How combining data, curiosity and operational expertise is improving immunisation uptake

Vaccination is one of the most effective public health interventions, but uptake is decreasing. It will require dedicated uptake improvement programmes to reverse this trend. Analysis and reporting of data is crucial in identifying vaccine eligibility and take-up, areas of highest need and potential barriers. However, in our experience of working with public health and NHS teams, operational insights – particularly around primary care – are essential to interpret that data accurately so that vaccination campaigns are appropriately targeted and resources are well spent.

Vaccinations reduce serious illness and hospitalisation, benefiting both individuals and health and care providers. The World Health Organization reports that childhood vaccines prevent between 3.5 and 5 million deaths every year across the globe and COVID-19 vaccines are estimated to have saved more than a hundred thousand lives in England alone. However, vaccination uptake was already in decline before the COVID-19 pandemic, and in the three years from 2020 to 2023, 67 million children globally were reported to have missed out on one or more vaccinations. NHS data for the UK showed that coverage for all 14 standard childhood vaccinations decreased in 2023/24, with uptake lower among children living in the areas of greatest deprivation.

To realise the benefits of better health and reduced burden on NHS services through improved immunisation uptake, it is necessary to understand what barriers exist and why, before deciding how best to direct staff and financial resources.

Key principles for vaccination programmes

Through NHS South, Central and West CSU’s work in delivering the National Immunisation Management Service, Child Health Information Services (CHIS) and wider operational and analytical support for public health, we’ve identified three core principles that can be applied across any geography to increase vaccination uptake while making best use of limited resources:

1. Making data meaningful

Regional screening and immunisation teams often tell us they are “drowning in data”. The challenge lies in making that data useful – getting, cleansing and interpreting the right data to enable robust, informed decisions. This requires regional teams, commissioners, GP practices and CHIS providers to collaboratively extract and process live data from operational systems to give a timely, accurate picture of vaccination status, rather than relying on information that may be several weeks out of date.

But we also need to ensure we are making recommendations and decisions on data that is accurate and complete. Building in mechanisms to fill gaps in data or improve how information is coded, such as insight reporting, can significantly improve an organisation’s ability to target the right cohorts in the right way. To improve quality of primary care ethnicity data in London, for example, we used a text message campaign to enable registered patients to select their ethnicity which was automatically coded into the practice record.

2. Understanding the issues

Being curious about what the data appears to show, and applying operational insights to inform interpretation, can make a significant difference to the direction – and ultimate success – of a vaccination programme. For example, when the East of England region was experiencing poor COVID-19 vaccine uptake among white working-class young males, it was easy to link this to typically low engagement with health services.

A contact centre campaign to call those who hadn’t responded to invitations revealed that the real issues were the high number of people on zero-hour contracts, who couldn’t afford to take time off work for appointments, and lack of access to transport to get to vaccination centres. By deploying vaccination buses to places of high employment, such as large warehouses and farms, take-up improved, benefiting individuals, health services and large regional employers who were able to avoid operational disruption.

Similarly, when COVID-19 uptake levels within the Chinese population in the North West were reported to be low, initial assumptions were that this was culturally motivated. By viewing the data through a primary care operations lens, however, we were able to discern that the issue was only among 20- to 30-year-olds, who had registered with practices near to universities, but had since moved areas or countries. It was a simple record-keeping issue rather than a more complex cultural issue, avoiding the need for a costly community engagement campaign.

3. Enabling multidisciplinary discussion

Real-time data and dashboards are useful tools but bringing together people to discuss and interrogate what the data means is incredibly valuable. Allowing time to talk though the ‘why’ helps to ensure that when organisations take action, it is productive and cost-effective. Useful questions to cover include: what are the key issues coming through? What are the continuing trends? Where is the evidence for this? What methodology is being used and is it sound? What could this mean operationally?

In the North West, the NHS England regional team uses monthly reports on the measles, mumps and rubella (MMR) vaccination campaign to bring together public health, screening and immunisation colleagues to share and work through the analysis, making time for important dialogue and collaboration on potential issues and interventions. This approach has proved so positive that it has now been commissioned for the entire 0-5s childhood immunisation programme across Greater Manchester.

Using limited resources effectively

Vaccine promotion must be targeted in the most effective way possible to benefit our patients and communities. This is as much about the activity organisations stop doing as it is the plans they pursue. In applying the above principles, we are seeing organisations develop cost and resource-efficient strategies based on a sound understanding of both the data and how it applies operationally.

Using this approach, Blackburn with Darwen ICS discovered that clinic locations and language were the main barriers to flu vaccine uptake among 2- to 3-year-olds in deprived and multi-ethnic areas. Adopting a collaborative approach with regional, ICB and GP practice colleagues, including arranging weekend clinics and sending out information in multiple languages, has helped to increase flu vaccine uptake by 10 per cent in 12 practices.

Bringing curiosity and operational expertise to data analysis has also avoided additional investment in a resource-intensive ‘call and recall’ campaign to improve MMR vaccination rates in young adults and teenagers. Although the data initially suggested the campaign was working, further analysis showed this was due to vaccination records being retrospectively updated within GP practices rather than vaccine uptake increasing.

The Darzi investigation urges the NHS to focus on furthering the shift from ‘treatment to prevention’. Ensuring our core public health interventions are optimised is a solid first step, and these principles apply not just to vaccines but also to screening and health checks programmes. More than 12 months on from the launch of the first NHS vaccination strategy, there is still much learning and best practice to emerge. But in our drive to progress, we must take time to challenge assumptions and fully understand what the data is telling us so that interventions are resource-efficient and deliver results.