From pandemic to practice: applying COVID-19 engagement lessons to MMR vaccine equity

Introduction

This report describes a community engagement programme developed by Dudley Public Health to address inequities in measles, mumps, and rubella (MMR) vaccine uptake, offering a replicable framework for other public health departments. The programme is informed by crucial lessons in building trust and co-producing health communications learned during the ‘Living with COVID’ project, an initiative designed to understand the lived experience of residents from minoritised communities.

In Dudley, these lessons are now being applied to address the growing threat of measles, as global outbreaks become more common due to declining MMR vaccine uptake. This decline has been driven, in part, by reduced vaccine confidence. ¹ In the UK, MMR coverage has fallen below the herd immunity threshold. ² This has contributed to a national resurgence of measles, with a significant outbreak centred in the West Midlands in late 2023 ³ and again in 2025. ⁴ These echo the 2017–2018 West Midlands epidemic, where cases were primarily drawn from racially minoritised groups. ⁵ Nationally, inequalities in vaccine uptake persist by ethnicity and deprivation. ⁶ In Dudley, a metropolitan borough of approximately 320,000 residents, MMR coverage fell from a peak of 94.8% in 2016–2017 to 89.3% in 2022–2023, with the greatest reductions in the most ethnically diverse wards. ² This article outlines the core lessons from Dudley's community engagement approach and how they are being applied to address these widening inequalities in MMR uptake.

Approach

Between October 2021 and January 2022, Dudley Public Health co-produced the ‘Living with COVID’ project to explore the lived experiences of residents from minoritised communities. Thematic analysis was conducted on transcripts of 157 community conversations hosted by local community leaders. This project was not initially designed to deliver public health messages but to listen and understand community priorities. Vaccination naturally emerged as a key theme, and the trust established through this process created a foundation for collaboration. The core lessons learned are detailed below.

Lesson 1: Build From A Network Of Trust

The engagement began by leveraging existing trusted relationships between the council’s Healthy Communities Team and local community groups. These leaders initiated conversations within their communities, organically expanding the network of trust. This preestablished network proved invaluable for co-producing solutions to improve MMR uptake, such as developing a shared communications strategy. The foundation of the work was nonjudgmental listening, which demonstrated that the local authority was responsive to community priorities, thereby building reciprocity.

This approach informed Dudley’s ‘supportive conversations’ programme, where frontline workers are trained to hold empathic, nonjudgmental dialogues about the MMR vaccine. The goal is to explore understanding with curiosity rather than to persuade. This model has been successfully integrated into a ‘call-recall’ pilot, where general practice staff engage households with low vaccination uptake, significantly improving reach into minoritised ethnic households.

Lesson 2: Co-Produce And Diversify Communications

Community engagement highlighted that official communications were not reaching minoritised communities, who often relied on informal channels like family and friends. These channels were considered more reflective of their communities and were sometimes the only source of information in their language.

In response, Dudley Public Health partnered with Tandrusti, a trusted community organisation, to develop and deliver culturally relevant communications. Tandrusti shared key messages via WhatsApp and social media in local languages, answered community questions, and trained members to address concerns from friends and family. This cascaded information through trusted networks, enhancing the perceived safety of vaccination and fostering community ownership over health. This strategy also utilised testimonials from previously vaccine-sceptical individuals who had since become champions for vaccination, a powerful tool for reaching hesitant groups.

Feedback indicated that conventional messaging was often too complex and was perceived as blaming minoritised communities for disease spread. Consequently, the new childhood vaccination webpage uses animated videos and plain language explanations in 11 languages, co-produced with community engagement teams.

Lesson 3: Maintain And Strengthen Relationships Proactively

Mistrust of local authorities was a prevalent theme, with a perception that government bodies lacked transparency. The ‘Living with COVID’ project was critical in building and strengthening these relationships. This underscored the need to move beyond transactional engagement (i.e. acting only in a crisis) towards a proactive, reciprocal model that supports communities to thrive.

This requires cultural humility from public health teams: a process of self-reflection, valuing community expertise, sharing power, and continually learning from communities. ⁷ It involves enabling communities to define their own health needs and co-design acceptable interventions. Practical applications of this in Dudley include working with faith leaders to set up pop-up vaccination sites in community settings, tailoring risk assessments for culturally important activities, and promoting porcine-free MMR formulations for Jewish and Muslim residents. Such initiatives have helped Dudley Council to build trust and improve health literacy.

Continued investment in the vaccination workforce is essential to ensure sustainability. High staff turnover within primary care teams has necessitated regular training in the call-recall programme. Furthermore, health visitors and school nurses report that delivering vaccinations is increasingly difficult due to competing workload pressures, such as a rising child safeguarding workload, which risks the de-prioritisation of vaccination provision and a deskilling in these sectors. Addressing these systemic workforce issues is critical to the long-term success of community-led vaccination programmes.

Conclusion

Co-produced activities, such as Dudley’s community conversations, are effective strategies for engaging marginalised ethnic communities and addressing their health needs. The trust and insights gained from this work have been instrumental in developing a more culturally sensitive and equitable local strategy to increase MMR vaccine uptake. This community-centred approach, built on listening and partnership, offers a robust and adaptable model for public health departments responding to the ongoing measles epidemic and other health inequalities.