This is one of those travel health questions that sounds as though it should have a very simple answer.

A traveller is going somewhere where access to medical care may be difficult. They completed their routine tetanus vaccinations years ago, but their last tetanus-containing dose was more than 10 years ago. Current guidance recommends a tetanus-containing booster before travel. The vaccine we would use in an adult is Td/IPV, usually Revaxis.

But here is the question I get asked again and again:

If tetanus is indicated because of the travel risk, but polio is not indicated for the destination, is that dose of Revaxis free on the NHS in England, or should it be given privately?

I have given various versions of “it’s complicated” on courses over the years, which is never a terribly satisfying answer when somebody is actually sitting in front of you in clinic.

So I decided to properly go digging.

And, unfortunately, it really is complicated.

First: is tetanus actually indicated for travel?

This bit is relatively straightforward.

The current Green Book, Chapter 30: Tetanus says that for travellers going somewhere where medical attention may not be readily accessible, a booster should be given if the last tetanus-containing vaccine was more than 10 years ago, even if the traveller has previously received five doses.

It then states “Where tetanus, diphtheria or polio protection is required… Td/IPV should be given.” That is on page 7 of Chapter 30.

So clinically, there is no real argument. A traveller can have an indication for tetanus vaccination because of their travel plans even when there is no particular polio risk at their destination.

The difficulty starts when we stop asking “is it clinically indicated?” and start asking “who pays for it?”

Those are not the same question.

What does the current GP contract actually say?

The document we need for this is the General Medical Services Statement of Financial Entitlements Directions 2026, usually shortened to the SFE. This sets out, amongst many other things, which vaccinations GP practices in England are paid to provide. If you go straight to the section headed “Vaccines and immunisations required for the purposes of foreign travel”, things initially look fairly clear:

Table 2 starts on page 58 of the SFE.

It lists four diseases:

• Cholera

• Hepatitis A

• Poliomyelitis

• Typhoid

Tetanus is conspicuous by its absence.

For polio, the document says “A course of immunisation (using an age appropriate combined vaccine) is to be offered where the traveller is at risk of exposure, or vaccination is an entry requirement."

So if polio is genuinely indicated, there is no problem. An adult would normally receive Td/IPV and it is part of NHS travel provision.

But what about our traveller going somewhere where tetanus protection is indicated but polio is not?

If you stop reading there, it is entirely reasonable to conclude that tetanus is not listed as an NHS travel vaccination, therefore a tetanus-only travel indication is private.

That is certainly how I and others had begun to interpret it.

There is another interesting detail on the following page. Tetanus does appear in the SFE on page 59, but there it sits within the section dealing with vaccination in response to a localised outbreak.

Again, that does not obviously help our traveller.

So at this point the “private” argument looks fairly convincing.

Except...

There is another section of the SFE. And it changes things quite considerably. The bit buried on page 41.

Much earlier in the SFE is Section 16, which deals with dispensing and reimbursement for personally administered products.

Td/IPV is specifically discussed here. On page 41, paragraph 16(8) it says: “Payments are payable under this Section” in respect of Td/IPV in adults, or when it is “supplied to patients who require such products prior to travelling outside the United Kingdom provided the Td/IPV product has been purchased directly from the manufacturer".

Again, this wording can be seen in the 2026 SFE PDF.

That is rather important.

It does not say “patients who require polio vaccination prior to travel.” It refers to Td/IPV being supplied to patients who require it before travelling abroad.

And suddenly the answer looks rather different.

So can the practice charge instead?

This brings us to the GMS Contracts Regulations 2015. Regulation 25 sets out the circumstances in which a GP contractor is allowed to charge a patient. For travel vaccinations it permits charging for “an immunisation for which no remuneration is payable by NHS England” when it is requested in connection with travel abroad.

And this is where it gets really interesting.

If Section 16(8) of the SFE says that payment is payable for Td/IPV supplied to somebody who requires it before foreign travel, can we really then say that no NHS remuneration is payable and charge the patient privately?

That is the question I am currently trying to get definitively answered. My interpretation at this point is increasingly leaning towards no.

In other words, clinically indicated Td/IPV for travel probably should be provided on the NHS, even where tetanus rather than polio is the reason the traveller needs it. But I don't think the documents make this anywhere near as clear as they should.

And then I found the older guidance...

And this is where the history becomes particularly helpful.

An older NHS England guidance document on payments for travel vaccines is much more explicit.

Under “Tetanus (only available as combined vaccines)” it specifies Td/IPV and says it is free under the NHS Global Sum for “Travellers requiring vaccination or booster.”

That's about as unambiguous as you could wish for.

So the idea that Revaxis is NHS-funded when tetanus is required for travel certainly hasn't appeared from nowhere. It was explicitly stated in previous NHS England guidance.

And intriguingly, the Td/IPV reimbursement wording hasn't simply appeared in the 2026 SFE either. The 2024 SFE also contained essentially the same provision allowing payment for Td/IPV supplied to patients requiring it before travelling outside the UK.

That makes me wonder whether what has changed over time is less about the actual entitlement and more about how the headline travel-vaccine list is presented.

Current NHS England guidance adds another piece

There is more.

NHS England's current Items which should not routinely be prescribed in primary care guidance was last updated in August 2025.

When discussing vaccines administered exclusively for travel, it says that the following may still be administered on the NHS if clinically appropriate:

“diphtheria/tetanus/polio” along with cholera, hepatitis A and typhoid.

That again supports the interpretation that Td/IPV remains an NHS travel vaccine when clinically indicated.

Interestingly, the current NHS travel vaccinations page is less clear. Its patient-facing information lists “polio (given as part of the combined TD/IVP vaccination)” as free, without separately listing tetanus.

And that, I think, illustrates the problem beautifully.

Depending on which NHS document you open, you may come away with a different understanding.

Scotland, meanwhile, just says it.

I also looked at Scotland because its wording is refreshingly straightforward.

NHS Inform Scotland's travel vaccination guidance currently states that free NHS travel vaccines in Scotland include: “diphtheria, polio and tetanus (combined booster)” alongside hepatitis A, typhoid and cholera.

Scotland obviously operates under a different system, so this does not determine the position in England.

It does, however, demonstrate just how much easier this question is when somebody actually writes down what they mean.

Clinical indication is not the same as funding.

I think this is the part that causes quite a lot of confusion.

The fact that tetanus vaccination is recommended in the Green Book, NaTHNaC guidance or a PGD tells us whether the vaccine is clinically appropriate and can be administered within that framework.

It does not, by itself, tell us who pays.

For example, rabies may be very clearly indicated for a traveller. That does not make pre-exposure rabies vaccination an NHS-funded travel vaccine.

Likewise, somebody travelling to see a newborn overseas may request a pertussis-containing vaccine because of a local recommendation for “cocooning” or ring vaccination.

That vaccine may also contain tetanus, diphtheria and polio.

But that does not automatically make it NHS-funded in England simply because some of its antigens also appear in NHS programmes.

The reason for vaccination and the relevant funding mechanism matter.

What about combined hepatitis A and B?

This is slightly different and, in my view, rather easier.

Hepatitis A is explicitly listed in the SFE as an NHS-funded travel vaccination.

So if hepatitis A is clinically indicated and a combined hepatitis A/B product is appropriately selected, there has historically been guidance that the patient should not be charged simply because the chosen preparation also contains hepatitis B.

The principle there is easier to understand because there is an unquestionable NHS-funded antigen driving the vaccination.

With our tetanus example, the confusion arose because none of the antigens explicitly listed in Table 2 appears to be indicated for that particular journey, yet elsewhere the SFE specifically provides reimbursement for Td/IPV required before travel.

That is the nuance.

So, what would I do today?

If you had asked me after reading Table 2 alone, I would have said “Tetanus isn't listed. If polio isn't indicated, logically it looks private.”

Having now read Section 16(8), the charging regulations, the older NHS England guidance and the current NHS England prescribing guidance together, I think the evidence points more strongly towards if Td/IPV is clinically indicated for a traveller, it should be provided on the NHS, even where the clinical reason for the dose is tetanus rather than polio.

I would still describe this as my current interpretation, rather than definitive contractual advice.

There is a possible alternative interpretation. Section 16 deals specifically with reimbursement of personally administered products, whereas Section 20 defines the travel vaccinations contractors are required to offer under the Global Sum. Someone could therefore argue that reimbursement of the product and contractual entitlement to the travel vaccination are not quite the same thing.

However, Regulation 25 only permits charging where no NHS England remuneration is payable, and Section 16 quite clearly says that payments are payable for Td/IPV supplied in the travel context.

That is why I now think the “free Revaxis” interpretation has the stronger case.

It also explains why longstanding travel-health teaching has consistently treated Td/IPV as NHS-funded. The further back you look, the more explicit the wording becomes.

But I have asked for a definitive answer.

I have now asked the BMA's General Practitioners Committee specifically about this scenario: "A traveller has a genuine tetanus indication because of their travel risk, but polio vaccination is not indicated. Is Td/IPV an NHS service, or may the GP practice charge privately?"

Their initial response acknowledged that the question is not straightforward and they are checking the specific Td/IPV position further. So I am going to leave this blog slightly unfinished.

As things stand, I think the weight of the evidence points towards Revaxis being NHS-funded when clinically indicated for travel, including where tetanus is the reason for giving it. But I would really like somebody responsible for the contract to say that plainly.

Because clinicians should not need to read page 58 of one section, discover a seemingly contradictory paragraph on page 41, consult the charging regulations, find an eight-year-old NHS England payment document and then compare it with another current NHS prescribing policy just to decide whether the patient sitting in front of them should pay £50. And patients certainly shouldn't get bounced between an NHS practice and a private travel clinic because neither side can confidently work out what the national rules intended.

I will update this when I receive a definitive response.