Recommendation COVID-M4.2: Formalise Community Vaccine Equity Networks

The government agrees with the Inquiry that trusted relationships with communities are important to improving vaccine uptake, reducing inequalities and supporting clear, targeted communications. We agree that strong and sustained engagement with communities is important to ensure future vaccination programmes are accessible, effective and responsive to local needs. Building trust takes time and cannot begin only when a pandemic occurs.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive recognise that disparities in vaccination coverage persist and that sustained effort is required to improve access and confidence across all communities. Addressing these disparities is an essential part of their approach to vaccines. They are therefore continuing to:

strengthen community engagement and develop tailored approaches to improve vaccine equity

deepen understanding of the barriers to vaccination uptake and take action to address them

In England, the government and delivery partners are acting to improve equity in vaccination coverage among underserved communities. This action is co-ordinated across 4 areas:

making it easier for families to access vaccination services. This includes:

incentivising general practice to improve uptake in areas where rates are low

undertaking a multi-pronged programme of work to improve school-age delivery, overseen by our ministerial taskforce

evaluating new delivery models to improve access to vaccinations, such as through community pharmacies and health visitors

reforming the NHS so that it is best set up to improve vaccination uptake. This includes delegating the commissioning of vaccination services to integrated care boards (ICBs) so that they can:

tailor vaccination services to the needs of local communities

work to improve uptake. The performance of ICBs to improve uptake will be assessed through the NHS Outcomes Framework

giving parents and families more information about vaccination. As set out above, this includes:

provision of accessible resources to support informed consent through a bespoke web resource

delivering evidence-led, targeted national communications (across TV, radio and social media)

supporting healthcare professionals to have confident conversations with families about vaccination

counteracting misinformation and disinformation

investing in modern digital systems for vaccination to improve uptake. This includes:

giving patients and families access to a single vaccination record (viewable in the NHS App in the future)

making sure all relevant healthcare professionals can check vaccination records and record vaccinations

giving the NHS the data it needs to understand and improve vaccination uptake. This will be supplemented by local community-led information sharing with trusted partners

Underpinning these actions, UKHSA is leading work to further improve vaccine confidence and engagement with underserved communities. Through its Immunisation Equity Strategy: commitments for 2025 to 2030, UKHSA works with local authorities, the NHS, and voluntary organisations and community groups to better understand barriers to vaccination and support locally tailored approaches. UKHSA has also established an expert panel of voluntary and community sector organisations to support implementation of the strategy and strengthen links with communities.

In June 2026, UKHSA published a toolkit to support local areas to identify and act on immunisation inequities across all their communities, Understanding and addressing immunisation inequities: a practical toolkit for a collaborative, multi-agency approach, which uses a place-based approach and includes advice on approaches to community engagement and involvement.

NHS England has also published outreach guidance (on NHS Futures - requires sign in) to support commissioners and providers to plan, deliver and evaluate targeted outreach initiatives to understand communities.

Building on learning from the COVID-19 pandemic and wider resilience activity, considerations around equitable vaccine delivery have also been incorporated into preparedness work. For example, immunisation equity was considered through Exercise Pegasus, which brought together government, NHS, local resilience forums and other partners to test pandemic preparedness arrangements, including approaches to reaching groups who may face barriers to accessing vaccination during a future health emergency.

Furthermore, we are taking steps to strengthen collaboration and mutual learning through the UK Four Nations Forum - a UK-wide immunisation forum, convened by UKHSA (established in 2023), that brings together colleagues from across England, Scotland, Wales and Northern Ireland to consider factors contributing to:

declining uptake in some routine immunisation programmes

increasing inequalities across the UK

In 2026, an equity strategy subgroup of the forum is being established to support co-ordination and shared learning across the 4 nations in response to declining coverage and increasing inequalities in routine immunisation programmes. It is intended to support:

co-ordination between the 4 nations

mutual learning about approaches to immunisation inequalities

the sharing of learning on effective interventions

consideration of community engagement approaches

The devolved governments have also established arrangements that support the aims of this recommendation. These include vaccine equity networks, community partnerships, outreach approaches and national immunisation frameworks that have been designed to improve uptake and reduce inequalities. As health is a devolved matter, implementation will continue to reflect the different responsibilities, delivery models and local circumstances in each nation.

Reporting on progress to improve vaccine uptake and reduce inequalities is essential. Evidence on vaccine equity is currently reported through a range of publications and accountability arrangements across the devolved governments. To avoid duplicating existing work, we will focus on aligning any reporting progress with existing assurance and publication routes rather than publishing a single annual report.

Moving forwards, the government and devolved governments will work together to consider how best to:

build on existing community networks and governance structures

share learning on the effectiveness of interventions

identify specific and measurable actions to improve uptake and reduce inequalities

align any reporting on progress with existing assurance and publication routes

This will help avoid duplication while supporting a proportionate and joined-up approach across the UK.

The Scottish Government accepts this recommendation.

The Scottish Government recognises the Inquiry's finding that, while Scotland's Covid-19 vaccination programme achieved high levels of uptake overall, disparities remained across some communities and population groups.

We agree that sustained engagement with communities is essential to reducing health inequalities, improving vaccine confidence, and ensuring equitable access to vaccination programmes in both routine immunisation programmes and future public health emergencies.

We believe that responsibility for the establishment and management of those relationships should sit with the Scottish Vaccination & Immunisation Programme (SVIP), which is led by Public Health Scotland (PHS), but encompasses representation from the Scottish Government, NHS Boards, local authorities, the third sector and community organisations.

SVIP was formally launched in January 2024, with PHS taking on the role of senior responsible officer (SRO) with national leadership and coordination remit for delivery of all vaccination programmes in Scotland. PHS are resourced for this function by the Scottish Government.

Throughout the pandemic, Scotland adopted targeted approaches to improve vaccine uptake among underserved communities, including minority ethnic groups, people experiencing deprivation, faith organisations, disabled people, and others facing barriers to access. These approaches demonstrated the value of trusted community relationships and locally tailored communication and delivery models and CIREG members’ feedback highlighted the critical and essential role these relationships and organisations should play in any future whole-system civil emergency.

The Scottish Government already works closely with PHS, NHS Boards, local authorities, the third sector and community organisations to support equitable vaccine delivery. We agree that these relationships should be maintained and strengthened between public health emergencies, building on existing structures and avoiding duplication of established local engagement mechanisms.

The objectives of this recommendation align closely with the SVIP’s 5-Year Vaccination and Immunisation Framework and Delivery Plan, published in November 2024, which places equity, community engagement and public confidence at the heart of Scotland's vaccination programme.

The Framework sets out goals to improve impact, reduce inequalities, and reduce illness from vaccine-preventable disease, and also commits to ensuring timely and equitable access to vaccination, addressing barriers faced by underserved communities, and improving public engagement through the SVIP.

In taking forward this recommendation, the Scottish Government will continue to build on existing arrangements through the Framework and Delivery Plan, including:

Strengthening partnerships with local communities, third sector organisations, community leaders and NHS Boards to better understand and address barriers to vaccination.

Using population health intelligence and local insight to identify communities with lower uptake and develop targeted interventions to reduce inequalities.

Initial work is being undertaken to recognise the individual needs of protected characteristics and underserved groups in relation to vaccine accessibility and equity. This includes burden of disease and vaccine uptake data, some of which is focussing on certain disabilities, and learning disabilities.

Improving vaccine confidence through ongoing engagement and evidence-based conversations about vaccination.

Supporting a whole-system approach that mobilises the wider health and care workforce to promote vaccination and improve access.

Monitoring vaccine uptake and inequalities through SVIP and using this information to inform local and national improvement activity.

Annual reporting

To support this work, PHS began reporting childhood immunisation data by ethnicity and urban-rural classification in 2024. PHS has been publishing ethnicity and urban-rurality data for adult vaccines since the pandemic. It has now been rolled out across all vaccination areas subsequently and it is now standard to have a suite of equality breakdowns (e.g. by deprivation, ethnicity, urban-rurality, age, sex) in our uptake statistics.

In addition, more granular data is provided to stakeholders through the password protected platform (Discovery) for management information, local situation awareness, and local action.

PHS publishes an annual ‘Vaccination and Immunisation report’ that encompasses all programmes, as well as standalone reports for individual programmes that can be accessed via their ‘Publications’ page. PHS also report regular vaccine inequality data through its Vaccination Surveillance Dashboard. PHS also contribute to UK-wide reports, such as the ‘Influenza in the UK, annual epidemiological report’ published by the UK Health and Security Agency (UKHSA). We believe that the publications above meet the recommendation to publish an annual report.

Local Community Networks

PHS has a commitment to strengthen multi-sector stakeholder engagement with statutory, third sector, community, religious, workforce and other partners to increase support for vaccination within their networks. Engagement with organisations such as the Health and Social Care Alliance Scotland and Voluntary Health Scotland is well established, and partnerships are being expanded with organisations including the Scottish Refugee Council, Deep End GPs, Community Links Workers and charities representing ethnic minority communities, faith groups, LGBTQ+ communities, people with disabilities and those with specific health conditions.

Engagement with third sector partners has highlighted financial and capacity challenges and the importance of working through existing community networks rather than creating new vaccine-specific structures. Partners have also emphasised the need to build trust by addressing the wider issues affecting communities, including poverty, racism and exclusion.

Stakeholder feedback, including from CIREG members, has also highlighted the need for greater focus on people with learning disabilities and other disabled groups. PHS has undertaken initial engagement with relevant charities and support organisations to better understand barriers to vaccination and identify opportunities to improve uptake. This included a survey and workshop with charities representing people with disabilities, long-term conditions and older adults; research with primary and secondary care professionals, and a winter vaccines stakeholder webinar to raise awareness of the 2026 programme and encourage uptake among those most at risk. Further, PHS have been working with Scottish Government and the Adult Learning Disabilities - Annual Health Checks Implementation Group to support improved content on vaccinations.

Healthcare professionals remain among the most trusted sources of vaccine information. PHS has commissioned qualitative research with primary and secondary care professionals to explore the acceptability and feasibility of recommending vaccination across different care pathways. Early findings indicate knowledge and confidence gaps among healthcare professionals who do not routinely deliver vaccinations, and recommendations will be considered through SVIP governance structures during 2026.

Public Services Delivery Scotland (PSD Scotland) leads national workforce education on behalf of SVIP and has developed resources including:

Vaccine Conversations

Combatting False Vaccine Information

Inclusive Vaccination Practice

In addition, the SVIP Workforce Engagement and Development Sub-group is mapping the wider health and care workforce to support a "make every contact count" approach to vaccination promotion.

Four Nations Partnerships

The four nations address questions on equity in multiple forums, but in 2023 the nations, convened by UKHSA, participated in a UK Four Nations Forum to consider factors contributing to declining uptake in some routine immunisation programmes and increasing inequalities across the UK. Its report was published in March 2026, an equity strategy subgroup of the forum is being established to support co-ordination and shared learning across the 4 nations in response to declining coverage and increasing inequalities in routine immunisation programmes.

UKHSA have also begun to incorporate Scottish participants into its attitudinal and insight surveys for the first time, which should support greater co-ordination and coherence.

Communication strategies

PHS is committed to adopting an audience-first approach to vaccine communications, using insight to understand and address barriers to uptake within specific groups. Working with NHS Boards and community partners, PHS develops clear, accessible and evidence-based vaccine information, supports informed decision-making, works with trusted voices to reach groups with lower uptake, and evaluates the effectiveness of communications activity to support continuous improvement.

Work to support the aims of this recommendation is already well established in Scotland. Scotland's Population Health Framework (June 2025) sets the Scottish Government and COSLA’s long-term collective approach to improving health and reducing inequalities, recognising the role of prevention, including vaccination. Public bodies are also progressing towards becoming Public Health Organisations, embedding prevention and reducing inequalities across health and social care services.

Health Information Integrity Strategy

The Scottish Government's Health Information Integrity Strategy (October 2025) provides a framework for addressing false and misleading health information, recognising its potential impact on health inequalities and vaccine confidence. Delivery of vaccination-related actions under the Strategy is being taken forward through SVIP's Citizen Engagement Group.

Alongside this work, Scotland is continuing to strengthen and streamline vaccination data systems, including the collection, reporting and analysis of equality data, to support evidence-based improvements to vaccination services and reduce inequalities in uptake.

We also recognise the importance of collaboration across the four nations to share evidence and learning on effective approaches to increasing vaccine confidence and uptake among populations experiencing health inequalities. This will support a more resilient and equitable vaccination system for future pandemics and routine immunisation programmes. There are already examples of collaboration in four nation forums, including some vaccine programme specific groups, as well as the UK Forum on declining coverage and increasing inequalities across the routine immunisation programmes 2023-2025. In this, the four UK public health agencies explored factors that may be contributing to the continuing declining trend in immunisation uptake for some programmes together with increasing inequalities, which had occurred within all nations of the UK over the last decade.

We will work with colleagues across the four nations to ascertain the value of establishing a formal group to share evidence and best practice, beyond those that currently exist.

2.1 The Welsh Government fully recognises the importance of fair access to vaccines and trusted information. One of our key concerns is the divide in vaccination uptake between the most and least deprived in society, as well as other specific demographic groups and we are committed to addressing the discrepancy in health equity including wider determinants. Reaching and supporting communities who may face barriers to vaccination will remain central to the Welsh Government and the NHS in Wales future planning and approach.

2.2 The Welsh Government will continue to work with the UK government and the other devolved governments where shared principles, learning or coordinated action would add value. Wales’s approach reflects both the UK Health Security Agency’s community network model and the Welsh legislative, partnership and policy arrangements.

2.3 The National Immunisation Framework was published in 2022 and set out a programme of work to support the ongoing development of vaccination services in Wales. It reflected learning from the pandemic, and placed a clear focus on improving equity, access and uptake.

2.4 Since its publication, work under the framework has included the central procurement of the influenza vaccine, the development of equity strategies for each health board, and collaborative work to promote equal access and opportunity to receive vaccinations across Wales.

2.5 The framework also provided an opportunity to review governance arrangements for vaccination programme planning and delivery, with the aim of strengthening oversight. As part of this, a Vaccination Oversight Board was established, chaired by the Director of Public Health, to support decision making and assurance. The arrangements also included a Vaccination Equity Expert Group, chaired by a Health Board Director of Public Health, and a Vaccination Equity Network, to share learning and best practice.

2.6 Work supported through the Vaccination Equity Group includes the development of a health equity toolkit, which was rolled out to health boards in March 2026. A review of Health Board Equity Strategies and wider equity work, undertaken by a Clinical Research Fellow, has identified specific areas of improvement, including the need for a more consistent approach to local equity strategies across Wales.

2.7 Work has now begun to develop a new 5-year vaccination strategy. This will continue to focus on reducing inequity and improving uptake across Wales, by strengthening vaccination access, engagement and digital support. The forthcoming strategy will draw on existing activity to improve equitable access to vaccinations across Wales, supported by our renewed governance mechanisms.

2.8 Our approach will build on existing activities and learning from within Wales and elsewhere including use of behavioural science, co-production and asset-based approaches and public engagement and feedback including the Public Health Wales Time to Talk surveys. This includes strengthening links with community organisations, making better use of behavioural insights, developing clearer tools and standards, and working with partners to identify measurable actions to increase community engagement and trust and demonstrate improvements in take up and equity. This will continue to support co-production, statutory partnership working and the Well-being of Future Generations approach.

2.9 Progress will continue to be reported through national public health reporting arrangements, including reporting across deprivation and wider demographic factors. Reporting on this basis will strengthen further as work progresses towards a single vaccination record, which is discussed in more detail in our responses to recommendations 3 and 4.

Accepted in Principle

The Northern Ireland Executive are already acting to improve vaccine equity including through community engagement, tailored delivery models and work to understand and address barriers to vaccination. Across the UK, governments and delivery partners are using targeted outreach and local enhanced services; inclusive and accessible communications; and data-led approaches, in addition to routine monitoring, to identify variation in uptake, to support more equitable uptake amongst underserved communities.

In 2026, an equity strategy subgroup of the UK Four Nations Forum was established to support coordination and shared learning across the four jurisdictions in response to declining coverage and increasing inequalities in routine immunisation programmes.

The devolved governments also have established arrangements that support the aims of this recommendation. These include vaccine equity networks, community partnerships, outreach approaches and national immunisation frameworks, designed to improve uptake and reduce inequalities. As health is a devolved matter, implementation will continue to reflect the different responsibilities, delivery models and local circumstances in each nation.

Moving forwards, the NI Executive will work together with the other devolved governments to consider how best to build on existing community networks and governance structures, share learning on the effectiveness of interventions, identify specific and measurable actions to improve uptake and reduce inequalities, and align any reporting on progress with existing assurance and publication routes. This will help avoid duplication while supporting a proportionate and joined-up approach across the UK.

The Department of Health and Public Health Agency are in regular contact with counterparts in the Republic of Ireland to share relevant information.