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Theme 3: Vaccine delivery and confidence

The overarching aim of the ‘Vaccine Delivery & Confidence’ research theme is to understand factors that contribute to challenges in programme delivery and performances, lack of public confidence in immunisation and poor vaccine uptake.

The aim is to collect date that will help determine ways to resolve these issues. Our research strategy focuses both on the organisation of health systems involved in the immunisation programme and populations with poor vaccination coverage (e.g. elderly, risk groups aged <65 years, pregnant women, health care workers, urban migrants) in order to improve coverage and programme efficiency.

In addition, the plan is to be responsive and flexible and to make use of on-going data produced by Public Health England in order to tailor subsequent research to under-served populations and particular concerns that arise. We aim to deliver results that feed directly into policy recommendations to ensure that the immunisation programme and related health systems can respond intelligently, rapidly and effectively. 


  • Influenza vaccination of health care staff in acute hospitals
    Sandra Mounier-Jack, Sadie Bell, Tracey Chanter, Angela Edwards, Jo Yarwood, Pauline Paterson
    In this study commissioned by NHS improvement and PHE, we aimed to identify factors which drive high or low vaccination uptake of healthcare workers in acute trusts, and investigate the effect of the opt-out policy introduced in 2018/19. The study explored the views of vaccinators and flu programme managers on the seasonal influenza vaccination. The study was conducted in 9 acute hospitals with varying coverage and involved over 50 interviews. The study results are helping the Department of Health and NHS England to refine national policy guidance for next year.
  • Understanding factors influencing vaccination access and uptake in Polish and Romanian communities
    Sadie Bell, Michael Edelstein, Vanessa Saliba, Mateusz Zatonski, Mary Ramsay, Sandra Mounier-Jack
    In a two-phase interview study, we have looked at factors affecting vaccination access and uptake in Polish, Romanian and Roma Romanian communities. Study findings have highlighted a need for clearer signposting on how to navigate the NHS, the provision of information about vaccinations in translated forms, and support for healthcare workers to manage differences in vaccination schedules between countries. To promote vaccination and prevent disease outbreaks, healthcare workers and public health partners need to work together to build trust and links with underserved communities who may face additional barriers to accessing health services.
  • Evaluation of the Implementation of Routine Vaccination at GP Practice Level in England
    Tim Crocker-Buque, Mary Ramsay, Sandra Mounier-Jack
    The aim of this study was to undertake an evaluation of the implementation of routine vaccination at GP practices in England. Time-Driven Activity Based Costing was used to undertake a process evaluation and costing analysis, alongside semi-structured interviews in a geographically and demographically diverse set of GP practices. Findings showed that reimbursement was likely to meet costs associated with the programme, however there was potential to improve the funding mechanism. Practices were found to be isolated and lacking information on performance and support to make programme improvements. Greater strategic leadership at national and practice level and better coordination between professional groups could build on high levels of intrinsic motivation among staff to improve programme delivery. Some parents did not consent to their child being vaccinated as part of school based influenza immunisation pilots. The purpose of this study is to learn more about their concerns in order to inform future implementation.
  • Providing evidence to improve HPV vaccine delivery in schools
    Tracey Chantler, Sadie Bell, Pauline Paterson, Vanessa Saliba, Michael Edelstein, Louise Letley, Sandra Mounier-Jack
    We conducted a mixed method evaluation to identify service-related factors, which may have contributed to a decline in HPV vaccination coverage from 2014 when there was a change from a three dose to a two dose schedule. This involved interviews with commissioners, providers and focus group discussion with parents and adolescents, as well as immunisation observation in several regions. This study determined that service-related factors including non-return consent forms, complex data management systems, and lack of engagement and collaboration with some schools may have contributed to the slight downward trend in HPV vaccination coverage since 2014 and identified ‘good practice’ which could mitigate these. Subsequently, a follow up study was conducted to evaluate an innovative e-consent process in 8 London boroughs. 
  • Delivering immunisation in the context of organisational change
    Tracey Chantler, Saumu Lwembe, Sandra Mounier-Jack
    In this study we are evaluating how the national immunisation programme in England is adapting to changes in the health care environment, with a particular focus on programme delivery and performance.
  • Parental concerns about the school-aged influenza vaccination programme
    Pauline Paterson, Tracey Chantler, Heidi Larson
    Some parents did not consent to their child being vaccinated as part of school-based influenza immunisation pilots. The purpose of this study is to learn more about their concerns in order to inform future implementation.
  • Understanding factors influencing vaccination uptake among ethnic minorities during pregnancy: A qualitative study of pregnant women and healthcare workers in England
    Rose Wilson, Pauline Paterson, Heidi Larson
    This doctoral study explores perceptions of pertussis and influenza vaccination during pregnancy.
  • Vaccine information-seeking behaviour: Its predictors and influence on vaccination during pregnancy
    Richard Clarke, Pauline Paterson
    Pauline Paterson is supervising a Bloomsbury ESRC-funded PhD student, Richard Clarke, who has conducted two systematic reviews and two survey studies on the predictors and influence of vaccine information-seeking behaviour on vaccination during pregnancy.

Lead researchers

Heidi Larson

Senior Lecturer

London School of Hygiene & Tropical Medicine

Sandra Mounier-Jack

Associate Professor in Health Policy

London School of Hygiene & Tropical Medicine

Joanne Yarwood

Immunisation Programme Manager

Public Health England