Vaccination coverage is the best indicator of the level of protection a population will have against vaccine-preventable communicable diseases. Coverage is closely related to levels of disease; monitoring coverage identifies possible drops in immunity before levels of disease rise.
In England, vaccinations for diphtheria, tetanus, polio, pertussis and haemophilus influenza b (Hib) were offered separately between 1994/95 and 2005/06, and uptake declined slightly over this period. From 2006/07 onwards a combined vaccination against all five diseases was introduced, and uptake subsequently improved.
The availability of a single, combined vaccination may have simplified the childhood vaccination schedule for children and parents. However, between 2006/07 and 2010/11 similar improvements in uptake were observed for the pneumococcal (PCV) vaccination and the Hib/meningococcal group C (MenC) vaccination, suggesting an overall increase in vaccination coverage, irrespective of the new delivery method. In 2017, the five-in-one vaccine was replaced by the hexavalent six-in-one vaccine that additionally offers protection against hepatitis B. In 2018/19, children received either the five-in-one or six-in-one vaccine, depending on when they were vaccinated. The figures used here refer to five-in-one coverage, as all children received this component of the vaccine.
Between 1994/95 and 1996/97, there was a relatively steady rate of measles, mumps and rubella (MMR) vaccine coverage for children reaching their second birthday in England, of around 91%. In 1998, a now discredited article appeared in The Lancet which linked the MMR vaccination to autism. Uptake decreased significantly, and by 2003/04 only 79.9% of children were vaccinated. The Lancet partially retracted the paper in 2004 and fully retracted it in 2010, and coverage consequently improved, reaching 92.7% in 2013/14. However, MMR vaccine coverage has now fallen for the fifth successive year. Uptake was 90.3% in 2018/19 – down from 91.2% in 2017/18, and the lowest level since 2010/11.
Coverage for all of the childhood vaccinations plateaued between 2011/12 and 2013/14, and has since declined. The World Health Organisation (WHO) recommends that on a national basis at least 95% of children are immunised against vaccine-preventable diseases and these diseases are targeted for elimination or control. There is an expectation that all UK routine childhood immunisations that are evaluated up to five years of age achieve the 95% coverage in line with the WHO target. In 2018/19, for the first time since 2008/09, none of the routine vaccinations met this target.
In 2018/19, childhood vaccination coverage for DTaP/IPV/Hib, PCV and MMR was over 90% for all UK countries. In general, there was little variation between the four nations, although England's coverage was around 3% lower than the other three nations.
The latest provisional data shows that in 2018, there were 968 laboratory-confirmed measles cases in England. This is a steep rise in cases compared to the 283 confirmed measles cases in 2017. The current outbreak is linked to importations from Europe that have led to some limited spread in the community, particularly among teenagers and young adults who did not receive the MMR vaccine when they were younger. There were also previous outbreaks in 2008 (1,280 cases) and 2012 (1,920 cases).
Rising cases of mumps are also a concern among young adults who did not receive the MMR vaccine when they were younger. Provisional data shows that there were 5,042 lab-confirmed cases of mumps in England in 2019, up from 1,066 cases in 2018 – this is the highest number of cases for a decade (data not shown).
The UK achieved WHO measles elimination status in 2017. However, the increase in cases in 2018 led the WHO to conclude that transmission of the measles virus had been re-established, and elimination status was lost. The UK Measles and Rubella elimination strategy was launched in 2019, and includes a national ambition to achieve and sustain the WHO target of 95% coverage for two doses of the MMR vaccine in five-year-olds.
Uptake of the first dose of the MMR vaccine in five-year-olds met the 95% WHO target for the first time in 2016/17, but fell to 94.5% in 2018/19 (data not shown). Coverage of the second MMR dose in five-year-olds has fallen for the last four years and is suboptimal at 86.4% – well below the 95% WHO target. In March 2019, the chief executive of NHS England warned that vaccination deniers were gaining traction on social media, and may be contributing to the decline in the uptake of the measles vaccine in recent years.
The UK's DTP vaccination coverage has improved over time, from 91% in 2000 to 94% in 2018. Belgium, Greece, Japan, and Portugal have very high DTP vaccination rates, all showing over 98% coverage in 2018. Austria's DTP coverage was 82% in 2018, which is the lowest of the OECD countries compared here.
Between 2000 and 2004, the UK's vaccination coverage for measles fell from 88% to 81%. This was in response to the safety concerns surrounding the measles, mumps and rubella (MMR) vaccine. Since 2004 the coverage rate has recovered, reaching 92% in 2018. In 2018, Portugal had the highest measles vaccination coverage (99%) whilst Canada had the lowest (90%).
All girls aged 12 to 13 are offered the HPV (human papilloma virus) vaccination as part of the NHS childhood vaccination programme, and given a series of injections within a 12-month period. The vaccine protects against a group of viruses that have been linked to the development of cervical cancer, and some rarer anal and genital cancers, and cancers of the head and neck. Not all cervical cancers are caused by HPV and so the vaccine does not result in immunity to cervical cancer, only to one of its potential causes.
There has been a consistently higher uptake of the first dose of the vaccine than subsequent doses, over time in England. Uptake for the HPV vaccination remained fairly static between 2011/12 and 2013/14, with an average uptake of 90.9% for the first dose and 89.7% for two doses. By 2018/19, uptake had declined slightly, with an uptake of 88.9% for the first dose and 83.9% for two doses.
It is important to note that the vaccine coverage data collected from 2014/15 onwards are not directly comparable to previous years due to changes to the HPV schedule from three doses to two in September 2014. From the 2019-20 school year, the HPV vaccination programme will be extended to boys aged 12 to 13 years in England. This decision is based on advice from the Joint Committee on Vaccination and Immunisation (JCVI), and will help prevent more cases of HPV-related cancers in boys and girls, such as head and neck cancers and anal and genital cancers.
Despite high vaccine coverage since the early 1990s, in the five years prior to 2012 there were nearly 800 confirmed cases of whooping cough, where on average there were 270 babies admitted to hospital per year and four deaths. Babies under three months of age are too young to have completed a primary course of the pertussis vaccine, but the incidence of the disease is highest in infants of this age and they have the greatest risk of complications and mortality (Public Health England). In response to a national outbreak, the Department of Health announced that pertussis immunisation would be offered to pregnant women from 1st October 2012 to protect infants by boosting the short-term immunity of babies until they can be vaccinated themselves (Department of Health).
As shown in the chart, pertussis vaccination coverage for pregnant women in England is not especially high, reaching 69.4% in September 2019. Since its introduction in October 2012 there has been an increase in uptake from 43.7% to a peak of 76.2% in December 2016.
About this data
For the schedule of vaccinations please see the NHS website.
For all vaccinations some caution should be exercised when comparing coverage figures over time due to data quality issues reported by some data providers. Apparent trends could reflect changes in the quality of data reported as well as real changes in vaccination coverage. Please see individual data collections for any additional information associated with these data.
Definitions and comparability for the international indicators are taken directly from the OECD’s Health at a Glance 2019: OECD Indicators. Detailed information about the definitions and the source and methods for each country can be found here.