Official Statistics

Seasonal influenza vaccine uptake in GP patients in England: winter season 2023 to 2024

Published 23 May 2024

Applies to England

This report describes the final influenza vaccine uptake data for GP-registered patients in England for 2023 to 2024 (1 September 2023 to 29 February 2024). 

The extrapolated number of GP-registered patients that were recorded as vaccinated in 2023 to 2024 season was over 18.8 million.  

Main points

From 1 September 2023 to 29 February 2024 in England, cumulative influenza vaccine uptake in GP-registered patients: 

• aged 65 years and over was 77.8% compared with 79.9% in 2022 to 2023 
• aged 6 months to under 65 years in one or more clinical risk groups was 41.4% compared with 49.1% in 2022 to 2023 
• aged 2 and 3 years combined was 44.4% compared with 43.7% in 2022 to 2023 
• aged 2 years was 44.1% compared with 42.3% in 2022 to 2023 
• aged 3 years was 44.6% compared with 45.1% in 2022 to 2023 
• and in pregnant women was 32.1%, compared with 35.0% in 2022 to 2023

The 2022 to 2023 annual flu letter outlines the national vaccine uptake ambitions which was to demonstrate a 100% offer and to achieve equal or above the uptake levels of 2022 to 2023 for each cohort. Those aged 2 and 3 years achieved the national vaccine uptake ambitions of equivalent or higher uptake in the 2023 to 2024 season than in 2022 to 2023 season. Combined vaccine uptake in this cohort increased 0.7 percentage points between seasons. Compared with the previous season, vaccine uptake percentages decreased in all other groups (those aged 65 years and over, those aged 6 months to under 65 years in at-risk groups, and pregnant women. For a fourth consecutive season in those aged 65 years and over, vaccine uptake continued to exceed the World Health Organization (WHO) vaccine uptake target of 75%. In those aged 65 years and over, 77.3% (82 out of 106) sub-integrated care boards (sub-ICBs) achieved the WHO target vaccine uptake of at least 75% compared with 86.8% (92 out of 106) sub-ICBs last season (2022 to 2023).

In pregnant women, vaccine uptake is the lowest on record since the 2011 to 2012 season.

Results of influenza vaccine uptake for GP patients

Data tables showing final influenza vaccine uptake for each of the eligible groups accompany the publication of this report and are available at NHS region, ICB and sub-ICB level, as well as local authority. Note for the previous season (2021 to 2022), data was presented by NHS region, sustainability and transformation partnership (STP) and CCG level, as well as local authority.

GP practice response rate

GP response rate from GP practices in England for the main GP flu survey was 96.9% (6,152 out of 6,346 practices), compared with 97.1% last season (2022 to 2023). The GP response rate for the child GP flu survey was 93.6% (5,934 out of 6,342 practices), compared with 98.4% last season. Data represents both automated and manual uploads. For further information about these surveys, see the background information.

The extrapolated number of GP-registered patients that were recorded as vaccinated in 2023 to 2024 season was over 18.8 million (Table 1).

Weekly versus monthly vaccine uptake comparison (provisional data)

The start of the 2023 to 2024 season (up to week 46, week ending 19 November 2023) saw data reporting issues for adult cohorts from one GP IT supplier. Weekly headline influenza vaccine uptake data was published in the weekly disease surveillance report without data from that GP IT supplier. This data was also missing from the first monthly influenza vaccine uptake report of the season (capturing vaccination activity between 1 September and 31 October 2023, with a response rate of 58.1%. Some regions were underrepresented in the published data). Once data from all GP IT suppliers was reported (from week 47 onwards), there was overall good agreement between weekly and monthly data, with the provisional national results from the remaining 4 monthly returns closely matching their weekly equivalent. This confirms that the weekly sentinel survey collection is an excellent indicator of uptake at a national level. For further information on the sentinel survey collection, see the data sources and methodology.

The weekly sentinel survey only used automated extracts, the response rate (weeks 40 to 46 retrospectively updated) ranged between 96.5% in week 40 to 89.0% in week 41 (2023) for the main GP survey; and from 94.7 % in week 43 (2023) to 90.7% in week 3 (2024) for the child GP survey.

Observed and extrapolated estimate of number of patients registered with GP practices and numbers who received influenza vaccine

The total extrapolated estimate of individuals who received an influenza vaccine in 2023 to 2024 season was 18,888,896 compared with 21,024,208 in 2022 to 2023 season (Table 1). This is over 2,135,000 fewer than in the previous season (2022 to 2023), however, eligibility differed between seasons (see background information). Fewer individuals were eligible for the programme this season, with those aged 50 to 64 years not in clinical risk groups no longer eligible.

Patients aged 65 years and over

Vaccine uptake in patients aged 65 years and over was 77.8% in the 2023 to 2024 season, a 2.1 percentage point decrease compared with 79.9% last season (Table 1). The extrapolated estimate of the number of patients aged 65 years and over registered at a GP practice who would have been vaccinated by end of February 2024 was over 8.8 million (8,879,699). This is over 56,000 more patients than the previous season. The size of the denominator for the 65 years and over cohort increases every year (an aging population) and this season increased by over 361,000. Although the percentage uptake is lower than last season, the number of vaccines given is higher. Although the ambition of equivalent or higher uptake than the 2022 to 2023 season was not reached, the end of season uptake for this cohort did exceed the WHO target of at least 75% for the fifth time since the 2005 to 2006 season (Figure 1). Note that the 2005 to 2006 season is not shown in Figure 1, but this group saw an uptake of 75.3% in that season. See the 2017 to 2018 GP annual report (341 KB) and Figure 4 for data from 2000 to 2001 onwards for this cohort.

Table 1. Observed and extrapolated estimate of number of patients registered with GP practices and numbers who received influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season in England

Target groups for vaccination in one or more clinical risk groups	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
Aged 65 years and over	11,061,423	8,608,243	77.8	10,723,554	8,563,437	79.9
Aged 65 years and over extrapolated	11,410,239	8,879,699	77.8	11,049,185	8,823,474	79.9
All patients aged 6 months to under 65 Years [note 1]	50,745,044	9,703,211	19.1	49,600,961	11,841,165	23.9
All patients aged 6 months to under 65 years extrapolated	52,345,262	10,009,197	19.1	51,107,143	12,200,734	23.9
Total observed (65 years and over and all patients under 65 years) [note 1]	61,806,467	18,311,454	29.6	60,324,515	20,404,602	33.8
Total extrapolated (65 years and over and all patients under 65 years)	63,755,501	18,888,896	29.6	62,156,329	21,024,208	33.8

Figure 1. Influenza vaccine uptake for those aged 65 years and over, and those aged under 65 years who are at-risk from 2008 to 2009 to 2023 to 2024 in England

At-risk patients aged 6 months to under 65 years

Vaccine uptake in patients aged 6 months to under 65 years in one or more clinical risk groups was 41.4 % compared with 49.1% in 2022 to 2023 (Table 2, Figure 1). This is a 7.7 percentage point decrease compared with last season. The extrapolated estimate of the total number of patients aged 6 months to under 65 years in a clinical at-risk group who would have been vaccinated was over 4.0 million (4,031,332) (Table 2), Figure 1. Due to a population (denominator) increase for those in clinical risk groups aged 6 months to under 65 years between this season and last season, the number of vaccines given is broadly comparable to last season (over 191,000 fewer patients were vaccinated in the 2023 to 2024 season compared with the 2022 to 2023 season).

There have been no changes to eligibility of risk groups between this season and last season, but this season’s denominator is 1,139,404 larger than last season (9,743,426 this season, 2023 to 2024, compared with 8,604,022 in the last season, 2022 to 2023). The last time there was a comparable increase in the denominator for this cohort (with no change to risk group eligibility) was between the 2019 to 2020 and 2020 to 2021 seasons, with a difference of 1,162,692 (7,134,083 in 2019 to 2020 compared with 8,296,775 in the 2020 to 2021 season). See the 2020 to 2021 GP annual report (Table 2). In comparison, between the 2021 and 2022 and 2022 to 2023 seasons, the increase in denominator was 231,800. See the 2022 to 2023 GP annual report (Table 2).

Table 2. Observed and extrapolated estimate of number of registered patients aged 6 months to under 65 years and in one or more clinical risk groups (excluding pregnant women without other risk factors and carers), who received an influenza vaccine in the 2023 to 2024 season compared with 2022 to 2023 season in England

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
Aged 6 months to under 65 years in a clinical risk group	9,445,565	3,908,092	41.4	8,350,452	4,098,547	49.1
Aged 6 months to under 65 years in a clinical risk group extrapolated	9,743,426	4,031,332	41.4	8,604,022	4,223,003	49.1

Figure 2. Extrapolated estimated number of vaccines administered in the 65 years and over, and those under 65 years at-risk, from 2008 to 2009 to 2021 to 2022 in England

Note that data prior to 2018 to 2019 includes data up to the end of January.

Table 3. Observed and extrapolated number of at-risk registered patients aged 6 months to under 65 years by age band who received an influenza vaccine in the 2023 to 2024 season in England

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
Total observed 6 months under 65 years in a clinical risk group	9,445,565	3,908,092	41.4	8,350,452	4,098,547	49.1
Total extrapolated 6 months under 65 years in a clinical risk group	9,743,426	4,031,332	41.4	8,604,022	4,223,003	49.1
6 months to under 2 years in a clinical risk group	17,872	1,734	9.7	16,271	1,652	10.2
6 months to under 2 years in a clinical risk group extrapolated	17,326	1,681	9.7	16,765	1,702	10.2
2 years to under 5 years in a clinical risk group	61,895	28,397	45.9	59,860	27,970	46.7
2 years to under 5 years in a clinical risk group extrapolated	63,847	29,292	45.9	61,678	28,819	46.7
5 years to under 16 years in a clinical risk group	600,289	309,648	51.6	563,390	268,272	47.6
5 years to under 16 years in a clinical risk group extrapolated	619,219	319,413	51.6	580,498	276,418	47.6
16 to under 65 years in a clinical risk group	8,765,509	3,568,313	40.7	7,710,931	3,800,653	49.3
16 to under 65 years in a clinical risk group extrapolated	9,041,925	3,680,838	40.7	7,945,081	3,916,064	49.3

Vaccine uptake for clinical at-risk groups broken down by age categories is given in Table 3 and Figure 3. Compared with the previous season in children aged 5 years to under 16 years in a clinical risk group, vaccine uptake has increased. All other age categories saw a decrease between seasons. Vaccine uptake remains lowest in those aged 6 months to under 2 years in a clinical risk group (9.7 % down from 10.2% in 2023 to 2024) and is the lowest on record since the 2009 to 2010 season (Figure 3). Uptake is highest in those aged 5 years to under 16 years in a clinical risk group (51.6% compared with 47.6% in 2022 to 2023) (Table 3 and Figure 3).

Figure 3. Vaccine uptake (%) in those at-risk and aged under 65 years by age group in the 2023 to 2024 season compared with previous survey seasons

Note that from the 2015 to 2016 season, patients with morbid obesity with no other clinical risk groups was included in the denominator. Also note that there were supply issues for the live attenuated influenza vaccine (LAIV) vaccine in the 2019 to 2020 season which affected those aged 2 years to under 16 years.

Individual risk groups

Vaccine uptake percentages in the individual risk groups varied for patients in a clinical risk group aged under 65 years, and for all groups was below last season (2022 to 2023 (Table 5). Among the general population aged 6 months to under 65 years, the proportion in each of the risk groups decreased between 2022 to 2023 and 2023 to 2024 season (Table 4), apart from in patients with a severe learning disability and in patients with chronic kidney disease (which were broadly comparable). Prior to this season, the proportion had been relatively stable over the previous 3 seasons (Table 4).

Vaccine uptake percentages varied across individual risk groups and by age (Table 5). The greatest variation by age was seen in patients with diabetes ranging from 9.2% in those aged 6 months to under 2 years, to 50.9% in those aged 16 to under 65 years (Table 5). Similar differences were seen between these age groups for patients with immunosuppression (ranging from 7.3% in those aged 6 months to under 2 years to 48.5% in those aged 16 to under 65 years) and patients with chronic kidney disease (ranging from 10.2% in those aged 6 months to under 2 years, to 49.2% in those aged 16 to under 65 years). The least variation by age was seen in patients with any learning disability (including severe), ranging from 19.6% in those aged 6 months to under 2 years, and 32.8% in those aged 5 years to under 16 years. 

Vaccine uptake percentage pattern for individual risk groups were similar to last season (Table 5 and Figure 4a). This season the highest vaccine uptake by individual risk group was in patients with a severe learning disability at 60.1% (compared with 63.6% last season which was also the highest-ranking group). The only other group to vaccinate over 50.0% was in patients with diabetes (50.8% compared with 60.3% last season). As was seen last season, the lowest uptake this season was in patients with any learning disability (including severe) at 35.5% (Table 5 and Figure 4a). This was compared with 35.1% last season (Table 5 and Figure 4a). Following a similar pattern as last season, the second and third-lowest uptake was seen in patients with chronic liver disease at 36.7% (compared with 44.6% last season) and patients with morbid obesity at 37.5% (compared with 43.8% last season). Groups with vaccine uptake percentages below 45% this season were patients with chronic heart disease (41.7% compared with 49.8% last season) and patients with chronic neurological disease (42.7% compared with 51.7% last season) in the 2022 to 2023 season (Table 5 and Figure 4a).

Table 4. Percentage of each risk group in the at-risk total population in the GP record this season (2023 to 2024) compared with last season (2022 to 2023) for all those aged 6 months to under 65 years

Risk group	Prevalence per 100 in total 6 months to under 65 years population 2023 to 2024	Prevalence per 100 in total 6 months to under 65 years population 2022 to 2023
Patients with diabetes	2.1	3.5
Patients with chronic kidney disease	0.5	0.7
Patients with immunosuppression	0.7	1.4
Patients with chronic neurological disease (including stroke or TIA, cerebral palsy, or MS)	0.9	1.8
Patients with a severe learning disability (subset of chronic neurological disease)	0.1	0.1
Patients with any learning disability (including severe)	0.7	1.8
Patients with chronic respiratory disease	3.1	6.2
Patients with chronic heart disease	1.7	3.8
Patients with chronic liver disease	0.6	1.6
Patients with asplenia or dysfunction of the spleen	0.2	0.5
Patients with morbid obesity (BMI more than 40) (aged 16 to under 65 years only)	0.6	2.3

Table 5. Vaccine uptake by individual clinical risk groups and age band for GP-registered patients aged 6 months to under 65 years for this season (2023 to 2024) and last season (2022 to 2023)

Risk group [note 1]	2023 to 2024: 6 months to under 2 years	2023 to 2024: 2 years to under 5 years	2023 to 2024: 5 years to under 16 years	2023 to 2024: 16 years to under 65	2023 to 2024: total under 65 years	2022 to 2023: 6 months to under 2 years	2022 to 2023: 2 years to under 5 years	2022 to 2023: 5 years to under 16 years	2022 to 2023: 16 years to under 65
Patients with diabetes	9.2	45.4	51.3	50.9	50.8	13.9	44.9	47.8	60.3
Patients with chronic kidney disease	10.2	42.1	44.0	49.2	49.1	9.3	40.5	40.1	58.5
Patients with immunosuppression [note 1]	7.3	40.4	45.9	48.5	48.3	7.6	44.3	43.6	56.6
Patients with chronic neurological disease (including stroke or TIA, cerebral palsy or MS) [note 1]	9.7	42.6	46.9	42.5	42.7	12.6	43.5	44.9	51.7
Patients with a severe learning disability (subset of chronic neurological disease)	[note 2]	42.7	44.2	61.7	60.1	25.0	45.1	42.1	63.6
Patients with any learning disability (including severe)	19.6	35.3	40.5	32.8	35.5	21.3	37.8	37.5	35.1
Patients with chronic respiratory disease	12.9	51.8	53.6	46.3	47.1	15.5	52.9	49.9	52.4
Patients with chronic heart disease [note 1]	10.4	42.6	49.4	41.4	41.7	10.2	43.9	46.2	49.8
Patients with chronic liver disease [note 1]	9.9	41.4	42.1	36.7	36.7	10.8	45.0	38.1	44.6
Patients with asplenia or dysfunction of the spleen*	15.0	50.7	54.0	46.5	47.2	15.1	51.5	49.1	51.0
Patients with morbid obesity (BMI>=40) [note 1]	[note 3]	[note 3]	[note 3]	37.5	37.5	[note 2]	42.9	39.0	43.8

Note 1: there were adjustments to classification in clinical coding of these groups in the Systematized Nomenclature of Medicine Clinical Terminology (SNOMED CT) transition and caution should be applied in historical comparisons.

Note 2: this indicates data was suppressed because of small numbers.

Note 3: data not available.

The prevalence of individual at-risk groups can vary from year to year depending on current definitions of persons who are at risk and the quality of the data capture, see SNOMED CT transition for further context. See Table 4 for the changes to the prevalence of each risk group in the at-risk population aged 6 months to under 65 years.

Figure 4a. Extrapolated number of registered patients who received an influenza vaccine in 2023 to 2024 season, by individual clinical risk group for all those aged 6 months to under 65 years

Figure 4b. Vaccine uptake (%) in 2023 to 2024 and 2022 to 2023 seasons, by individual clinical risk group for all those aged 6 months to under 65 years

Data is up to the end of February 2024.

Pregnant women

This group was added to the national programme in 2010 to 2011 and the highest end of season uptake on record was during the 2017 to 2018 season (47.2%) (Figure 5). Vaccine uptake in all pregnant women (healthy and at-risk groups combined) was 32.1% in the 2023 to 2024 season, decreasing 2.9 percentage points from 35.0% in 2022 to 2023 (Table 6). This is the lowest end of season uptake on record since 2011 to 2012 (27.3%). The extrapolated estimate of the number of pregnant women registered at a GP practice who would have been vaccinated by end of February 2024 was 232,547 which is 7,207 more individuals than the previous season. Data on the uptake of influenza vaccine by pregnant women needs to be interpreted with caution, see data limitations: pregnant women.

Figure 5. Vaccine uptake (%) in pregnant women in the 2023 to 2024 season compared with previous survey seasons

Note 1: The maternal influenza vaccination programme was introduced in 2010 to 2011 season, but data was collected in a different format for that season and is therefore not reported above.

Table 6. Observed and extrapolated estimated number of pregnant women registered and who received an influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
All pregnant women (includes both ‘healthy’ and at risk)	702,559	225,438	32.1	625,383	218,699	35
All pregnant women extrapolated (includes both ‘healthy’ and at risk)	724,714	232,547	32.1	644,373	225,340	35.0
Pregnant women and in a clinical risk group	124,998	51,755	41.4	75,691	36,188	47.8
Pregnant women and in a clinical risk group extrapolated	128,940	53,387	41.4	77,989	37,287	47.8
Pregnant women not in a clinical risk group	577,561	173,683	30.1	549,692	182,511	33.2
Pregnant women not in a clinical risk group extrapolated	595,774	179,160	30.1	566,384	188,053	33.2

Pre-school-aged children

Combined vaccine uptake in those aged 2 and 3 years was 44.4% in 2023 to 2024, compared with 43.7% in the previous season (Table 7), which is an increase of 0.7 percentage points. The extrapolated estimate of the number of those aged 2 and 3 years registered at a GP practice who would have been vaccinated by the end of February 2024 was 557,608. This is 3,219 more individuals than the previous season. Vaccine uptake for individual year groups can be found in the accompanying tables.

For historical context of this cohort, the highest influenza vaccine uptake on record was 56.7% in 2020 to 2021 (the first year of the COVID-19 pandemic). End of season vaccine uptake fell for the 2 consecutive seasons after that (2021 to 2022 was 50.1% in the second year of the COVID-19 pandemic, and 2022 to 2023 was 43.7%). Prior to the COVID-19 pandemic (2019 to 2020), uptake was 43.8%, however due to supply issues for this group that season data is not wholly comparable. The season before that (2018 to 2019) saw uptake of 44.9%. This season’s uptake is broadly comparable with that seen before the COVID-19 pandemic.

Table 7. Observed and extrapolated number of GP-registered patients aged 2 and 3 years who received an influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
All 2 and 3 years (includes both ‘healthy’ and at risk)	1,176,128	521,735	44.4	1,247,032	545,525	43.7
All 2 and 3 years (includes both ‘healthy’ and at risk) extrapolated	1,256,994	557,608	44.4	1,267,295	554,389	43.7
All 2 and 3 years and in a clinical risk group	38,998	18,674	47.9	39,968	19,325	48.4
All 2 and 3 years sand in a clinical risk group extrapolated	41,679	19,958	47.9	40,617	19,639	48.4
All 2 and 3 years and not in a clinical risk group	1,137,130	503,061	44.2	1,207,064	526,200	43.6
All 2 and 3 years and not in a clinical risk group extrapolated	1,215,315	537,650	44.2	1,226,677	534,750	43.6

Vaccine uptake in those aged 2 years was 44.1% in 2023 to 2024, compared with 42.3% in the previous season (Table 8), which is an increase of 1.8 percentage points. The extrapolated estimate of the number of those aged 2 years registered at a GP practice who would have been vaccinated by end of February 2024 was 273,698. This is 11,306 more individuals than the previous season.

Table 8. Observed and extrapolated number of GP-registered patients aged 2 years who received an influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
All 2 years (includes both ‘healthy’ and at risk)	580,974	256,090	44.1	610,163	258,197	42.3
All 2 years (includes both ‘healthy’ and at risk) extrapolated	620,920	273,698	44.1	620,077	262,392	42.3
Aged 2 years and in a clinical risk group	16,448	7,733	47.0	16,782	7,781	46.4
Aged 2 years and in a clinical risk group extrapolated	17,579	8,265	47.0	17,055	7,907	46.4
Aged 2 years and not in a clinical risk group	564,526	248,357	44.0	593,381	250,416	42.2
Aged 2 years and not in a clinical risk group extrapolated	603,341	265,433	44.0	603,023	254,485	42.2

Vaccine uptake in those aged 3 years was 44.6% in 2023 to 2024, compared with 45.1% in the previous season (Table 9), which is a decrease of 0.5 percentage points. The extrapolated estimate of the number of those aged 3 years registered at a GP practice who would have been vaccinated by the end of February 2024 was 283,910. This is 8,087 fewer individuals than the previous season. Although vaccine uptake in this cohort has continued to decrease for a third consecutive season, uptake remains above levels seen before the COVID-19 pandemic (the 2019 to 2020 season saw an uptake of 44.2%).

Table 9. Observed and extrapolated number of GP-registered patients aged 3 years who received an influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	2023 to 2024 number of patients registered	2023 to 2024 number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 number of patients registered	2022 to 2023 number of patients vaccinated	2022 to 2023 percentage vaccine uptake
All 3 years (includes both ‘healthy’ and at risk)	595,154	265,645	44.6	636,869	287,328	45.1
All 3 years (includes both ‘healthy’ and at risk) extrapolated	636,075	283,910	44.6	647,217	291,997	45.1
Aged 3 years and in a clinical risk group	22,550	10,941	48.5	23,186	11,544	49.8
Aged 3 years and in a clinical risk group extrapolated	24,100	11,693	48.5	23,563	11,732	49.8
Aged 3 years and not in a clinical risk group	572,604	254,704	44.5	613,683	275,784	44.9
Aged 3 years and not in a clinical risk group extrapolated	611,974	272,217	44.5	623,655	280,265	44.9

All patients aged 6 months to under 65 years

Overall vaccine uptake is lower than last season at 19.1% (compared with 23.9% in 2022 to 2023 season), but as stated previously in the report, those aged 50 to 64 years and not in clinical risk groups were no longer eligible for the programme this season. This means that vaccine uptake in those aged 16 years to under 65 years is lower this season than last season (13.7% compared with 20.6% in 2022 to 2023 season). All age bands except 6 months to under 2 years and 5 years to under 16 years showed a decrease in uptake (see Table 10). Those aged 6 months to under 2 years were comparable with last season. The extrapolated number of all registered patients aged 6 months to under 65 years (including those in a clinical at-risk group) who received an influenza vaccine by the end of February 2024 was over 10,009,197).

Table 10. Observed and extrapolated figures for ‘all patients’ aged 6 months to under 65 years who received influenza vaccine by age band in the 2023 to 2024 season compared with the 2022 to 2023 season

All GP registered patient data (Includes those in a risk group and those not in a clinical risk group)	Number of patients registered	Number of patients vaccinated	2023 to 2024 Percentage vaccine uptake	2022 to 2023 Number of patients registered	2022 to 2023 Number of patients vaccinated	2022 to 2023 Percentage vaccine uptake
Total observed 6 months under 65 years	50,745,044	9,703,211	19.1	49,600,961	11,841,165	23.9
Total extrapolated 6 months under 65 years	52,345,262	10,009,197	19.1	51,107,143	12,200,734	23.9
6 months to under 2 years	848,974	2,461	0.3	872,345	2,682	0.3
6 months to under 2 years extrapolated	875,746	2,539	0.3	898,835	2,763	0.3
2 years to under 5 years	1,843,551	703,776	38.2	1,827,905	706,118	38.6
2 years to under 5 years extrapolated	1,901,686	725,969	38.2	1,883,411	727,560	38.6
5 years to under 16 years	7,905,761	3,482,078	44.0	7,755,486	3,081,946	39.7
5 years to under 16 years extrapolated	8,155,065	3,591,883	44.0	7,990,989	3,175,532	39.7
16 years to under 65 years	40,146,758	5,514,896	13.7	39,145,225	8,050,419	20.6
16 years to under 65 years extrapolated	41,412,764	5,688,805	13.7	40,333,909	8,294,878	20.6

Refused or declined vaccinations

Refused or declined vaccinations have increased in all target groups except total aged 6 months to under 65 years at risk for vaccination. The largest increase was in pregnant women in a clinical risk group (14.0% compared with 11.3% in 2022 to 2023). See Table 11 and Figure 6. This is the second consecutive season where the percentage of those who have refused or declined have increased (see 2022 to 2023 report). Caution should be exercised when looking at these figures as different GP system suppliers use different ways of recording this and some may be collected via non-coded mechanisms.

Table 11. Number of registered patients who refused or declined the influenza vaccine in the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	Number of vaccinations refused or declined	2023 to 2024 percentage of population refused or declined	2022 to 2023 percentage of population refused or declined
Aged 65 years and over	795,052	7.2	6.5
Total aged 6 months to under 65 years at risk	1,217,282	12.9	10.1
Total aged 6 months to under 2 years at risk	938	5.2	3.7
Total aged 2 years to under 5 years at risk	5,842	9.4	7.4
Total aged 5 years to under 16 years at risk	28,023	4.7	3.7
Total aged 16 years to under 65 years at risk	666,041	13.2	10.6
All pregnant women (includes both healthy and at risk)	56,979	8.1	6.2
Pregnant women in a clinical risk group	17,389	13.9	11.3
Pregnant women not in a clinical risk group (‘healthy women’)	39,590	6.9	5.5

Figure 6. Percentage of refused or declined vaccination by target group for the 2023 to 2024 season compared with the 2022 to 2023 season

Other healthcare settings

The 2023 to 2024 season saw most vaccinations still delivered within GP practices, with comparable percentages to the previous season (2022 to 2023) in all cohorts apart from in individuals aged 2 and 3 years who saw a 2.6 percentage point decrease in GP practice delivery (96.5% compared with 98.2% the previous season), (Table 12). For cohorts that saw comparable percentages of vaccinations given in GP practices between seasons, the figures were as follows: in those aged 65 years and over (67.3% compared with 67.5%), for those in at-risk groups (62.0% compared with 62.8%) and in pregnant women (56.6% compared with 56.9%), (Table 12).

In those aged 65 years and over, comparable percentages of vaccinations given in pharmacies and other healthcare settings was also seen between this season and last season (Table 12). For those in an at-risk cohort, compared with the previous season there was a decrease of 3.2 percentage points in pharmacy delivery (21.6% in 2022 to 2023 compared with 24.8% in 2023 to 2024). Delivery in other healthcare settings increased 4.0 percentage points from 12.4% in 2022 to 2023 to 16.4% in 2023 to 2024) (Table 12).

Other healthcare settings include antenatal clinics, homes and private or occupational health. Pregnant women and individuals aged 2 and 3 years saw an increase in the percentage of influenza vaccinations given in other healthcare settings this season compared with last season (a 3.0 percentage point increase in pregnant women and a 1.7 percentage point increase in individuals aged 2 and 3 years. See Table 12. For individuals aged 2 and 3 years, this is the largest increase seen in a season for delivery outside of GP practices.

See last season’s report (2022 to 2023) for more details of historical trends in vaccination delivery location from 2019 to 2020 (pre-COVID-19 pandemic) to the 2023 to 2024 seasons.

Recording of vaccinations given in another healthcare setting outside of the GP practice does not come under an existing information standard, therefore location recording can be varied among GP practices and GP system suppliers (see data limitations).

Table 12. Percentage vaccine uptake by GP practices, pharmacies, and other healthcare settings in the 2023 to 2024 season compared with the 2022 to 2023 season

Patient group	2023 to 2024 GP practices	2023 to 2024 pharmacies	2023 to 2024 other healthcare settings and schools	2022 to 2023 GP practices	2022 to 2023 pharmacies	2022 to 2023 other healthcare settings and schools
Aged 65 years and over	67.3	25.2	7.5	67.5	25.2	7.3
Aged 6 months to under 65 years at risk	62.0	21.6	16.4	62.8	24.8	12.4
All pregnant women	56.6	14.5	29.0	56.9	17.1	26.0
All 2 and 3 years	96.5	0.1	3.4	98.2	0.1	1.7

Figure 7. Percentage of vaccinations given by location for those aged 65 years and over, patients aged 6 months to under 65 years and in one or more clinical risk groups, pregnant women, all aged 2 and 3 years in the 2023 to 2024 season compared with the 2022 to 2023 season

Carers

Vaccine uptake for carers aged 16 to under 65 years and not in a clinical risk group was 32.7% compared with 42.4% in the 2023 to 2024 season, a decrease of 9.7 percentage points (Table 13).

Table 13. Observed and extrapolated figures for carers who received an influenza vaccine during the 2023 to 2024 season compared with the 2022 to 2023 season

Target groups for vaccination	Number of patients registered	Number of patients vaccinated	2023 to 2024 percentage vaccine uptake	2022 to 2023 percentage vaccine uptake
Aged 16 years to under 65 years not at risk who fulfil the carer definition	333,078	108,996	32.7	42.4
Aged 16 years to under 65 years not at risk who fulfil the carer definition extrapolated	344,000	112,000	32.7	42.4

Social care workers

The collection of vaccination data for GP-registered patients who are social care workers was introduced to the GP survey in the 2019 to 2020 season as an experimental cohort. In 2023 to 2024, data was available for 62.4% (3,961 out of 6,346) of all GP practices in England. This is compared with 59.8% (3,855 out of 6,447) of all GP practices in England in the 2022 to 2023 season. The response rate ranged from 32.4% in London to 90.5% in the South West. Therefore, caution should be used when interpreting the data. 

There were 32,278 social care workers who were recorded on data submitted by GP practices, increasing from 31,667 last season. This is likely to account for around 2.0% of social care workers (1.63 million in adult social care). Of social care workers included in this data collection, 38.1% were vaccinated, compared with 47.6% last season. At the regional level, vaccine uptake ranged from 26.9% in London to 41.5% in the East of England.

Despite SNOMED CT codes for social care occupations being added in 2018, this is still poorly recorded in the GP record and is not likely to be kept up to date on such a fluid workforce with very little available occupational health support. Data flows from social care employers and pharmacies will need to improve to ensure that vaccination status is reflected accurately in the GP record similar to other vaccinations given in other settings.

Sex

Those with sex not specified or unknown were removed because of small numbers.

Aged 65 years and over by sex

For those aged 65 years and over, there was little or no difference in uptake between sex for the last 3 seasons (Figure 6).

Figure 8. Influenza vaccine uptake (%) in those aged 65 years and over, by sex, in England for the 2023 to 2024 season compared to the 2022 to 2023 season

At-risk patients aged 16 to under 65 years by sex

For the current and previous season, data was collected for at-risk patients aged 16 years to under 65 years. The at-risk cohort includes pregnant women with other risk factors but excludes otherwise ‘healthy’ pregnant women. In the 2023 to 2024 season, vaccine uptake in at-risk patients aged 16 years to under 65 years was 7.5 percentage points higher in females than males in England (see Figure 9). This does not account for differences caused by the vaccination of pregnant women. Last season (2022 to 2023) saw over a 9-percentage point difference between males and females.

Figure 9. Influenza vaccine uptake (%) in at-risk patients aged 16 to under 65 years, by sex, in England for the 2023 to 2024 season compared to the 2022 to 2023 season

Ethnicity

Trends in ethnicity data are comparable to previous seasons. Ethnicity data was collected for the following cohorts: adults aged 65 years and over, those aged 16 to under 65 years in a clinical risk group, pregnant women and pre-school aged children (aged 2 and 3 years). The data presented in Table 14a, Table 14b, Table 14c, and Table 14d is near final end of season data, however end of season trends will not differ from what is presented. Ethnicity is coded using the 16+1 ethnic data categories defined in the 2001 census that forms the national mandatory standard for the collection and analysis of ethnicity.

For those aged 65 years and over, 85.7% were recorded with a 2001 code, 3.8% were recorded with no code and 10.1% were recorded with a non-2001 census code. Individuals who refused were recorded at 0.4%, and uptake for those who refused to give their ethnicity data was 63.8%. For those aged 16 to under 65 years in a clinical risk group, 88.0% were recorded with a 2001 code, 2.9% were recorded with no code and 8.7% with a non-2001 census code. Individuals who refused were recorded at 0.5%, and uptake for those who refused to give their ethnicity data was 26.9%. For pregnant women, 89.8% were recorded with a 2001 code, 2.8% were recorded with no code and 7.0% with a non-2001 census code. Individuals who refused were recorded at 0.4%, and uptake for those who refused to give their ethnicity data was 25.6%. For pre-school aged children, 90.1% were recorded with a 2001 code, 6.6% were recorded with no code and 4.2% with a non-2001 census code. Individuals who refused were recorded at 0.7%, and uptake for those who refused to give their ethnicity data was 38.2%.

At a national level, the Black and Black British: Caribbean group had the lowest uptake in all 4 cohorts, but at a regional level (presented in the ethnicity data by region on the heat maps tab in the additional tables) the group with the lowest uptake varied by region. In the additional tables (in the ethnicity data by region on the heat maps tab) regional ethnicity uptake data is presented with heat maps in descending order with highest uptake in green and lowest uptake in red. At a national level, the highest uptake for those aged 16 to under 65 years in a clinical risk group, as well as those aged 65 years and over, was in the White British group. For the pregnant women and pre-school aged cohort, the highest uptake was in the Other ethnic group: Chinese.

For both pregnant women and those aged 65 years and over, all regional data reflected what was seen at the national level with regards to the groups with the highest uptake. However, for the clinical risk cohort, the White British group had the highest uptake in all regions except London, where 3 groups (Asian or Asian British: Bangladeshi; Asian or Asian British: Indian; Asian or Asian British: any other Asian background) had higher uptake than the White: British group, which was ranked fourth.

Aged 65 years and over by ethnicity

For those aged 65 years and over, when grouped by ethnicity at a national level, only one ethnic group was higher than the national average vaccine uptake of 81.7%, which was White: British (Table 14a). This group was 3.9 percentage points higher than average. The 6 groups with the lowest uptake were seen in all of the Black and Mixed or Multiple Black groups (Black or Black British: Caribbean; Black or Black British: African; Black or Black British: any other Black background; Mixed or Multiple: White and Black African; Mixed or Multiple: White and Black Caribbean) and the Asian or Asian British: Pakistani group. All Black and Mixed and Multiple Black groups had uptake below 54.0%, with percentage point differences ranging from 32.3 to 24.2 (below the national average). The Pakistani ethnic group was 26.6 percentage points lower than average.

At-risk patients aged 16 to under 65 years by ethnicity

For those in clinical risk groups and aged 16 to under 65 years when grouped by ethnicity at a national level, 6 groups had vaccine uptake higher or equivalent to the national average of 40.7%: These were some White (British and Irish), and some Asian (Bangladeshi; any other Asian; Chinese; and Indian) groups (Table 14b). The highest uptake was in the White: British group, which was 4.5 percentage points above average. The 5 groups with the lowest uptakes were in Black groups (Black or Black British: Caribbean; Mixed: White and Black Caribbean; Black or Black British: Any other Black background) as well as in the White: Other; Asian or Asian British ethnic group: Pakistani. The percentage point differences below the national average ranged from 17.6 to 12.7 for these groups.

Pregnant women by ethnicity

For pregnant women, when grouped by ethnicity at a national level, 6 groups had vaccine uptake higher or equivalent than the national average of 32.1% (Table 14c). The highest uptake, in the Other ethnic groups: Chinese, was 9.3 percentage points higher than average. The other groups reaching above average uptake were some White (British and Irish) and some Asian (Asian or Asian British: Indian; any other Asian background: any other Asian background, and Mixed or Multiple White and Asian) groups. The group with the lowest uptake (Black or Black British: Caribbean) was 19.9 percentage points lower than the national average. The 6 groups with the lowest uptake were Black groups (Caribbean; Mixed or Multiple White and Black Caribbean; and any other Black background), White: Other, Asian or Asian British: Pakistani ethnic groups, and those in the Other ethnic group.

Pre-school children (aged 2 and 3 years) by ethnicity 

For those aged 2 and 3 years, when grouped by ethnicity at a national level, 5 groups had vaccine uptake higher than or equivalent to the national average of 44.4%. The highest uptake in the Other ethnic groups: Chinese, was 21.5 percentage points higher than average. The other groups reaching above average uptake were White British and some Asian (Asian or Asian British: Indian; Mixed or Multiple White and Asian; and any other Asian background) groups. The group with the lowest uptake (Black or Black British: Caribbean) was 26.7 percentage points lower than the national average. The 5 groups with the lowest uptake were Black groups (Caribbean; Mixed or Multiple White and Black Caribbean; and any other Black background), White: Other; Asian or Asian British: Pakistani ethnic groups.

Table 14a. Influenza vaccine uptake in those aged 65 years and over by ethnicity group

Ethnicity Group	Aged 65 years and over Number of patients registered	Aged 65 years and over Number of patients vaccinated	Aged 65 years and over Percentage vaccine uptake
White - British	7,970,435	6,511,087	81.7
White - Irish	95,560	72,544	75.9
White - Other	374,235	224,836	60.1
Mixed - White and Black Caribbean	15,926	8,540	53.6
Mixed - White and Black African	11,548	6,152	53.3
Mixed - White and Asian	11,114	7,642	68.8
Mixed - Any other mixed background	27,407	17,264	63.0
Asian or Asian British - Indian	214,306	149,002	69.5
Asian or Asian British - Pakistani	101,771	52,343	51.4
Asian or Asian British - Bangladeshi	28,109	18,523	65.9
Asian or Asian British - Any other Asian background	101,395	68,305	67.4
Black or Black British - Caribbean	78,396	35,685	45.5
Black or Black British - African	77,795	37,337	48.0
Black or Black British - Any other Black background	21,169	10,572	49.9
Other ethnic groups - Chinese	40,886	25,700	62.9
Other ethnic groups - Any other ethnic group	79,325	46,060	58.1
Ethnicity not stated	140,327	92,334	65.8
Ethnicity code not recorded (no code)	411,889	248,172	60.3
Ethnicity not given – patient refused	47,825	30,491	63.8
Ethnicity code is a non-2001 ethnicity code	1,105,401	862,845	78.1
Total	10,954,819	8,525,434	77.8

Table 14b. Influenza vaccine uptake in those 16 to under 65 years in a clinical risk group by ethnicity group.

Ethnicity Group	16 to under 65 years in a clinical risk group Number of patients registered	16 to under 65 years in a clinical risk group Number of patients vaccinated	16 to under 65 years in a clinical risk group Percentage vaccine uptake
White - British	5,360,168	2,422,999	45.2
White - Irish	48,388	20,119	41.6
White - Other	506,082	138,121	27.3
Mixed - White and Black Caribbean	43,164	10,738	24.9
Mixed - White and Black African	36,188	10,892	30.1
Mixed - White and Asian	28,218	10,628	37.7
Mixed - Any other mixed background	60,357	19,370	32.1
Asian or Asian British - Indian	289,069	119,741	41.4
Asian or Asian British - Pakistani	282,727	79,064	28.0
Asian or Asian British - Bangladeshi	115,505	50,010	43.3
Asian or Asian British - Any other Asian background	182,545	76,781	42.1
Black or Black British - Caribbean	94,367	21,802	23.1
Black or Black British - African	242,720	75,325	31.0
Black or Black British - Any other Black background	63,404	16,556	26.1
Other ethnic groups - Chinese	40,107	16,491	41.1
Other ethnic groups - Any other ethnic group	136,078	40,589	29.8
Ethnicity not stated	122,971	34,999	28.5
Ethnicity code not recorded (no code)	250,132	66,799	26.7
Ethnicity not given – patient refused	41,007	11,019	26.9
Ethnicity code is a non-2001 ethnicity code	756,194	296,494	39.2
Total	8,699,391	3,538,537	40.7

Table 14c. Influenza vaccine uptake in all pregnant women by ethnicity group

Ethnicity group	Pregnant women number of patients registered	Pregnant women number of patients vaccinated	Pregnant women percentage vaccine uptake
White - British	350,733	128,718	36.7
White - Irish	3,574	1,293	36.2
White - Other	67,057	15,161	22.6
Mixed - White and Black Caribbean	4,843	914	18.9
Mixed - White and Black African	4,828	1,239	25.7
Mixed - White and Asian	3,476	1177	33.9
Mixed - Any other mixed background	7,718	2,040	26.4
Asian or Asian British - Indian	38,157	13,721	36.0
Asian or Asian British - Pakistani	34,429	7,957	23.1
Asian or Asian British - Bangladeshi	14,926	4,544	30.4
Asian or Asian British - Any other Asian background	21,248	7,336	34.5
Black or Black British - Caribbean	5,090	620	12.2
Black or Black British - African	30,525	7,996	26.2
Black or Black British - Any other Black background	5,523	1066	19.3
Other ethnic groups - Chinese	4,179	1,730	41.4
Other ethnic groups - Any other ethnic group	20,216	4,884	24.2
Ethnicity not stated	9,406	2,456	26.1
Ethnicity code not recorded (no code)	19,464	4,711	24.2
Ethnicity not given – patient refused	2,761	706	25.6
Ethnicity code is a non-2001 ethnicity code	48,744	15,254	31.3
Total	696,897	223,523	32.1

Table 14d. Influenza vaccine uptake in aged 2 and 3 years by ethnicity group

Ethnicity group	2 and 3 years number of patients registered	2 and 3 years number of patients vaccinated	2 and 3 years percentage vaccine uptake
White - British	596,773	300,849	50.4
White - Irish	2,940	1,110	37.8
White - Other	96,908	28,873	29.8
Mixed - White and Black Caribbean	12,468	3386	27.2
Mixed - White and Black African	10,242	4,058	39.6
Mixed - White and Asian	13,556	6755	49.8
Mixed - Any other mixed background	25,636	9,913	38.7
Asian or Asian British - Indian	46,117	24,889	54.0
Asian or Asian British - Pakistani	48,303	11,592	24.0
Asian or Asian British - Bangladeshi	17,324	6,256	36.1
Asian or Asian British - Any other Asian background	28,278	13,348	47.2
Black or Black British - Caribbean	5,360	947	17.7
Black or Black British - African	38,708	16,549	42.8
Black or Black British - Any other Black background	9,580	2954	30.8
Other ethnic groups - Chinese	4,904	3,230	65.9
Other ethnic groups - Any other ethnic group	30,572	10495	34.3
Ethnicity not stated	30,341	12,300	40.5
Ethnicity code not recorded (no code)	75,356	26,702	35.4
Ethnicity not given – patient refused	7,835	2,995	38.2
Ethnicity code is a non-2001 ethnicity code	48,284	23,056	47.8
Total	1,149,485	510,257	44.4

Deprivation

Vaccine uptake by deprivation is presented below using indices of multiple deprivation (IMD) deciles for the following cohorts: aged 65 years and over; aged 16 to under 65 years at-risk, and pregnant women. GP postcode is used as a proxy for IMD of the patients in the practice therefore caution is advised. Vaccinations in these cohorts all show the same trend where vaccine uptake is highest in the least deprived areas and the lowest uptake in the most deprived areas (Table 15). The largest difference in vaccine uptake by IMD is in those aged 65 years and over (Figure 10). This varies by 7.6 percentage points compared with 0.6 percentage points in those aged 16 to under 65 years who are at-risk (Figure 11); and 5.9 percentage points in pregnant women (Figure 12). Trends by IMD are similar across other national immunisation programmes and there is still work to be done to reduce vaccine inequality.

Table 15. Influenza vaccination uptake in those aged 65 years and over, all pregnant women and 16 to under 65 years in a clinical risk group and all pregnant women by IMD

IMD	Target group influenza vaccination uptake (%) aged 65 years and over	Target group influenza vaccination uptake (%) aged 16 to under 65 years at- risk	Target group influenza vaccination uptake (%) all pregnant women
1 (most deprived)	74.5	39.9	30.1
2	75.4	39.8	33.9
3	76.2	41.0	34.4
4	78.4	43.7	31.1
5	80.1	37.5	33.0
6	80.8	37.1	34.9
7	80.0	44.5	34.3
8	80.4	46.9	33.3
9	82.1	45.0	31.7
10 (least deprived)	82.1	40.5	36.0

Deprivation by those aged 65 years and over

Figure 10. Influenza vaccine uptake in those aged 65 years and over by IMD in each NHS commissioning region

Note that 1 to 10 is a scale of IMD with 1 being the most deprived and 10 being the least deprived.

Vaccine uptake by IMD varies by region in those aged 65 years and over. The largest variation by IMD is seen in the Midlands where vaccine uptake is 16.0 percentage points lower in the most deprived group compared with the least deprived group. The regions with the least variation by IMD was in the South West region with around 3.5 percentage points variation between the least and most deprived groups.

Deprivation by those at risk and aged 16 to under 65 years

Figure 11. Influenza vaccine uptake in those aged 16 to under 65 years in a clinical risk group by IMD in each NHS commissioning region

Note that 1 to 10 is a scale of IMD with 1 being the most deprived and 10 being the least deprived.

Vaccine uptake by IMD varies by region in those aged 16 to under 65 years and at risk. The largest variation by IMD is seen in the North West region where vaccine uptake is 19.1 percentage points lower in the most deprived group compared with the least deprived groups. The regions with the least variation by IMD was in the East of England region with around 6.1 percentage points variation between the least and most deprived groups.

Deprivation and pregnant women

Figure 12. Influenza vaccine uptake in all pregnant women by index of multiple deprivation in each NHS commissioning region

Note that 1 to 10 is a scale of IMD with 1 being the most deprived and 10 being the least deprived.

Vaccine uptake by IMD varies by region in all pregnant women, the largest variation by IMD is seen in Midlands region where vaccine uptake is 26.1 percentage points lower in the most deprived cohort compared with the least deprived group. The region with the least variation by IMD was the South West region with 9.3 percentage points variation between the least and most deprived groups.

Vaccine type

Vaccine type was introduced to the GP survey in 2018 to 2019 as experimental data. This season data was available for 99.0% of those vaccinated aged 65 years and over; and 98.4% of those vaccinated aged 16 to under 65 years and in a clinical risk group. Despite the high response, only 52.7% and 48.2% of those aged 65 years and over and those in clinical risk groups, respectively, had vaccinations which were coded with a defined vaccine type (compared with 42.8% and 40.4% respectively last season). Therefore, caution should be used when interpreting the data.

A recombinant quadrivalent vaccine (QIVr) was commissioned for use in the UK in 2020 to 2021. QIVr continued to be administered in the 2023 to 2024 season as advised by the Joint Committee on Vaccination and Immunisation (JCVI) (PDF, 224 KB) in at-risk adults and those aged 65 years and older as a first line vaccine. See Figure 13b and Table 16.

For those aged 65 years and over, the percentage of vaccination coded with a defined type was higher than the 2022 to 2023 season, with 52.7% in 2023 to 2024 compared with 42.8% last season. Where vaccine type was provided for 52.7% of GP practices responding (Figure 13a), 96.6% received the first line recommended vaccine. Adjuvanted quadrivalent influenza vaccine (aQIV), was administered to 94.9%, with an additional 1.6% vaccinated with recombinant quadrivalent influenza vaccine (QIVr). JCVI also recommended the high dose quadrivalent influenza vaccine (QIV-HD); however, QIV-HD is not currently available in the UK market, see Figure 13a and Table 16. Second-line vaccination (cell-grown quadrivalent influenza vaccine (QIVc) was administered to 3.1%. Egg-grown quadrivalent influenza vaccine (QIVe), which was not recommended to those aged 65 years and over, was given to 0.3%. This compares with 0.6% of this group last season (2022 to 2023) who were vaccinated with QIVe.

For those aged 16 to under 65 years in a clinical risk group, the percentage of vaccination coded with a defined type was higher than the 2022 to 2023 season, with 48.2% in 2023 to 2024 compared with 40.4% last season. Where vaccine type was provided, 93.4% received the recommended first-line vaccines, (89.4% were QIVc and 4.0% were recorded with QIVr), which is higher than those that received first line vaccines last season (83.5% in 2022 to 2023). A further 6.6% were vaccinated with the second-line QIVe vaccine (which is lower than last season (16.5% in 2022 to 2023)). See Figure 13b and Table 16. 

Data by vaccine type still remained very low. However, where vaccine type was available, it is encouraging to see that a very high proportion of the vaccinations given were in line with recommendations for first-line vaccine types for each cohort.

Figure 13a. Percentage of vaccine type codes in the GP record by target cohort and vaccine type in vaccinated patients aged 65 years and over

Figure 13b. Percentage of vaccine type codes in the GP record by target cohort and vaccine type in vaccinated patients aged 16 to under 65 years in a clinical risk group

Table 16. Extrapolated number of vaccinations given by vaccine type in patients aged 65 years and over; and those aged 16 to under 65 years and in one or more clinical risk groups during the 2023 to 2024 season

Vaccine type [note 1]	Percentage of those vaccinated aged 65 years or older where vaccine type is available (%)	Extrapolated number of people vaccinated aged 65 years or older	Percentage of those vaccinated aged 16 to under 65 years and at risk where vaccine type is available (%)	Extrapolated number of people vaccinated aged 16 to under 65
All vaccines	77.8	8,880,000	41.4	4,031,000
Adjuvanted vaccine (aQIV)	94.9	8,426,000	[z]	[z]
Cell based vaccine (QIVc)	3.1	275,000	89.4	3,604,000
Recombinant quadrivalent vaccine (QIVr)	1.6	142,000	4.0	161,000
QIV non- adjuvanted vaccine (QIVe)	0.3	26,000	6.6	266,000

Note 1: Caution should also be exercised when interpreting the extrapolated number of people vaccinated by vaccine type as this is based on the limited available data (a large proportion of vaccine type is unknown or not stated; at 47.2% and 51.8%, respectively, for those aged 65 years and over, and for those aged 16 to under 65 years in a clinical risk group). Caution should also be exercised when interpreting these figures because of rounding.

The number of live attenuated influenza vaccine (LAIV) vaccinations recorded for patients aged 2 and 3 years have been collected as an experimental cohort for the last 4 years. Where vaccine type was provided for 96.9% of GP practices responding, 93.7% of those aged 2 and 3 years who were vaccinated received LAIV (Table 17).

Table 17. Influenza vaccine uptake in those aged 2 and 3 years for England from 2020 to 2021 season to 2023 to 2024 season; and the proportion of LAIV vaccinations recorded for this cohort

All aged 2 and 3 years	2023 to 2024	2022 to 2023	2021 to 2022	2020 to 2021
Vaccine uptake (%)	44.4	43.7	50.1	56.7
Extrapolated number of people vaccinated	558,000	554,000	648,000	746,700
% of those vaccinated with LAIV	93.7	96.2	97.5	92.1
Extrapolated number of people vaccinated with LAIV	522,000	533,000	632,000	688,000

Glossary

At-risk

Patients with clinical risk groups as listed in the Green Book.

Child GP survey

The flu vaccination uptake survey that collects all the child cohort data.

dm+d     

Dictionary of medicines and devices.

Green Book

The Green Book is also known as ‘Immunisation against infectious disease’, a UKHSA publication on vaccines, vaccine-preventable infectious diseases, and vaccination procedures. Chapter 19 refers to influenza.

ImmForm      

ImmForm is a website that provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection.

Main GP survey

The flu vaccine uptake survey that collects data on all adult cohorts and children in clinical risk groups.

School-age year

The school-age year is determined by their age on the 31 August 2023. This will be correct for the majority of children.

SNOMED CT codes

Systematized Nomenclature of Medicine Clinical Terminology. This is a structured clinical vocabulary for use in electronic health records.

Data sources and methodology

Prior to the start of the seasonal data collection, the influenza surveillance team produce a data set for the collection. The team commission PRIMIS to write an accompanying coding specification for GP system suppliers (GPSS) to extract the data from GP practices. The PRIMIS specification provides rules for the extraction of the data from GP systems using the following clinical code terminologies: Systematized Nomenclature of Medicine Clinical Terminology (SNOMED CT).

Cumulative data on seasonal influenza vaccine uptake were collected for all GP practices in England between 1 September 2023 to 29 February 2024 using the ImmForm website.

ImmForm provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection.

The data collections consist of:

• a weekly sentinel survey using an automated extraction only (XML bulk upload or a web service)
• 5-monthly surveys starting with a collection covering the 1 September 2022 up to the end of September which is then refreshed each month up until the end of February 2024.

GP-practice level data was submitted to the ImmForm website either via an automated extraction provided by GPSS (who extract data directly from GP practice systems) or via manual upload, across England. Automated data extraction results in an almost zero burden on GP practices providing the data. The weekly data allows near ‘real-time’ monitoring of the programme at a national level from calendar week 36 (week ending 11 September 2023) to calendar week 4 (week ending 29 January 2024). The user guide for the survey can be found at seasonal influenza vaccine uptake (GP patient survey) data collection.

The vaccine uptake figures reported here are based on the practices which have supplied data. This report includes extrapolated estimates of the total eligible population and the total number vaccinated in each cohort if there was a 100% response rate to the survey.

The extrapolated number of vaccinations is derived by multiplying the mean number of vaccinations per practice by the total number of practices. This calculation assumes that the GP-practice population is the same across all practices and that the uptake rate is the same as that seen nationally.

Median calculations are based on sub-ICB level data. There were no configuration changes between CCGs and sub-ICBs for 2023 to 2024 season.

Last season (2022 to 2023) an additional survey was added for September. February surveys were introduced as an experimental collection in 2017 to 2018, extending the data collection period by a month to allow for better inclusion of data returning from outside the practice and later in-practice vaccinations. Following evaluation, the February collection was adopted for the end of season figures. During the 2018 to 2019 season, only automated extractions were expected however manual upload was added to the end of February data return from the 2019 to 2020 season.

ImmForm

Influenza vaccine uptake data is submitted via the ImmForm website. Data is submitted at GP practice level and can then be aggregated as required to the different hierarchies such as sub-ICB (previously CCG), ICB (previously STP) or local authority. During the season, specific functions were available weekly and monthly on ImmForm to enable local management of the vaccination programme. These functions include the ability to:

• view and evaluate influenza vaccine uptake rates by cohort and age band for their area down to the GP practice level
• compare GP-practice level data within the sub-ICB (or previously CCG) and to previous years
• validate data at point of data entry
• download ‘non-responder’ reports to aid local areas following up GP practices that have yet to respond to the survey

Data validation

Data validations are built into the ImmForm website to validate at point of entry. Data is then further validated by the UKHSA influenza surveillance team on a weekly and monthly basis. PRIMIS are commissioned by UKHSA to write the clinical code specification for the surveys and commissioned to conduct 2 data validation reports to check alignment with the clinical code specification.

Data limitations

Denominator data for some localities and at-risk groups should be interpreted with caution due to data validation and data quality issues. A summary of these limitations is provided below.

Further information on definitions and data limitations can be found in the user guide.

Snapshot of influenza vaccine uptake data

Influenza vaccine uptake data presented in this report is a snapshot of GP-registered patients vaccinated at the time of data extraction. The annual report includes data up until the end of February to allow time for data to flow from other services to the GP record when vaccines are delivered in other settings. Patients who are vaccinated but have not had their electronic patient record updated by the time of data extraction, will be included within the denominator, but will not be included in the count of ‘number vaccinated’. This data will, therefore, not include patients in the numerator or denominator who have received the vaccine but have subsequently died; or changed clinical status (for example, ‘joining’ or ‘leaving’ a clinical risk group); or patients changing carer status; and ‘temporary’ patients who may have received the vaccine but were not registered on the date of data extraction. The extract will also exclude the prison population unless the individuals were registered with a GP practice at the time of data extraction and their vaccination details were recorded on their primary care electronic record. Healthcare workers and social care workers will only be counted in the number vaccinated if they were vaccinated at the GP practice or their vaccination details were entered on their GP practice’s electronic record.

Transition to SNOMED CT

In the 2019 to 2020 season all GPSS in England moved over to SNOMED CT. However, some GPSS are still working with older versions of SNOMED. Because of the transition, mapping errors between SNOMED CT and previous clinical terminologies are being identified and corrected across GPSS but small numbers of mapping issues may remain.

Despite these data limitations, the granular data is considered valid with a degree of caution, especially when drawing comparisons to historical data where they may be affected by the SNOMED transition.

Clinical coding changes

It is important to note that clinical coding frequency can increase or decrease depending on the coding behaviour of GP practices and other NHS organisations; and the definitions used to extract the data. These changes in coding frequency can be driven by policies such as changes to the Quality Outcomes Framework (QOF) or the introduction of new initiatives to drive better quality of data through better coding of data. Changes to the coding can greatly affect smaller groups such as the data we collect on individual at-risk groups. We monitor this each year by looking at the prevalence of each risk group within the general population and the at-risk population while considering any wider changes to the health system that may impact the data.

Pregnant women: denominator variance

Determining an accurate denominator for eligible pregnant women is challenging because of the complexities in the way pregnancy is recorded and coded on local clinical systems in primary care. In addition, in recent years, influenza vaccine for pregnant women has increasingly been delivered through midwifery services and pharmacies and so vaccination data needs to flow back to the GP record in the appropriate format to allow capture in the ImmForm collection.

Reported influenza vaccine coverage in pregnant women is likely to be an underestimate for the following reasons:

• the dynamic nature of the denominator with women continually entering and leaving the cohort throughout the season through conception, miscarriage, abortion, or delivery
• there are multiple ways to record ‘pregnancy’ in the GP record with a range of SNOMED codes available that are not applied consistently
• the delay in updating the individual’s electronic GP clinical record following birth or loss of pregnancy
• delay or gaps in data flows that allow capture of vaccines delivered outside the GP practice

The scale of the underestimation is not clear and could vary between GP practices and regions. For further details of pregnancy data limitations, see the GP survey user guide.

Vaccination in other healthcare settings

The number of individuals vaccinated in a school, pharmacy and other healthcare setting was captured by the survey. It is important to note that the evaluation of vaccines delivered outside of GP practice does not come under an existing information standard therefore the quality of location recording may vary between GP practices and GPSS. In 2023 to 2024, pharmacies were commissioned to administer influenza vaccinations to:

• any patient aged 18 to under 65 years in a clinical risk group 
• pregnant women 
• carers 
• people living in long-stay residential care homes or other long stay care facilities 
• close contacts of immunocompromised individuals

They were also commissioned to administer influenza vaccinations to frontline health and social care staff employed by:

• a registered residential care or nursing home
• registered domiciliary care provider
• a voluntary managed hospice provider
• direct payment (personal budgets) and/or personal health budgets, such as personal assistants

While the number of vaccinations reported as given in pharmacies can be taken as correct because there is a specific clinical code associated with this, there is likely to be a lag in data being fed back into the GP record.

As expected, vaccination delivered in other healthcare settings is much higher for the pregnant cohort because of increasing administration by midwifery services. The vast majority of school-aged children are vaccinated in school and therefore in the survey vaccines recorded in these age groups are assumed to be school-delivered in the survey unless specifically coded as ‘vaccinated in a pharmacy’. As data flows from school-aged immunisation services (SAIS) and the Child Health Information Systems (CHIS) to the GP record are not yet well established, flu vaccination data for the school-aged cohorts in the GP survey remain experimental. Improved data flows from other healthcare settings to the GP record are important to both reduce the administrative burden on GP practices and ensure timely and accurate vaccine coverage can be reported for all eligible cohorts. Results for the LAIV programme in primary school-aged children will be available in a separate report based on manual returns from local NHS teams. The national childhood influenza vaccination programme report is available online.

Vaccine type

Vaccine type can be coded using dictionary of medicines and devices (dm+d) codes and SNOMED CT codes. All GPSS in England have now moved over to SNOMED CT clinical terminology. Vaccine type was introduced to the GP survey in the 2018 to 2019 season and the experimental data collected thus far show that this information is not routinely recorded in the required coded format to allow extraction. The information is likely to be recorded in the GP record as free text and therefore not extractable using a clinical code specification. We expect this variable to become better recorded in the future.

Social care workers

Vaccine uptake in social care workers was included for the first time in the 2019 to 2020 data collection. The SNOMED CT codes for this workforce were introduced on the 1 April 2018 but appear to be a poorly applied in the GP record therefore the denominator estimate in the survey is not currently reliable.

There are a range of options for employers offering the vaccine to social care workers which makes this cohort particularly difficult to evaluate. Only a minority will get vaccinated through their GP practice. Data flows for vaccinations delivered to social care workers outside of the GP setting are not well established, therefore, caution should be used when interpreting the data.

Learning disability

Vaccine uptake in those with wider learning disabilities including severe learning disability as a subset of this cohort was included for the first time in the 2020 to 2021 season as an experimental cohort and continues to be included in the 2023 to 2024 season. The clinical coding specification is defined within the PRIMIS specification. The wider learning disability cohort includes all those on the QOF learning disability register (PDF, 10.9 MB) and a small number of additional patients with other learning disability coding. The clinical codes related to severe learning disability are also still included within the chronic neurological disease clinical risk group and therefore comparable to previous years. Please note that those who have a wider learning disability with no other clinical risk group are not included in the overall at-risk category data.

Background information

The purpose of the seasonal influenza immunisation programme in England is to offer protection to those who are most at risk of serious illness or death should they develop influenza.

In 2012, the JCVI recommended the implementation of a universal childhood influenza vaccine programme with LAIV. The childhood LAIV programme was introduced in 2013 to 2014 and progressively expanded across year groups in a phased implementation. In the 2023 to 2024 season, LAIV was offered to all those aged 2 and 3 years through primary care. It was also offered through a largely school-based programme to primary school-aged children (Reception to Year 6) and secondary school-aged children (Years 7 to 11). The aim of the childhood programme is to both directly protect children and reduce influenza transmission. This provides indirect protection to the rest of the population, including those at increased risk of the severe consequences of influenza infection.

NHS England, through ICBs and regional public health commissioning teams, has responsibility for commissioning the influenza programme with general practices, midwives, and other healthcare professionals. Immunisation managers and coordinators in NHS teams play a significant role in delivery within their ICBs (and previously STP boundaries).

GP practices provide monthly coverage data between September and February, with most practices providing this through automated uploads from their electronic clinical systems. For 2021 to 2022 and 2022 to 2023, an additional collection was published in October (for all vaccination activity between 1 and 30 September). This was not continued in 2023 to 2024. Automated extraction provides near-complete data, with many practices also contributing data weekly, and gives consistent data for comparisons over time. The UKHSA influenza surveillance team has responsibility for collating the data and reporting on the progress in the uptake of the seasonal influenza vaccine. The ImmForm website enables the monitoring, tracking and reporting on provisional vaccine uptake on a weekly and monthly basis during the influenza season.

The seasonal influenza vaccine uptake survey in GP-registered patients was first split into the ‘main GP Survey’ and the ‘child GP survey’ in the 2017 to 2018 season. Data presented in this report and accompanying tables is for the end-of-season data, up to the end of February in England.

The data counts the cumulative number of GP-registered patients who have had at least one dose of influenza vaccine from 1 September 2023 to 29 February 2024. The survey does not include vaccinations given to patients who have since moved practice or who have died, but does include those vaccinated by another healthcare provider (provided the GP patient electronic record is updated). This end-of-season report provides the final influenza vaccine uptake figures in GP-registered patients. This data is collated for public health surveillance purposes only and this system is not designed to support GP-practice payments.

The programme for 2023 to 2024 was announced in the annual flu letter jointly issued to the NHS by UKHSA, the Department of Health and Social Care (DHSC) and NHS England (NHSE) on 25 May 2023 (with an amendment published on 3 July 2023 outlining an expansion of the programme). In May 2023 it was recommended that influenza vaccine be offered to:

• all children aged 2 and 3 years
• all children of school age in years Reception to Year 6 (aged 4 years rising to 10 years)
• those aged 65 years and over
• those aged 6 months to under 65 years in clinical risk groups
• pregnant women
• those in long-stay residential care homes
• carers (as defined in the influenza chapter of the Green Book)
• close contacts of immunocompromised individuals
• frontline health and social care staff

In July 2023 it was announced that eligibility would be extended to:

• secondary school-aged children (Year 7 to Year 11) 

Fewer individuals were eligible for the programme this season with those aged 50 to 64 years not in clinical risk groups no longer eligible.

The national vaccine uptake ambition for 2023 to 2024 was to demonstrate a 100% offer and to achieve equal or above the uptake levels of 2022 to 2023 for each cohort

Feedback and acknowledgements

You are welcome to contact us directly by emailing influenza@ukhsa.gov.uk with any feedback you may have about this report and data.

The authors would like to thank everyone that contributed to the data collection, specifically:

• all those who participated in and supported the influenza vaccine uptake collection (GP patient survey), principally GP practice data providers, NHSE regional public health commissioning teams, screening and immunisation teams and screening and immunisation influenza coordinators in England
• the participation of GP IT system suppliers and third-party suppliers in providing the reporting tools and services for their customers in particular; EMIS Health, VISION and TPP, who enabled automated extracts of data
• the participation of the PRIMIS team based in Nottingham, who was commissioned to provide the SNOMED CT Codes specification for this collection
• the ImmForm helpdesk and development team that provided and supported the online survey