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Clinical Effectiveness Group

Preventing future measles outbreaks

Rainbow over high rise residential buildings

The challenge

After clean water, immunisation is the most effective public health intervention in the world. But London has an immunisation problem, particularly with the Measles Mumps and Rubella vaccine (the ‘MMR’) which is given in early childhood. The capital is bottom of the UK league for MMR, and no London Authority is meeting the World Health Organisation (WHO) target of 95% immunisation. When rates fall below 95% there is real danger of a measles outbreak.

In 2019 there was an outbreak of measles, and the WHO removed the UK’s measles elimination status. Over half of the UK’s cases were in London.

This issue does not affect the population equally. Children living in areas of high deprivation or from Black and Asian ethnic backgrounds are more likely to completely miss - or be late in receiving - these protective vaccines. We want to reduce the impact of underlying inequalities and ensure every child is fully protected. To get there, we need to make it easier to spot children who may be missing out and make sure the health services reach them.

What we are doing

We are using patient data to empower the teams in east London general practices to improve childhood immunisation levels. We are developing a patient- and practice-facing tool called the Active Patient Link Immunisation tool (‘APL-Imms’) that uses data from the electronic health records held by GPs.

The tool has two steps: First, it enables staff working in a GP practice to list all children registered with their practice by different criteria: for example, their age, or whether MMR and other immunisations are due or overdue. Second, the practice team can view all relevant information about each child and use this to approach parents. The practice knows their patients and families best and will understand the issues that influence whether a parent can bring their child into the surgery. Using insight from APL-Imms, they can decide how best to encourage timely immunisation - whether that’s simply having a conversation or arranging a convenient time and place to give the vaccine.

The path to equitable immunity

Every child deserves the same chance of a healthy start in life, and a huge part of that is timely vaccination against serious and preventable childhood infections. We know these types of data-driven call/recall systems in general practice really do work to reduce inequalities and get children protected.

We have been funded to develop and test APL-Imms across east London, but our ambition is greater - we have designed it to work with all UK GP systems. We would like to roll it out across London and beyond, with clear guidance, to help healthcare professionals work smarter and put London on the path to become top of the class for equitable immunisation.


Team: Carol Dezateux, Ana Gutierrez, Milena Marszalek, Zaheer Ahmed, Isabel Dostal, Nicola Firman


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