Mind the Gap: London’s low flu vaccination rates, and how to fix them

This report explores the reasons why Greater London reports the lowest uptake in England for adult flu vaccination.

The World Health Organisation recommends that at least 75% of people aged 65 or over receive a vaccine against influenza – a target which England failed to reach between 2004-05 and 2019-20. Greater London fares especially poorly when measured against this standard, with coverage 6.6% lower than the national average in 2019/20, a gap wider than it has been since the programme began in 2000.

Some of our most notable findings include:

  • The gap in reported vaccination rates between high- and low-income households is wider in London than other major urban areas in England. In London, 58% of eligible people from households earning below £20,000 were vaccinated against the flu in 2019-20, compared to 93% for patients from households earning above £80,000.
  • Nevertheless, despite having one of the highest levels of deprivation in the UK, Tower Hamlets was the London borough with the highest flu vaccine uptake among all eligible groups.
  • While the Tri-borough (Westminster, Hammersmith and Fulham, and Kensington and Chelsea), one of the most affluent areas in London, had the lowest uptake.
  • The 2012 Health and Social Care Act centralised the commissioning and coordination of immunisations, leaving commissioning teams for London with 36 times more patients than they had before the Act. With reduced capacity to address the particular needs of local areas within Greater London, the gap between the capital and the rest of England increased by 5 percentage points

The 2020-21 flu season has seen greater resourcing and expanded eligibility criteria on the basis of research suggesting an increased risk of severe illness and death from co-infection with flu and Covid-19. But many barriers to improving coverage identified in this report will persist beyond the pandemic, and therefore require sustained policy change.


Our key recommendations include:

  • NHS England should explore using pop-up clinics for flu vaccination.
  • NHS England and Improvement (NHSEI) should work to establish local immunisation coordinator roles.
  • A more London-friendly commissioning structure - a review of where strategic responsibility for improving immunisation coverage sits, to address the disparities in the numbers of patients and providers for which teams are responsible.
  • Improved primary care access for underserved areas – Efforts must be made to ensure distribution of the new GPs enrolled in line with the Conservatives’ 2019 manifesto is targeted to deprived areas that are currently underserved.
  • Better data sharing - Greater integration of community pharmacies by ensuring data sharing technology in both general practices and pharmacies are fully up to date.