Maximising uptake of antenatal vaccinations during the Autumn flu and COVID-19 vaccine programmes

Classification: Official
Publication reference: PRN00817


  • Integrated care board (ICB)/local maternity and neonatal system (LMNS) maternity leads
  • ICB chief nurses
  • NHS trust and foundation trust:
    • Chief nurses
    • Directors/heads of midwifery
    • Medical directors
  • Primary Care Networks
  • All community pharmacies
  • Directors of public health and primary care


  • ICB chief executives
  • NHS trusts and foundation trusts chief executives
  • Regional:
    • Directors
    • Directors of commissioning
    • Chief nurses
    • Chief midwifery officers

Dear colleague,

Maximising uptake of antenatal vaccinations during the Autumn flu and COVID-19 vaccine programmes

Following the announcement by the Department of Health and Social Care (DHSC) and the UK Health Security Agency (UKHSA) (30 August) in relation to the risks presented by the new BA.2.86 variant of COVID-19, the NHS has been asked to take pre-emptive steps to bring forward the adult COVID-19 and flu vaccination programmes.

While it is difficult to predict the combined effect of the large number of mutations on severity, vaccine escape and transmissibility, expert advice is clear that this represents the most concerning new variant since Omicron first emerged. UKHSA has determined the most appropriate intervention with the greatest potential public health impact is to vaccinate all those eligible, quickly.

The Government has accepted JCVI advice that the seasonal COVID-19 vaccine should be offered this autumn to all pregnant women – because they are at higher risk of severe COVID-19 infection. Pregnant women are also eligible to receive vaccination against flu, as part of the programme that will begin locally on 11 September 2023 and end on 31st March 2024, and against pertussis as part of the year-round offer.

As the seasonal flu and COVID-19 vaccination programmes begin, we’re setting out the essential role of maternity and vaccination services in advising pregnant women of their eligibility for vaccination against flu, COVID-19, and pertussis, and facilitating easy access to these vaccines.

Wherever possible, vaccinations for flu, COVID-19 and pertussis should be offered at the same time (whilst at the same time reflecting individual preferences,), making it easier and more convenient to get vital protection and ensuring as many eligible people as possible are vaccinated by the end of October, in line with the updated guidance. Feasibility of offering all three vaccinations at the same time may also be affected by the recommendation that pertussis is offered between 16-32 weeks of pregnancy where possible.

In line with previous seasonal campaigns, there will be no national call/recall system for pregnant women to receive their seasonal flu and COVID-19 vaccines. Local services must therefore ensure that all pregnant women are informed of their eligibility, as part of routine care.

To support uptake of these vaccine offers, we therefore ask that:

1. Maternity, community pharmacy and primary care services ensure that all pregnant women are encouraged at every opportunity to take up the offer of vaccination against flu, COVID-19 and pertussis ahead of the winter months.

For maternity services in particular, this should include:

  • Providing UKHSA leaflets on COVID-19 vaccination, COVID-19 vaccination in pregnancy, and flu and pertussis in pregnancy in the pre-booking pack sent to all pregnant women. Leaflets can be ordered via UKHSA.
  • Making Every Contact Count to initiate a vaccine confidence discussion antenatally.
  • Making information, such as leaflets and posters in languages and formats appropriate for the local population, available across all antenatal settings for all three vaccines.

2. Maternity and vaccine services collaborate so that women are signposted locally to receive all three vaccines as easily as possible. Vaccination and maternity services should be brought together wherever possible, so that it is as easy as possible to get vaccinated at any point in the maternity pathway.

  • The COVID-19 vaccine should be offered at the same time as the flu and pertussis vaccines, although services should not delay providing any one vaccine in order to provide them together.
  • Dependent on local services’ participation in the vaccination programmes, women may be able to receive seasonal flu and COVID-19 vaccinations together from their local GP, pharmacist or maternity service. This should be supported wherever requested.
  • A list of contact details for Regional Vaccination Operations Centres (RVOCs) can be found in Appendix A of this letter. Maternity service leads are asked to co-ordinate with RVOCs so that all maternity staff can signpost local women effectively, and so that vaccine provision can be co-located with maternity services wherever possible.

For more information and guidance on vaccine confidence discussions, please refer to the RCOG/RCM information leaflet and decision aid, and the Green Book Chapter 14a for COVID-19 specifically, Green Book Chapter 19 for influenza. For more information on vaccination in pregnancy, visit NHS.UK.

Further information and guidance

  • Leaflets on COVID-19 vaccination, COVID-19 vaccination in pregnancy, and flu and pertussis in pregnancy are all available to order for free in English and to download in a range of languages and accessible formats.
  • Pregnant women across England can book a COVID-19 vaccine appointment from the 11 September locally (via GPs and community pharmacies where arrangements are in place) and from 18 September using The National Booking System, on the basis of self-declaration. There will be no requirement to prove pregnancy status.
  • Pregnant women should be made aware that pertussis vaccination is advised for each pregnancy and the flu vaccination is offered annually.
  • The COVID-19 vaccine dose should be offered at least 3 months after the previous dose. Operational flexibility may be applied to maximise timely delivery of the autumn programme and in consideration of individual circumstances.

We are grateful for services working to Make Every Contact Count (MECC) in advising pregnant women about COVID-19, flu and pertussis vaccination, and for collaboration between maternity and vaccination leads to make it as easy as possible to get vaccinated at any point in the maternity pathway.

Yours sincerely,

Kate Brintworth, Chief Midwifery Officer for England, NHS England  

Dr Matthew Jolly, National Clinical Director for Maternity and Women’s Health, National Maternity Safety Champion, NHS England  

Steve Russell, Chief Delivery Officer and National Director for Vaccination and Screening, NHS England 

Appendix A: List of contact details for Regional Vaccination Operation Centres, Autumn/Winter 2023