Prevention begins with childhood immunization

Disclaimer: MSD funded and had editorial control over this article

The Government has rightly put preventing and reducing health inequalities at the heart of its ambitions for NHS reform, recognizing that early intervention, including during the first 1,000 days of life, is critical to improving long-term health outcomes and giving every child the best possible start.¹

However, immunization is still not reaching every child equally. Vaccination coverage rates are now falling below the World Health Organization (WHO) target of 95 per cent across all routine programs and the UK has lost measles elimination status for the second time.^{2 3}

Persistent inequalities by geography, ethnicity and deprivation mean that the lowest coverage is often seen in the same communities that already face wider health barriers, with these inequalities continuing from early childhood to adolescence.⁴

Recent measles outbreaks clearly illustrate the consequences. During the 2023–2024 outbreak in Birmingham, 78 per cent of confirmed cases were concentrated in the city’s most deprived communities.⁵ Meanwhile, adolescent immunization programs such as HPV continue to demonstrate uneven coverage – among 9 girls in London at just 62.6 per cent in 2024/25, compared with 81.1 per cent in the East of England in the same cohort.⁶

The House of Lords inquiry into childhood vaccination therefore comes at a critical time, as the NHS prepares for changes to the way vaccination services are commissioned and delivered across England, with the NHS Modernization Bill set to give local health systems responsibility and flexibility in designing vaccination provision for their local populations.⁷

These reforms offer an important opportunity to strengthen prevention and improve access for underserved communities – but we cannot ignore the risk that regional variations and disparities could be further entrenched. Action must therefore be taken at every level of the NHS to more strongly embed equity in the design, delivery and evaluation of childhood immunization programs – from birth, to infancy and beyond.

The recent rollout of national infant RSV prevention provides an important example of how program design and delivery can affect equitable access to immunization during the earliest stages of life.

The UK infant program for RSV prevention currently consists of indirect coverage through maternal vaccination, supplemented by an offer of monoclonal antibodies (mAb) administered directly to a smaller group of high-risk infants.⁸

However, variations in maternal vaccination coverage have already emerged. In December 2025, maternal vaccination coverage ranged from 54.4 per cent in London to 72.1 per cent in the South West, while coverage was reported at 34.2 per cent among black Caribbean women, compared with 76.2 per cent among ethnic Chinese women.⁹ If we are serious about giving every child the best possible start in life, we cannot accept these gaps in protection against preventable disease as inevitable.

So what needs to change?

First, immunization programs must be designed around the needs of families and local communities.

While lower vaccination coverage may in some cases reflect reluctance, it is also shaped by a wider set of factors, including awareness and ability to access vaccination services, fragmented delivery routes, workforce pressures and local variations.¹⁰ Together, these affect whether families are able to take advantage of prevention offers.

To improve coverage and reduce disparities, immunization programs must “meet families where they are.” Experience from other countries suggests that programs built around locally tailored provision can support higher and more equitable coverage.

Spain achieved coverage rates of over 90 percent among in-season infants during the first year of its RSV infant immunization program, which used mAb for RSV prevention administered directly to infants.¹¹

Some Spanish regions supported outreach through parent engagement strategies, including the distribution of videos led by health care professionals on social media platforms, proactive messages addressing frequently asked questions, and translated materials sent directly to parents from underserved communities.¹²

This approach has been successful in promoting rapid uptake in other countries as well.

Ahead of the 2024/25 RSV season, Ireland introduced an infant tracking program that offered an RSV prevention mAb administered directly to infants born between September and February. The roadmap achieved 83 percent immunization coverage, with a range of 76.4 to 84.5 percent across regions of the country.¹³

Second, data and evaluation must play a greater role in guiding how immunization services are commissioned and delivered. Future evaluation efforts should focus not only on overall coverage rates, but also on how programs are equitably reaching different communities. This will require clearer accountability underpinned by transparency – similar to national audits – in evaluating services, more routine publication of vaccination data by geography, ethnicity and deprivation, and better use of data to guide commissioning decisions and design services around the needs of local populations.

Third, maternal vaccination programs should be treated with the same ambition and accountability as broader childhood immunization programs. Increasing coverage of maternal immunization programs requires sustained investment, sustained delivery and long-term commitment. The current maternal RSV vaccination program has already reached about 63 percent coverage after two years of investment.¹⁴ approaching coverage levels seen in the long-established maternal pertussis program in more than a decade.^{15 16}

However, maternal vaccination programs are too often considered separate from the wider childhood immunization agenda, despite their critical role in protecting infants during the earliest stages of life. If the government is serious about delivering a preventative NHS first, maternal immunization programs – including RSV – must be held to the same ambitions around coverage, equity and accountability as childhood vaccination programs more broadly. MSD is committed to supporting efforts across the health system to reduce vaccination disparities, share lessons from different delivery approaches, and support progress toward more equitable access to protection from birth. Ultimately, efforts to improve childhood vaccination coverage will only succeed if equity is not addressed as an outcome of vaccination policy, but as a principle that underpins the way programs are designed and implemented from birth.

1. Health and Social Care Committee, The first 1000 days: a renewed focus, January 2026 ↩︎
2. The Nuffield Trust, Immunization coverage for children and mothers, February 2025. ↩︎
3. BBC, UK loses measles elimination status, January 2026. ↩︎
4. Skirrow et al., Impact of pregnancy vaccine uptake and socio-demographic determinants on subsequent childhood measles, mumps and rubella vaccine uptake: A UK birth cohort study, January 2024. ↩︎
5. BMJ, Measles: children and vulnerable communities face disproportionate harm, 2026. ↩︎
6. UK Health Safety Agency, Adolescent human papillomavirus (HPV) vaccination coverage in England: 2024 to 2025, January 2026. ↩︎
7. NHS England Live Commissioning Update, March 2026. ↩︎
8. UK Health Safety Agency, RSV vaccination of pregnant women to protect babies: information for healthcare practitioners, March 2026. ↩︎
9. UK Health Safety Agency, Maternal respiratory syncytial virus (RSV) vaccination coverage in England: November 2025, 2026 report. ↩︎
10. Health and Social Care Committee, The first 1000 days: a renewed focus, January 2026. ↩︎
11. Pérez Martín, JJ, & Zornoza Moreno, M, Implementation of the first respiratory syncytial (RSV) immunization campaign with nirsevimab in an autonomous community in Spain, 2024. ↩︎
12. Pérez Martín, JJ and Zornoza Moreno, M, Implementation of the first respiratory syncytial (RSV) immunization campaign with nirsevimab in an autonomous community in Spain, 2024. ↩︎
13. HSE Public Health, Respiratory Syncytial Virus Immunization Pathfinder Program 2024-2025 Evaluation – Executive Summary, December 2025. ↩︎
14. UK Health Safety Agency, Maternal respiratory syncytial virus (RSV) vaccination coverage in England: November 2025, 2026 report. ↩︎
15. McAuslane H, Utsi L, Wensley A, Coole L, Inequalities in maternal pertussis vaccination uptake: a cross-sectional study of maternity units, 2018. ↩︎
16. UK Health Safety Agency Prenatal pertussis vaccination coverage in England January to March 2025 and annual coverage for 2024 to 2025, 2026. ↩︎

Work bag: GB-NON-13018
Date of preparation: June 2026

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