Inequalities in childhood vaccine uptake: a longitudinal analysis of national coverage in England 2019-23

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? What this study adds ### Competing Interest Statement DH and NF are currently in receipt of grant support from Seqirus UK Ltd. for the evaluation of influenza vaccines in the UK. NF, RV and DH have previously received research-initiated and industry-initiated research grant support from GlaxoSmithKline (GSK) Biologicals for evaluation of rotavirus vaccination in the UK. DH has also received grants from GSK, Sanofi Pasteur, and Merck & Co (Kenilworth, New Jersey, USA) for rotavirus strain surveillance. AF, VD, MA, SQ and DTR have no competing interests to disclose. ### Funding Statement There was no direct funding for this project. AF was funded by a National Institute for Health and Care Research (NIHR) Academic Clinical Fellowship. DH was funded by an NIHR Post-doctoral Fellowship (PDF-2018-11-ST2-006). DTR is funded by an NIHR Research Professorship (NIHR302438) and by the NIHR School for Public Health Research (PD-SPH-2015). DH, AF, RV and VD are affiliated to the NIHR Protection Research Unit (HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA), in collaboration with University of Warwick. RV and NF are affiliated to the NIHR HPRU in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UKHSA, in collaboration with University of Oxford. The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or the UKHSA. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data is open access and available through original sources at the UK Health Security Agency and the Office for Health Improvements and Disparities. https://www.gov.uk/government/publications/cover-of-vaccination-evaluated-rapidly-cover-programme-annual-data and https://fingertips.phe.org.uk/profile/general-practice I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes