Inequalities in uptake of childhood vaccination in England, 2019-23: longitudinal study

Abstract Objective To quantify changes in inequalities in uptake of childhood vaccination during a period of steadily declining overall childhood vaccination rates in England. Design Longitudinal study. Setting General practice data for five vaccines administered to children (first and second doses of the measles, mumps, and rubella vaccine (MMR1 and MMR2, respectively), rotavirus vaccine, pneumococcal conjugate vaccine (PCV) booster, and six-in-one (DTaP/IPV/Hib/HepB) vaccine covering diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B) from the Cover of Vaccination Uptake Evaluated Rapidly dataset in England. Participants Children aged <5 years eligible for vaccinations between April 2019 and March 2023 registered at primary care practices in England. 2 386 317 (2 309 674 for rotavirus vaccine) children included in the study were eligible at age 1 year, 2 456 020 at 2 years, and 2 689 304 at 5 years. Main outcome measures Changes in quarterly vaccine uptake over time and compared by deprivation level. Regression analyses were used to quantify the change in inequalities in vaccine uptake over time—expressed as changes in the slope index of inequality (SII). Cumulative susceptibility to measles and rotavirus disease at age 5 years was estimated. Analyses were repeated at regional level. Results The absolute inequality in vaccine uptake at baseline (2019-20) was largest for MMR2 in children at age 5 years (SII −9.6%, 95% confidence interval (CI) −10.2% to −9.0%). For all vaccinations studied, the SII for uptake increased over the study period: from −5.1% to −7.7% for the six-in-one vaccine, −7.4% to −10.2% for rotavirus, −7.9% to −9.7% for PCV booster, −8.0% to −10.0% for MMR1 at age 2 years, −3.1% to −5.6% for MMR1 at age 5 years, and −9.6% to −13.4% for MMR2 at age 5 years. The number of children susceptible to measles by the end of the study period increased 15-fold in the least deprived group (from 1364 to 20 958) and 20-fold in the most deprived group (from 1296 to 25 345). For rotavirus, a 14-fold increase was observed in the least deprived group (from 2292 to 32 981) and a 16-fold increase in the most deprived group (from 2815 to 45 201). Regional analysis showed greatest inequalities in uptake in London and the northern regions. Conclusion The findings of this study suggest that inequalities in childhood vaccination are increasing in England, as uptake rates for five key childhood vaccinations decreased between 2019 and 2023, below the World Health Organization’s recommended 95% uptake target, and with noticeable regional differences. Urgent action is needed to strengthen systems for childhood vaccination, with a key focus on reducing inequalities.