Unequal Vaccines? A Mixed Methods Study Exploring Socioeconomic Inequalities in Routine Vaccination Uptake in a Post-COVID-19 Era

Abstract

Introduction: The COVID-19 pandemic heightened global attention on vaccination and exacerbated health inequalities, particularly among those experiencing socioeconomic disadvantage. However, existing literature has not adequately explored the pandemic’s impact on socioeconomic inequalities in routine vaccination uptake. Aim: To understand and map the narrative and state of socioeconomic inequalities in vaccination uptake in a post-COVID-19 era. Methods: This project comprised two components: (1) an umbrella systematic review of global socioeconomic inequalities in routine vaccination uptake, and (2) a mixed methods study in England, focused on childhood vaccinations. The quantitative element used piecewise regressions to analyse the effects of COVID-19 and socioeconomic deprivation on MMR and pre-school booster uptake. The qualitative aspect involved interviews with professionals commissioning, supporting, and monitoring the childhood vaccination programme in the North East of England, focusing on areas of high socioeconomic deprivation. Transcripts were analysed using a framework approach. Findings: The umbrella review findings were complex. Lower routine vaccination uptake was identified across both advantaged and disadvantaged socioeconomic groups. Mechanisms, such as knowledge and confidence in vaccination and/or providers) were often understood to vary by level of education. The mixed methods study found complementary evidence. A COVID-19-associated decline in childhood vaccination uptake was identified, although rates were declining beforehand. The North East of England, an area of high socioeconomic deprivation, often achieved higher uptake levels than other regions. Despite this, interviewees spoke of pockets of low uptake within the North East and greater challenges faced by vaccination providers in socioeconomically deprived areas. Families with challenging personal lives were reportedly at a greater risk of low uptake. Conclusion: Vaccination uptake manifests differently from other healthcare interventions. Vaccination services that reflect the needs of the target population are required to improve uptake, regardless of socioeconomic position. Equitable funding that acknowledges the complexities of provision in underserved communities is warranted.