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State of Child Health 2026: Immunisations

Health Policy team
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This indicator examines the rates of uptake of two doses of the MMR vaccine by age 5 and uptake of the 6-in-1 vaccine by 12 months in each of the four nations and how those have changed over time, as a proxy for vaccination uptake in general.
Last updated
Post date
14 July 2026
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Contents

This is one of 12 indicators in our State of Child Health resource. 

What is the problem?

In our first State of Child Health report, published in 2017, the immunisation indicator painted a positive picture, with small increases across the four nations.1 Since then, however, immunisation rates have declined. Last year, very few routine childhood vaccines met the 95%2 target threshold in England, Wales and Northern Ireland, with England performing particularly poorly.

Immunisation uptake in Scotland remains higher, although it has been subject to a gradual long-term decline. In 2023, the 6-in-1 vaccine had been administered to 91% of one-year olds in England, 92% in Northern Ireland, 94% in Wales and 95% in Scotland. This compares with a peak in 2012 of 95%, 97%, 97% and 98% respectively.

See chart in full

Following the publication in 1998 of a now-discredited paper falsely linking the MMR vaccine to autism, rates of uptake fell sharply across the UK.3 Although there were signs of recovery, peaking around 2014 at 89% in England and 93% in Wales, Northern Ireland and Scotland, coverage has since declined again. By 2024, fewer than 90% of children in all four nations had received two doses of the MMR vaccine by age five, with uptake at 84% in England, 86% in Northern Ireland, and 89% in both Wales and Scotland.

See chart in full

Immunisation uptake is not uniform across the population. In Scotland, children living in the most deprived quintile have 5% lower uptake of the 6-in-1 vaccine by 12 months than those in the least deprived quintile, and 10% lower uptake for two doses of the MMR by age five,4 a pattern repeated across the nations.5, 6 

Immunisation uptake is also lower in looked-after children and the children of younger parents, with only 82% of looked-after children having up-to-date immunisations in 2023-24.

See chart in full

Why does it matter?

As immunisation rates fall, there has been an increase in vaccine-preventable disease, including measles outbreaks across the UK.7 Sadly, children died last year (2025) in the UK from measles and pertussis,8 entirely preventable diseases with vaccinations. As immunisation rates continue to decline, other preventable diseases are likely to re-emerge, leading to increases in hospital admissions, morbidity and long-term disability, resulting in economic impacts.

Drivers of poor outcomes

There are multiple, complex reasons for declining vaccination rates. Misinformation plays a part,9 but there are significant systemic barriers which can make it difficult for parents to vaccinate their children. These include inconvenient appointment booking systems, limited appointment availability, unsuitable locations, and a lack of reminders.10

Families in our most deprived communities face disproportionate challenges, including difficulty in accessing primary care, getting time off work, and travelling to appointments. A survey by the RCPCH Commission on Immunisation found parents want clear, accessible information, the opportunity to discuss concerns with a trusted healthcare professional, and an easy way to check their child’s vaccination status.11

Efforts to increase vaccination uptake also need to be culturally sensitive and tailored to address the concerns of each community. 

Why we need to act now

If we fail to reverse the decline in immunisation rates, we are likely to see a continued rise in outbreaks of vaccine-preventable diseases, with lifelong consequences and an increasing number of avoidable deaths amongst all age groups, not just in children and young people.

A paediatrician's insight

From Dr Helen Stewart, Consultant in Paediatric Emergency Medicine and RCPCH Officer for Health Improvement

Your experience of supporting and/or treating children and young people who have not been vaccinated - has anything changed over time?

"I work in a Paediatric Emergency Department and, more and more, I am coming across unvaccinated children and young people. Over my career, I have seen a number of outbreaks of preventable infectious diseases. I have seen children extremely unwell from measles, mumps and whooping cough, and we have all seen children die from RSV and flu. The significant, unnecessary burden that this places on healthcare resources pales in comparison to the difficulty of seeing a child suffer when they don’t need to."

What have been the challenges to supporting unvaccinated children and young people - what contributes to this or results in them needing the NHS for support?

"Frequently, I encounter parents who have actively chosen not to vaccinate their child. These can be very difficult conversations, but so can those I have with parents who have tried to vaccinate but come up against barriers in the system, such as a lack of appointments or difficulty travelling to a convenient location. Many parents are also not sure if their child is fully vaccinated, and they have no way to check."

Any examples of good practice to tackle low vaccine coverage that you have been part of or aware of?

"It can be hard to know what to do in the face of low vaccine coverage, but our local trust has a number of initiatives to improve vaccination rates. Our health visitor service has set up walk-in catch-up vaccination clinics in local schools, and we are exploring the possibility of having an opportunistic vaccinator in outpatients. Feedback from the parent survey in the RCPCH Access to Vaccinations report from 2025 also highlighted parents’ desire for good, reliable information about vaccinations, and every paediatrician should be able to signpost parents to this information.

"One of the difficulties with the data we have explored here is its reliability. Vaccination uptake may be better than reported but may not be fully captured due to data collection difficulties, especially in highly mobile populations. Until recently, in the ED, we had no way to update vaccination records when we gave a vaccine in the department. We had to document it on the discharge summary and rely on the GP to input it onto the system. We now have an electronic form that we can complete that goes straight to CHIS (Child Health Information Services)."

Any advice you'd give to paediatricians that would help increase vaccine uptake?

"All paediatricians should be curious about their patients’ immunisation status and offer a space for open, non-judgemental discussions about parents’ concerns. This may, at times, seem fruitless, but it can take hearing information several times for it to be absorbed. Clearly, from this data, this issue is urgent." 

Recommendations

England
  • Increase investment in vaccination services and workforce to scale evidence‑based outreach, particularly in underserved communities, delivering vaccines in trusted local settings and supporting uptake through improved NHS App booking.  
  • Develop and implement a fully digital Red Book to give families and health professionals easy, reliable access to vaccination records and support more streamlined, responsive care.
  • Strengthen the healthcare workforce by equipping staff interacting with families with the training and support to confidently promote vaccination and support informed choices, alongside establishing local community vaccination champions to strengthen community engagement.
  • Progress plans for the use of the NHS number as a Single Unique Identifier for children, ensuring that learning from current pilots informs the design of any wider rollout. This must be accompanied by a clear and sufficiently ambitious implementation timeline across health, education, and social care, to support effective information sharing with a clear focus on safeguarding, data governance and public trust. 
Scotland
  • Increase investment in vaccination services and the workforce to expand capacity and ensure more flexible, accessible appointment options, with a specific focus on improving access for families in rural and remote areas.
  • Establish a single unique identifier for children and young people to support consistent and appropriate information sharing across health, social care and education services, enabling more integrated, holistic care.
  • Develop and implement a fully digital Red Book to give families and health professionals easy, reliable access to vaccination records and support more streamlined, responsive care.
  • Deliver a sustained, multi‑channel public health campaign providing accessible, culturally appropriate and translated vaccine information, including through social media, to strengthen understanding and build confidence. 
Wales
  • Welsh Government should support Public Health Wales and NHS Wales to provide accessible, accurate, culturally appropriate and translated vaccine information.
  • Expand the location and delivery of vaccination programmes through community-based, convenient and tailored approaches to reach underserved populations and boost overall uptake.  
  • Establish a single unique identifier for children and young people to support consistent and appropriate information sharing across health, social care and education services, enabling more integrated, holistic care.
  • Expand access to and awareness of the digital Red Book to give families and health professionals easy, reliable access to vaccination records and support more streamlined, responsive care. 
Northern Ireland
  • Increase investment in the Healthy Child, Healthy Future child health promotion programme to increase compliance with the Northern Ireland regional immunisation schedule, including prioritising investment in the health visitor service for NI.  
  • Deliver and provide long-term funding for evidence-based public communication campaigns promoting routine childhood immunisation. These should be accessible to all, delivered through multiple channels, and include targeted outreach to underserved groups, including migrant communities, rural populations and families in the most deprived areas.
  • Assess the feasibility of establishing a single unique identifier for children and young people to support consistent and appropriate information sharing across health, social care and education services, enabling more integrated, holistic care. Alongside this, the Northern Ireland Executive should consider digitising the Red Book to allow parents and child health professionals easy access to a child’s vaccination records.  
  • Ensure campaigns and service models are tailored to vulnerable and underserved groups, including migrant communities, rural populations and families in deprived areas, to help reduce inequalities in uptake. 

This is one of 12 indicators in our State of Child Health resource.