| General vaccine hesitancy |
Interventions targeted at barriers of convenience, complacency and confidence [23,44] Behavioural change interventions [107,108] |
| Lack of perceived trusted information [24,59,70]; concerns over combined vaccines [24,70,81]; concerns over side effects [44,65,82] |
Annual countrywide measles and MMR awareness programme Web-based decision aid tool providing clear, unbiased and evidence-based information on measles and MMR Official fact-checking for immunisation posts on social media and signposting to valid sources. |
| Lack of awareness of measles severity and availability of MMR vaccination programme [23,24,59] |
Annual in-school education campaigns Radio and TV advertisement messages Highlight routine availability of MMR not containing porcine gelatine |
| Inequalities in service provision [22,65,73,74,75,76,77,103] |
Annual in-school MMR catch-up and education campaigns Out-of-workday hours vaccination availability Focus on populations most likely not to vaccinate i.e., living in larger households, traveller communities, migrants, looked-after children [23] and children with learning disabilities [65] Foster public health programmes and ethos as in the North East of England [44] |
| Community-specific needs are not addressed [23,24,71,78] |
|
| Inadequate immunisation training [9] |
Vaccine-specific training for healthcare professionals [51,77] Effective communication and cultural awareness MMR uptake awareness to encourage opportunistic vaccine checks and reduce missed opportunities [24,109] |
| Lack of advanced information technology for surveillance [13,40] |
|
| Lack of funding [9] |
|
| Vaccine availability and affordability [20,110] |
This has historically not been an issue in England [111] Novel vaccine delivery innovations including microarray patches, slow-release preparations and enhanced thermostability [112] |
