Tackling vaccine hesitancy

Childhood immunisations and tackling hesitancy

Vaccination is important in preserving public health. Vaccines prevent millions of deaths each year. The United Kingdom has a robust and comprehensive vaccination program. The offer spans the entire life course, starting in childhood. 

A key vaccination for children is the MMR. MMR offers protection against measles, mumps, and rubella. It is offered at 12 months and again at 3 years and 4 months. This vaccine is critical due to the severe consequences of measles. One in five children who contract measles need hospital treatment. The 6-in-1 vaccine, is given at 8 weeks with three consecutive doses. It provides defence against diphtheria, tetanus, and polio. 

Liverpool was key in a successful nationwide COVID-19 vaccination program. Despite this, routine childhood immunisations have seen a decline. This mirrors a global trend. The decline has been particularly pronounced in the city. As a result, we have increased focus on immunisation and partnership efforts from public health. 

The annual data for 2022-2023 reveals a drop in vaccination rates. Only 80% of the city’s 2-year-olds receiving their first MMR dose. This represents a 2.1% decrease from the previous year. Some areas report MMR uptake falling below 60%. This increases the risk of a measles outbreak. Cultural differences could be influencing vaccination acceptance. 

The local screening and immunisation oversight group have developed a governance structure. This enhances coordination among partners and maximises resources in a fragmented landscape. There remains a need to further understand how to reverse the falling vaccination rates. 

Annual coverage rates key childhood vaccinations; Liverpool 2022-23

  • MMR1 at 2 years old 80% (previous year 82.1%) 
  • MMR2 at 5 years old 73.6% (76.5%) 
  • 6 in 1 vaccine at 1 year old 84.3% (83.3%)

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MMR Dose 1 (24 months) across Liverpool, North West and England

Line graph showing take up of 1st dose MMR vaccine in Liverpool, Northwest and England


  • Percentage of take up of MMR 1st dose vaccine (given at 24 months), comparison across Liverpool, North West and England between 2010 and 2023.
  • Graph shows a clear decline for all areas from 2013, with the greatest decline in take up in Liverpool.
  • Liverpool take up in 2010 is 92% and in 2023 it’s down to 80%.

Insight and behaviour change

Understanding why people do things is crucial for making positive changes. In Liverpool, we wanted to understand why some parents and carers don’t vaccinate their children. In 2023, we focused on talking to parents and caregivers with children under 5 who weren’t fully vaccinated. The goal was clear: to understand how we could increase childhood immunisation rates.

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People don’t know enough about the diseases vaccines prevent. They may also be unaware of potentially serious consequences.

Covid vaccinations have created a shift in how people consider vaccines. The pandemic has muddied thoughts around what ‘immunity’ is.  

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There are still myths about the vaccines linked to autism and even other developmental delays.

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Some parents believe that it is better to let children build natural immunity to diseases. This is not clinically appropriate advice for measles.

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A proportion of parents don’t feel they have enough information to make an informed choice. They may get their children vaccinated if they feel better informed. 

Insights have supported the development and pilot of a multi-layered behaviour change campaign. This is being rolled out across the North West. We are working in partnership with The UK Health Security Agency (UKHSA), Department for Health and Social Care and NHS England. The pilot will launch March 2024. It will consider the diverse cultures and backgrounds in our community. 

Liverpool Health Equity Project (HELP) 

Building on community-based approaches from Phase One, developed to tackle Covid vaccination inequalities. Phase two of HELP broadened its scope to tackle inequalities, relating to MMR. 

Public Health enlisted the Liverpool School of Tropical Medicine for a specific task. To bring together engagement workers, voluntary organisations, and primary care practitioners. The aim was to form Community Innovation Teams (CIT). These teams are in Central and North Liverpool and undertook training to collect and study local data. We found that some minority communities and younger parents have lower MMR vaccination rates. This highlights the importance of cultural perspectives. 

The teams talked to families to understand barriers to MMR uptake. They worked with artists and parents to create new resources about measles and MMR. Resources aim to take into account the cultural diversity in our community. They are used to sharing information at community events. Talking about these health topics with local communities has been challenging. Working with those communities affected most, increased our understanding. We identified barriers we may not have otherwise understood. We are making progress to boost childhood vaccinations with cultural sensitivity. Our goal is to keep children, young people, and communities safe from preventable diseases. 

A monitoring form was developed to evaluate the results of the HELP approach to increasing MMR uptake. An event will take place in the spring of 2024 to share the learning. 

This work on MMR recovery forms part of the local and regional measles elimination plans. These plans aim to reduce the likelihood of measles spreading. It will ensure we are as prepared as possible in the event of an outbreak.