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19/83 Children and young people at risk of not being immunised




The aim of the HTA Programme is to ensure that high quality research information on the effectiveness, costs and broader impact of health technology is produced in the most efficient way for those who use, manage, provide care in or develop policy for the NHS. Topics for research are identified and prioritised to meet the needs of the NHS. Health technology assessment forms a substantial portfolio of work within the National Institute for Health Research and each year about fifty new studies are commissioned to help answer questions of direct importance to the NHS. The studies include both primary research and evidence synthesis.

Research Question: What strategies are used currently to increase immunisation uptake for children and young people who are at risk of being only partially immunised or not immunised at all? What is their evidence base and what sort of future primary research is needed?

  1. Intervention: Strategies to enhance uptake and completion of recommended immunisation schedule in the target groups.
  2. Target groups: Children and young people at risk of being only partially immunised or not immunised at all – to be defined and justified by applicants but should include those groups identified in NICE guidance.
    Applications are encouraged which include recruitment from geographic populations with high disease burden which have been historically underserved by research activity in this field.
  3. Setting: Any appropriate settings – to be defined and justified by applicants but consideration should be given to primary care, settings where health assessments, statutory health reviews and immunisations take place, hospitals, non-health care settings such as schools and remote options such as social media.
  4. Study design:
    Mixed methods. 
    (i) A scoping review of strategies used to increase immunisation uptake in targeted groups of children and young people.
    (ii) A survey of current practice and qualitative work involving a range of key stakeholders to identify strategies used to increase immunisation uptake in the target groups and to explore reasons for their use, barriers and facilitators. 
    (iii) Building on the findings of [i] and [ii], an assessment of whether identified strategies are likely to be generalisable or specific to particular target groups. In addition, an assessment of the type of future primary research needed, including the development of specific research recommendations.
  5. Important outputs: Findings of scoping review; findings of the survey of current practice; recommendations for primary research.


The national childhood immunisation service is offered routinely in the UK through the Healthy Child Programme. The European Region of the World Health Organisation (WHO) currently recommends that on a national basis, at least ninety-five percent of children are immunised against diseases which are targeted for elimination or control and preventable by immunisation. In the UK, immunisation coverage varies within and between regions and falls short of the WHO recommendation for a number of vaccines. Differences in uptake persist and are associated with a range of social, demographic, maternal and infant-related factors. Factors associated with low immunisation uptake are well described in the literature and recent NICE guidance (PH21) has identified specific groups of children and young people who are at risk of being only partially immunised or not immunised at all.

NICE specifically highlighted that looked after children and young people are particularly vulnerable to receive only partial or no immunisation at all, with associated increased personal and societal risks. In addition, NICE identified other at risk groups of children and young people including those with physical or learning disabilities, those not registered with a GP, those from minority ethnic groups, and vulnerable children and young people such as those whose families are travellers, asylum seekers or who are homeless. The HTA Programme recognises that the children of parents who choose not to immunise their children are also at risk but this group is not the focus of this brief.

Whilst there is research evaluating different interventions to increase immunisation uptake in general, there is only limited research focused on strategies to reduce inequalities or differences in uptake, or that targets particular groups at risk of being only partially immunised or not immunised at all. Research is needed to identify how the immunisation status of vulnerable groups of children and young people can be improved and, in the first instance, the HTA programme is interested in commissioning the preliminary work outlined above.

Applicants should note that the Programme Oversight Committee has estimated that the cost of this work should be around £250,000.

Additional commissioning brief background information

A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the Funding opportunities page.  To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 4th December 2019. Applications will be considered by the HTA Funding Committee at its meeting in January.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

IMPORTANT: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in May.

Applications received after 1300 hours on the due date will not be considered.

Should you have any queries please contact us:


Telephone: Commissioning Funding Committee 02380 595510