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Multipronged solutions are required. The covid-19 pandemic showed the need for a robust approach to routine vaccination delivery that can be pivoted in an emergency to attain high and equitable coverage. The covid-19 vaccination programme offers lessons for achieving greater vaccine equity, showing how responsibility for health protection could be shared with underserved communities to foster a sense of public ownership over progress.21 Communications were co-developed with underserved communities and vaccines routinely offered across the health system—generating new delivery models for the seasonal influenza programme.21 However, there are strong indications that lessons for preparedness are not being applied in England. Integrated care boards, the NHS organisations that plan and commission health services for their local populations, are expected to reduce operational costs by 50%,22 which will affect strategies for vaccine coverage recovery and community engagement. Fragmentation will persist if funding is directed to Best Start pathways but scaled back in other arms of the immunisation system. Improving vaccine equity in these circumstances requires recommending or offering vaccines opportunistically, making every contact with health services count for children.21

ity engagement. Fragmentation will persist if funding is directed to Best Start pathways but scaled back in other arms of the immunisation system. Improving vaccine equity in these circumstances requires recommending or offering vaccines opportunistically, making every contact with health services count for children.21 Reporting adverse events through the Yellow Card system is critical for monitoring vaccine safety. Patient reporting of vaccine adverse reactions has increased since 2005-07, probably because the routine schedule has expanded and public awareness of self-reporting procedures has increased.23 Healthcare professionals should always take patient concerns of adverse reactions seriously to help protect confidence in vaccine recommendations. Health professionals should have annual vaccine training, but provision remains sparse or difficult to attend. This should be prioritised to ensure anybody involved in vaccination is equipped and confident to have conversations with parents and patients. Attaining high and equitable vaccine coverage requires sustained investment. Coverage recovery can be advanced by enabling parents to draw confidence about vaccine safety from consensus. Service fragmentation can be reduced by coordinating system-wide action that clearly allocates responsibility and funding entitlements. Committing to family centred delivery strategies offers potential to reverse the decline in child health caused by austerity but will be most effective as part of a strategy to ensure vaccines are within arm’s reach of every child throughout their life course.