single dose for boys and girls since 2023.

HWB: Health and Wellbeing Board, the statutory committee of the council responsible for the JSNA and Joint Health and Wellbeing Strategy.

ICB: Integrated Care Board, established under the Health and Care Act 2022, taking over from clinical commissioning groups in July 2022.
ImmForm: The system used by UKHSA for vaccine ordering, distribution and uptake reporting.

JCVI: Joint Committee on Vaccination and Immunisation, the independent advisory committee that advises ministers on immunisation.

JSNA: Joint Strategic Needs Assessment, the statutory needs assessment produced by the HWB.

LGR: Local Government Reorganisation, the process of restructuring two-tier local government areas into unitary authorities.

MenACWY: Vaccine against meningococcal serogroups A, C, W and Y, given to teenagers in year 9.

MenB: Vaccine against meningococcal serogroup B, given in infancy.

MMR: Measles, mumps and rubella combined vaccine, replaced by MMRV from January 2026.

MMRV: Measles, mumps, rubella and varicella combined vaccine, introduced in England in January 2026.

OHID: Office for Health Improvement and Disparities, within the Department of Health and Social Care, holding health improvement functions.

PCV13: Thirteen-valent pneumococcal conjugate vaccine, given in infancy.

PHOF: Public Health Outcomes Framework, the national set of indicators for population health, hosted on OHID Fingertips.

RSV: Respiratory syncytial virus, a leading cause of severe respiratory illness in infants and older adults.

SAIS: School Age Immunisation Service, the commissioned provider of school-based vaccination.

Section 7A: The agreement under section 7A of the National Health Service Act 2006 by which the Secretary of State delegates commissioning of national public health services, including immunisation, to NHS England.

UKHSA: UK Health Security Agency, established in 2021, responsible for health protection, surveillance and the immunisation team.

VFR: Visiting Friends and Relatives, a category of travel typically associated with longer trips, closer contact with host populations, and higher risk of imported infection.