Childhood vaccination disparities are worsening in England, with coverage of five important vaccines lower in young children living in low-income areas and 20 times more children vulnerable to measles in the poorest areas, according to an observational study published last week in BMJ.
The University of Liverpool–led study evaluated data on uptake of the first and second doses of the measles, mumps, and rubella vaccine (MMR1 and MMR2), rotavirus vaccine, pneumococcal conjugate vaccine (PCV) booster, and six-in-one diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B (DTaP/IPV/Hib/HepB) among more than 2.4 million 5-year-old children from April 2019 to March 2023.
Need for catch-up vaccinations in underserved
Vaccine coverage remained below the 95% recommended by the World Health Organization throughout the study.
The greatest absolute inequality in vaccine coverage at baseline was for MMR2 (slope index of inequality [SII], −9.6% to −13.4%. The uptake SII rose for all studied vaccines: −5.1% to −7.7% for six-in-one, −7.4% to −10.2% for rotavirus, −7.9% to −9.7% for PCV, −8.0% to −10.0% for MMR1 at 2 years, −3.1% to −5.6% for MMR1 at 5 years, and −9.6% to −13.4% for MMR2 at 5 years.
Reduced access to and acceptability of childhood vaccinations, with more prevalent vaccine hesitancy in disadvantaged groups, is likely to play a role in the generation of these inequalities.
The number of children unprotected against measles climbed 15-fold among the least deprived (from 1,364 to 20,958), jumping 20-fold in the most deprived (from 1,296 to 25,345). For rotavirus, a 14-fold spike occurred among the least deprived (from 2,292 to 32,981), and a 16-fold rise was seen among the most deprived (from 2,815 to 45,201).
The authors called for stronger vaccination systems, interventions, and catch-up campaigns in underserved populations.
“Reduced access to and acceptability of childhood vaccinations, with more prevalent vaccine hesitancy in disadvantaged groups, is likely to play a role in the generation of these inequalities,” they wrote. “According to global studies, barriers to vaccine uptake in socially disadvantaged groups include perceptions of risk, low confidence in vaccinations, distrust of services, barriers to access, lack of community endorsement, and poor communication from trusted providers and community leaders.”
