Recommendation COVID-M4.3: Improve Vaccine Uptake Monitoring and Evaluation

The government agrees that effective monitoring and evaluation of vaccination uptake, confidence and delivery is essential to improving health outcomes for all vaccine-preventable diseases.

There are inequalities in coverage across our vaccination programmes. Additionally, childhood vaccination coverage has gradually declined over the past decade, and the government is clear that this trend must be reversed. We are maintaining close oversight of uptake and delivery, using data and evaluation to better understand the drivers and act to improve uptake.

As set out in our response to recommendation 2, a significant amount of work is being taken to improve vaccination uptake. In England, our 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 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

Across the UK, all 4 nations regularly assess uptake against measurable standards and monitor public attitudes towards vaccination. Governments and public health agencies also review evidence on interventions that support uptake and evaluate delivery approaches to inform future policy and operational decisions.

In England, vaccination coverage data is routinely published to enable national, regional and local trends to be identified, including differences in uptake between population groups. This data helps national and local partners to target interventions where inequalities persist, and assess the impact of efforts to improve access and uptake.

Alongside this, UKHSA, NHS England and local partners undertake research, service evaluation and evidence reviews to:

better understand public attitudes towards vaccination

identify barriers to uptake

assess which approaches are most effective

Moving forward, the government agrees with the Inquiry that lessons should continue to be identified from both routine vaccination programmes and the COVID-19 vaccination programme. While the circumstances of the pandemic were unique, there remains valuable learning on community engagement, communication, delivery models and reducing inequalities in uptake. This evidence will continue to contribute to future vaccination policy and planning.

Health is a devolved matter and approaches to monitoring and evaluation vary across the 4 nations. The government is committed to strengthening collaboration where this supports better outcomes. This includes recently implemented arrangements to share information across the 4 nations on:

how vaccination uptake data is gathered and reported

where we can share intelligence and learn from one another to support improvements in clinical practice and operational delivery

The government is also acting to further align the way data on public attitudes towards vaccination are collected and reported across the 4 nations, building on the findings of the Childhood vaccines: parental attitudes survey 2025, which covered the whole of the UK for the first time.

These actions will help the UK continue to revise and reshape its approach to improving uptake. Addressing declining vaccination coverage is a complex problem and requires us to work together to solve it.

Improving vaccine uptake requires a combination of approaches that reflect the characteristics of different vaccine programmes, communities and local areas. Evidence highlights the value of adapting delivery engagement strategies to local needs. This can include:

vaccination delivery using different types of health services

using tailored approaches to communicating information on disease risks and the benefits of vaccination

Decisions should therefore continue to be guided by the best available evidence and local intelligence.

Taken together, these actions will:

improve the evidence base for vaccination policy

improve understanding of what works to increase uptake

support more effective responses to inequalities in vaccination coverage across the UK

The Scottish Government accepts this recommendation in principle.

The Scottish Government agrees that robust monitoring, evaluation and reporting arrangements are essential to understanding vaccine uptake, identifying inequalities, addressing vaccine hesitancy and informing targeted interventions. We also recognise the value of collaboration and standardisation across the four nations to strengthen the evidence base on vaccine confidence and uptake and to support preparedness for future public health emergencies.

Scotland already maintains comprehensive systems for monitoring vaccine uptake through PHS and PSD Scotland. Vaccine uptake data are routinely collected, analysed and published across all national immunisation programmes, providing insight into coverage levels, demographic variation and inequalities in uptake. PHS also undertakes surveillance, analysis and research activities to inform service improvement and targeted action where lower uptake is identified.

The aims of this recommendation align closely with Scotland's 5-Year Vaccination and Immunisation Framework and Delivery Plan (2024-2029), which emphasises the importance of population health intelligence, reducing inequalities, improving equitable access to vaccination and using evidence to drive continuous improvement. The Framework commits partners across the SVIP to using data and insights to inform the design and delivery of vaccination services and to better understand barriers to uptake among different groups and communities.

SVIP are able to undertake large linkage studies using national datasets to investigate epidemiological and operational questions, to help inform, measure impact, evaluate and improve vaccine programmes.

A considerable number of large, national linkage studies have been undertaken since improvements to vaccination data and data structure at the beginning of the pandemic. These studies include measuring impact of vaccination programmes (e.g. effectiveness and safety) which provide evidence to support informed consent and decision making, and improvements to operational delivery, across immunisation programmes.

A key element of Scotland's approach to improving the monitoring and evaluation of vaccine uptake is the ongoing digital transformation of the SVIP. A multi-year programme is underway to modernise and expand Scotland's vaccination digital infrastructure, with the aim of delivering a lifelong national vaccination record and a more integrated digital experience for citizens and healthcare professionals. This will improve the quality, completeness and accessibility of vaccination data, enhancing interoperability across NHS systems, and strengthening Scotland's ability to monitor uptake, understand inequalities, evaluate interventions and support operational delivery.

Through implementation of the Framework, the Scottish Government will continue to work with PHS, NHS Boards and UK partners to:

Maintain and enhance surveillance of vaccine uptake and confidence levels across Scotland;

Strengthen understanding of inequalities in uptake and identify groups and communities that may benefit from targeted interventions;

Use data, insight and evaluation findings to support evidence-based approaches to increasing vaccine confidence and uptake;

Evaluate vaccination campaigns and improvement initiatives, using agreed measures where appropriate, to assess effectiveness and inform future policy and delivery;

Share learning and evaluation findings publicly, where appropriate, to support transparency and build confidence in vaccination; and

Work across the four nations to identify and share effective approaches to improving vaccination coverage and addressing vaccine hesitancy.

The Scottish Government supports ongoing collaboration between the public health agencies of the four nations to improve comparability of data and to develop a shared understanding of vaccine uptake trends, vaccine confidence and the effectiveness of interventions. While recognising that each nation operates within its own health system and data landscape, as well as responding to specific demographic and geographical realities, we agree that there is value in pursuing greater consistency where appropriate to support collective learning and pandemic preparedness.

The Scottish Government is currently considering the recommendation around the retrospective analysis of the Covid-19 uptake campaigns. Multiple analyses of various stages of the Covid-19 programme were undertaken during the pandemic and pandemic recovery phases and the learning from those analyses forms the genesis of most of the quality improvement work that has been completed and is underway. The Scottish Government and SVIP undertakes continual analysis of vaccine programmes, which informs quality improvement work at a national and local level.

3.1 The Welsh Government recognises the importance of accurate, consistent information on vaccine uptake in supporting confidence. Good quality data is essential to understanding where uptake is lower, identifying barriers, and supporting targeted action to reduce inequalities. There are historic challenges in the use of healthcare data to deliver effective public health outcomes that must be addressed, with vaccination uptake a priority across all programmes. This was set out in the National Immunisation Framework for Wales and continues to be part of national efforts to improve our vaccination infrastructure.

3.2 Public Health Wales has a central role in taking this forward, as one of the four public health agencies referenced in the recommendation. The Welsh Government, Public Health Wales, Directors of Public Health and Vaccine Programme Wales have reviewed existing surveillance data, evaluation of vaccine uptake and opportunities to strengthen monitoring work, including through national communication campaigns and improved data reporting.

3.3 Wales already contributes to regular national data forums attended by Public Health Wales. These forums provide an established way for the 4 nations to share data, compare approaches and consider where greater consistency or standardisation in reporting would help improve understanding of vaccine uptake and confidence across the UK. The ability to compare, and where appropriate combine, statistics across the UK is important for understanding variation, identifying shared learning and supporting public trust. It is also consistent with the Code of Practice for Statistics, which emphasises coherence, transparency and statistics that meet user needs.

3.4 The Welsh Government is also working with Digital Health and Care Wales to improve the collection, quality, and reporting of vaccination data through the ongoing development of the Welsh Immunisation System. This includes improving insights into vaccine uptake by deprivation, linked to the Welsh Index of Multiple Deprivation, and supporting more detailed reporting across a range of population characteristics, including sex, socio-economic status and rurality.

3.5 The Welsh Immunisation System already supports linked data between primary and secondary care as part of a single vaccination record for the Influenza, Covid-19 and Respiratory Syncytial Virus (RSV) programmes. The Welsh Government is committed to taking a planned approach to moving other vaccination programmes into this single record. This will support a move away from fragmented reporting arrangements towards a more consistent national approach. It will improve the ability to monitor uptake, identify variation and support targeted action where needed.

3.6 Welsh Government sets out expectations for vaccination uptake as part of its regular directions to the NHS in Wales ahead of programme delivery, or when programmes expand or change. The NHS in Wales also has high-level performance improvement targets for specific programmes set out in the NHS Wales Performance Framework. These targets are regularly reviewed as part of the same governance arrangements described in the response to recommendation 2. The Welsh Government also works closely with NHS Wales Performance and Improvement colleagues and NHS leaders to support improvements across the seven health boards.

3.7 Where vaccination uptake falls below expected levels, the NHS in Wales and the Welsh Government will continue to use, targeted catch-up campaigns where appropriate. The campaigns will be considered alongside other actions to improve uptake, such as changes, to how services are delivered, regulatory changes, or targeted communications. The Welsh Government fully recognises the importance of quality health data in understanding and driving improved performance and is committed to a health outcomes approach. This is why this Government has agreed to establish a Health and Care Data Audit Commission to oversee an audit of health data sources in Wales and the development of a health outcomes framework.

3.8 The Welsh Government and the NHS in Wales will continue to work with 4-nations partners to review approaches to vaccine confidence and uptake. We will also continue to commission, use and share research, such as in the recently published Public Health Wales study on RSV vaccination effectiveness in preventing hospitalisation, to support learning and improvement.

Accepted in Principle

The Northern Ireland Executive already carries out a significant amount of work to monitor and evaluate vaccination uptake and delivery. England, Scotland, Wales and Northern Ireland regularly assess uptake against measurable standards and monitor public attitudes towards vaccination. The NI Executive and the Public Health Agency, along with other devolved governments and public health agencies, also review evidence on interventions that support uptake and evaluate delivery approaches to inform future policy and operational decisions.

The NI Executive agrees with the Inquiry that lessons should continue to be identified from both routine vaccination programmes and the COVID-19 vaccination programme. While the circumstances of the pandemic were unique, there remains valuable learning on community engagement, communication, delivery models and reducing inequalities in uptake. This evidence will continue to contribute to future vaccination policy and planning.

As health is a devolved matter, approaches to monitoring and evaluation vary across England, Scotland, Wales and Northern Ireland. However, the NI Executive is committed to strengthening collaboration where this supports better outcomes. This includes recently implemented arrangements to share information across the four jurisdictions on how vaccination uptake data are gathered and reported, and where each country can share intelligence to learn from one another to support improvements in clinical practice and operational delivery.

In July 2026, an Oversight Board for the improvement of Vaccination Uptake was convened under the chairmanship of the Public Health Agency (PHA) Director of Public Health with the aim of halting the decline and improving vaccine uptake across all programmes (childhood, adult and seasonal) by providing strategic direction and coordination across all of the stakeholders involved in the development of vaccine policy, planning and delivery.

The NI Executive is also taking action to further align the way data on public attitudes towards vaccination are collected and reported across the four jurisdictions, building on the survey of parental attitudes to childhood vaccination in 2025 which covered the whole of the UK for the first time.

However, the actions taken will need to reflect the specific vaccine programme concerned, the population affected and local place-based circumstances. There is good evidence to confirm that no single intervention consistently improves uptake in all settings. While targeted vaccination delivery campaigns can be a valuable approach, there are many other effective ways to improve uptake, including vaccination delivery using different types of health services, and different approaches to communicating information on disease risks and the benefits of vaccination. Decisions should, therefore, continue to be guided by the best available evidence and local intelligence.

Taken together, these actions will strengthen the evidence base for vaccination policy, improve understanding of what works to increase uptake and support more effective responses to inequalities in vaccination coverage here and across the rest of 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.