Comment 5 June, 2024

Shooting your shot: now is not the time to cut funding for vaccine delivery

Florence Conway

If you want to know what NHS England's true vaccine strategy is, follow the money. Over the weekend, The Sunday Times reported that public health spending will be cut by 3.5 per cent, £50 million pounds, as NHS England attempts to balance its books and fill its multi-billion pound shortfall.

This sits in the context of rises in vaccine-preventable diseases. In particular, there have been disproportionate increases in illness affecting children. Whooping cough and measles are on the rise, with some cases requiring hospitalisation and others resulting in death. Evidently, this is worrying in terms of health, social and economic outcomes, especially as these cases have been more prevalent in lower-income and deprived communities.

To their credit, NHS England released a new vaccine delivery strategy in December 2023. The strategy aims to increase vaccine uptake and coverage, and to reduce health inequalities across England. It puts Integrated Care Systems at the heart of commissioning immunisations and vaccines, attempts to open the front door of delivery, thinking about ways that vaccines can be delivered outside of general practice and targets increasing accessibility by, for instance, making vaccinations easier to book online.

Yet, the seriousness of the strategy is not being met with the cash to effectively deliver.

The funding cuts are part of a wider, long-term picture of spending on non-public health growing at a disproportionate rate. Last week’s Nuffield Trust explainer highlighted the imbalance of funding between different frontline health services. The difficulty here is that there will always be incentives to firefight parts of the system under greatest strain through reactive treatment, undermining the shift to prevention. Finding ways to achieve this ‘leftward shift’ in resources from acute providers to vaccination and other public health programmes will be key to producing better outcomes.

The Association of Directors of Public Health say these cuts could mean a further decline in vaccine uptake, likely to impact already disadvantaged communities the most and exacerbate already declining coverage. Moreover, it will likely lead to people becoming ill with preventable or detectable diseases.

So, with diminishing resources, what else can we do to ensure healthy populations and prevent disease from rising even more?

Last week, Reform hosted a research roundtable which brought together a small group of local directors of public health, practitioners, clinicians, policy thinkers, academics and other experts for a discussion on the behavioural drivers impacting vaccine uptake. It was a fascinating and valuable discussion, with several key ideas arising in how to tackle this challenge.


Ensuring people can build, maintain and sustain trust with a range of healthcare professionals and community leaders is vital in increasing vaccine uptake. Trust depends on having these people delivering the message. Often central government tries to convey the benefits of vaccines through national celebrities or the chief medical officer. But we know that one-size-fits-all messaging is much less effective than a trusted, personalised approach.

Honest communication

Therefore, honest communication is also another key theme. People’s perceptions of institutions and systems have changed. And, significantly, more deprived communities with a strong immigrant population have different attitudes towards medical establishments. Effectively communicating the benefits of vaccines, along with explaining the benevolence of vaccine/immunisation programmes is something leaders must do to ensure and increase in vaccine uptake.

There is also merit in ensuring honest communication about the risks of vaccines. It is important to allowing people to have a continuous dialogue where they can raise concerns and feel as though they are part of a conversation so that they can have an informed decision, rather than having mandates imposed on them.

Access and convenience

Alongside these tools, points were also made about physical accessibility and workforce. Making sure that vaccines are available and work with the grain of people’s lives will also mean expanding the workforce of who can deliver vaccines and where.

There is a lot that can be done to increase vaccine uptake and promote better outcomes. But it cannot be done with funding cuts and a lack of seriousness around delivery. NHS England needs to rethink the value of encouraging uptake and match its strategy with the flexibility and funding to deliver.

Stay tuned for an upcoming report on how Reform believes we can encourage vaccine uptake, in order to reduce health disparities, and put prevention at the heart of health policy.