How can we increase the uptake of the MMR vaccination in children?

Evidence briefing: How can we increase the uptake of the MMR vaccination in children?

This briefing is aimed at professionals involved in the planning and commissioning of Measles, Mumps and Rubella (MMR) vaccination programmes, or those with responsibility for MMR vaccination delivery in the health and care system.

The context

The rate of vaccination against MMR is declining in England. Currently 92% of children aged 5 have received at least one MMR vaccination, and 84% have received two. When the vaccination rate drops below 95%, the risks of an outbreak increase.

Across the North East and North Cumbria (NENC) as a whole, 96% of children aged 5 have received at least one MMR vaccination. In areas of deprivation, the rate can be as low as 77% receiving at least one (49% receiving both).

Common barriers to vaccination are well understood, including vaccine hesitancy due to misinformation, cultural and religious barriers, confusion around vaccination schedules, lack of access to appointments, and language barriers.

There is limited evidence on the effectiveness of interventions to improve vaccination rates. The recommendations in this briefing are based on the limited evidence available, combined with insights from available data.

Recommendations

Who to target

Prioritise children aged 6 to 18. Across NENC the vaccination rate for children aged 5 is 96% (third highest across all ICB in England). Reported vaccination rates are lower in older age groups, where efforts to increase uptake may realise more public benefit. Lower rates in older children may, in part, be explained by data quality issues.

Prioritise families in areas of high disadvantage, where vaccination rates are lower.

Improve data collection on vaccination records to help target the right groups.

How to target

Deliver in-person education sessions to parents to discuss the benefits of the MMR vaccine. Do not focus on ‘myth busting’ anti-vax or conspiracy narratives. Give training to health care staff to deliver these sessions.

Phone calls or home visits are the most effective form of communication with parents and can increase vaccination rates by up to 6 %.

Text-messages, including follow-up messages, are also effective with one study showing an increase in vaccination rate of up to 5 %.

Follow-up letters sent to parents or patients have limited impact, with increase rates of under 1%.

Some evidence has shown that online tools or apps that use gamification can be effective in improving education and subsequent vaccination rates. These can be used directly with older children, rather than parent.

Key recommendation: Take a ‘stepped’ approach to contact, starting with text messages, (including follow-up texts), then phone calls, and then home visits.

Where to offer vaccinations

Community pharmacies – this is a good route for patients seeking vaccination, freeing capacity in GP practices to focus on patients who are more hesitant.

Schools (incl. nurseries): These models rely on consent from parents. Evidence suggests that opt-out models (rather than explicit consent) are deemed acceptable by parents and may improve vaccination rate.

Secondary and tertiary care settings: Shown to be effective in increasing vaccination uptake, although the benefits are limited to patients in these settings.

Pop-up vaccination sites in the community: An effective way of engaging hard to reach groups, though they are often costly, and not sustainable in the longer term. These are most likely to be effective in catch-up drives, rather than as a routine route to vaccination.

Addressing inequalities: Provide additional resources in areas of disadvantage.

About this briefing

This briefing was developed by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) as part of a Knowledge Mobilisation sprint between December 2025 and March 2026. It was developed in collaboration with the North East and North Cumbria Integrated Care Board (ICB), to support their planning for increasing the uptake of the MMR vaccination across the region.

For more information, contact Arne Wolters via [email protected].

The full briefing, including detailed findings, recommendations, and methods used can be found on the following pages.