Understanding differences in childhood vaccination uptake across regions in England
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Understanding differences in childhood vaccination uptake across regions in England
Quick-read summary
Fewer young children are getting their routine vaccines in England, including the measles, mumps, and rubella (MMR) vaccine. This drop has contributed to new measles outbreaks across the country. Our study looked at how the COVID-19 pandemic affected vaccination rates across different parts of England, and whether some areas were more affected than others.
We found that vaccination rates were already declining before the pandemic, but the first COVID-19 lockdown caused an extra drop in uptake. The impact varied across regions and by levels of deprivation. For example, children living in the most deprived areas were less likely to receive their MMR vaccine after the lockdown. In some regions, vaccine uptake declined further, while in others it improved.
Key finding: Local differences matter. Areas with similar levels of deprivation did not always see the same changes, meaning a one-size-fits-all national approach may not be enough. Efforts to improve vaccination should take into account both deprivation and regional context.
A greater understanding of the link between deprivation across regions in England and childhood vaccination uptake can support policy, practice, and decision-making with regard to the childhood vaccination schedule. This is especially important when deciding whether to include more vaccines in the routine schedule.
Efforts to improve childhood vaccination uptake are needed to protect children from harmful diseases. The findings from this study can be used to identify the places where interventions are most needed to improve vaccination rates.
More details
What is the issue?
Vaccination protects children from getting serious illnesses and their related, long-term issues. However, in recent years, vaccination rates have been declining across the world, causing the diseases to spread. For example, measles, mumps and rubella (MMR) vaccination rates are falling in the UK, which has led to measles outbreaks in areas such as Birmingham. The COVID-19 pandemic may have made this situation worse, and we wanted to find out whether that was the case.
Research summary
- We used freely available vaccination coverage data published by the government, and the Indices of Multiple Deprivation, which describes the deprivation profile of an area.
- Coverage of the pre-school booster and MMR vaccines was explored from 2014 to 2022.
- Statistical methods (spline regressions with interaction terms) that allow researchers to look at trends over time were used to test whether there was a change in vaccination uptake according to region and deprivation level. A “breakpoint” in the data was defined to represent the beginning of the first COVID-19 lockdown in England.
What did the research find?
- Vaccination uptake (for both pre-school booster and MMR) was already declining in England before the first COVID-19 lockdown.
- After the first lockdown, there was an additional drop: about 12% lower odds of getting the pre-school booster, and about 13% lower odds for MMR, compared to what would have been expected based on pre-lockdown trends.
- The decline was worse in more deprived areas for MMR: the most deprived 25% of areas experienced a larger post-lockdown drop in odds of MMR uptake.
- The changes differed a lot by region. For example, in Yorkshire and the Humber, the odds of uptake dropped a lot for both vaccines. However, for some regions (e.g. West Midlands, North West), there were increases in odds for MMR post-lockdown (i.e. did better than some other regions) in certain deprivation quartiles.
- Thus, even among similarly deprived areas, regions varied in how much vaccine uptake dropped after COVID-19. This means deprivation alone does not explain everything; geography/region also matters.
Why is this important?
The results show that COVID-19 did not cause a temporary disruption: there are sustained impacts in vaccination uptake, particularly for the MMR vaccine, and children in poorer areas are more likely to be affected, which could lead to more disease outbreaks in those areas. Also, national averages can hide big local differences; targeting interventions to the right places could prevent disease and reduce inequity.
Recommendations for policy and practice
- Focusing resources and interventions in regions and local authorities where uptake has declined most (especially deprived areas), rather than assuming the same problem everywhere.
- Tailoring interventions to local context – for example, what works in Yorkshire and Humber might differ from what works in the West Midlands.
- Ensuring that when adding new vaccines or changing schedules, equity is built in – so that more deprived or hard-to-reach areas do not fall further behind.
What happens next?
Further research to understand why some regions were more resilient or better able to maintain vaccination uptake than others (e.g. what worked in regions that did well, or what barriers exist in those that did poorly).
Get in touch about this work
Email: [email protected]
Read the full research paper
Acknowledgements
This research was funded as part of a PhD scholarship, awarded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC).