Late or missed childhood vaccination in the United Kingdom: Identifying the determinants

Background Increasing vaccine uptake is a priority to protect children and the population against infectious diseases, alongside addressing socio-demographic uptake inequalities. Childhood vaccine uptake began declining before the COVID-19 pandemic in the United Kingdom (UK) and has worsened since–contributing to measles and pertussis outbreaks. This thesis investigated the determinants of missed childhood vaccines, including maternal factors, and how to increase vaccine uptake. Methods This mixed-methods thesis comprises two primary studies: A national birth-cohort study, using routine primary-care data to examine measles, mumps and rubella (MMR) uptake among children between 2000-2020 and associated socio-demographic determinants. A life-course approach investigated the relationship between pregnant women’s’ pertussis vaccination and their children’s subsequent MMR vaccination. A co-production study with public partners–Mosaic Community Trust to explore parents’ attitudes towards childhood vaccines, including the pandemic’s impact. Results The birth-cohort study found children living in more deprived areas, Black ethnicity children or those with teenage mothers were less likely to be vaccinated with MMR compared with children from less deprived areas, White ethnicity children or those with mothers aged 31-40 years. Children of mothers vaccinated against pertussis in pregnancy were more likely to receive MMR vaccines compared to children with unvaccinated mothers, independent of deprivation, ethnicity, or maternal age. The co-produced questionnaire survey and focus groups found that some parents felt they lacked information and/or opportunities to talk to health professionals about vaccinations before appointments. Inconsistent reminders and difficulties booking or attending appointments also affected uptake. Some parents, particularly from ethnic minorities, have more questions about childhood vaccines since COVID-19. Conclusions A birth-cohort study suggests vaccine services should promote and facilitate access to both maternal and childhood vaccines during pregnancy. Co-production research suggests increasing childhood vaccine uptake requires simplified booking systems, easier access to appointments and more opportunities for discussion with health professionals, following COVID-19.