Inequalities in childhood vaccine uptake: a longitudinal analysis of national coverage in England 2019-23
Authors: Flatt Aidan , Vivancos Roberto , French Neil , Quinn Sophie , Ashton Matthew , Decraene Valérie , Hungerford Daniel , Taylor-Robinson David 
Published: February 2024

Objective

This study aims to quantify changes in inequalities in childhood vaccination uptake in the context of steadily declining overall childhood vaccination rates in England.

Design

Cross-sectional longitudinal study.

Setting

We analysed general practice (GP) level data for five childhood vaccinations (MMR1, MMR2, rotavirus, the pneumococcal (PCV) booster and the six-in-one vaccine) from the Cover of Vaccination Uptake Evaluated Rapidly dataset in England.

Participants

Children under 5 years of age eligible for paediatric immunisations between April 2019 and March 2023 registered at GPs in England.

Main outcome measures

Changes in quarterly vaccine uptake over time compared by deprivation level. Regression analyses to quantify the change in inequalities in vaccine uptake over time, expressed as changes in the Slope Index of Inequality (SII). We estimated cumulative susceptibility to measles and rotavirus disease at age five.

Results

The absolute inequality in vaccine uptake in 2019/20 was largest for MMR2 at 5 years of age (SII -9.8%; 95% CI -9.2 to -10.4). In all vaccinations the SII for uptake increased over the study period: six-in-one -5.1% to -7.8%; rotavirus -7.7% to -10.6%; PCV booster -7.9% to -9.9%; MMR1 at 2 years of age -8.1% to -10.1%, MMR1 -3.3% to -5.9% and MMR2 at 5 years of age -9.8% to -13.7%. The number of measles susceptible children in the least deprived decile increased 15-fold to 20958, and 20-fold to 25345 in the most deprived decile. For rotavirus there was a 14-fold increase in the least deprived decile, and a 16-fold increase in the most deprived decile to 45201.

Conclusion

Inequalities in childhood vaccination are increasing in England as uptake rates for five key childhood vaccinations have decreased between 2019 and 2023, below the recommended 95% uptake target. Urgent action is needed to strengthen systems for childhood vaccination, with a key focus on reducing inequalities.

What is already known on this topic?

Uptake rates of childhood vaccinations in England have been steadily declining in the last decade.

Socioeconomic deprivation is associated with lower rates of childhood vaccination uptake.

What this study adds

This analysis of national vaccination coverage data shows decreasing coverage and increasing inequality in five key childhood vaccinations in England from 2019 to 2023.

The most pronounced increase in inequality over time is seen in the MMR2 vaccination, with a 40% relative increase, whereby the absolute difference in vaccination uptake rates between GP practices serving the lowest and highest levels of deprivation increased from 9.8% to 13.7% across the study period.

Where vaccination catch up is not implemented, an increasing cumulative number of children more susceptible to infection exists as deprivation increases.

Policy and practice should respond quickly to address rising socio-economic inequalities in vaccine uptake in children by strengthening systems and tackling the drivers of low vaccination uptake for disadvantaged children.