An article in npj vaccines in August 2024 describes vaccine uptake for COVID-19 and influenza vaccines in pregnancy as “suboptimal”. The authors explored COVID-19 and influenza vaccine uptake and disparities through data from the Oxford Royal College of General Practitioners Research and Surveillance Centre Database in England and the Secure Anonymised Information Linkage Databank in Wales. They found that “socioeconomically deprived and ethnic minority groups” showed lower vaccination rates, highlighting the “necessity for interventions” to reduce vaccine hesitancy and encourage acceptance in pregnancy.
The study
Although infections with COVID-19 and influenza during pregnancy can “increase the risk of adverse pregnancy outcomes” and effective vaccines against these outcomes are included in routine immunisation schedules for pregnant women in the UK, the authors describe their uptake during pregnancy as “suboptimal”. This could be attributed to “concerns about side effects and vaccine safety”, which are related to “demographics and baseline health conditions”.
“Understanding vaccine uptake disparities in pregnant women would inform clinicians and policymakers in developing strategies to promote vaccination and reduce adverse pregnancy outcomes in the UK.”
During the pandemic, uptake of COVID-19 and influenza vaccines in pregnant women “could differ from normal times because of changes in vaccines hesitancy” and the introduction and deployment of new COVID-19 vaccines. Furthermore, vaccine hesitancy “may be more prevalent” for COVID-19 vaccines as evidence on maternal and neonatal safety was “limited” at the time.
The study was an opportunity to explore COVID-19 and influenza vaccine uptake and disparities in pregnant women in England and Wales during the pandemic between September 2020 and March 2022. 133,300 pregnant women were eligible for COVID-19 vaccination during pregnancy in England and Wales, and 178,690 pregnant women were eligible for 2020/2021 or 2021/2022 seasonal influenza vaccination in England and Wales. 133,140 pregnant women were eligible for both vaccinations during pregnancy.
Of the influenza cohort, 74,740 (41.8%) pregnant women received at least one dose of influenza vaccine. Of the 133,300 pregnant women in the COVID-19 cohort, 53,550 (40.2%) received at least one dose of COVID-19 vaccine. Among the 133,140 pregnant women eligible for both vaccinations, 57,970 (43.6%) did not receive either vaccine; 27,350 (20.5%) received both vaccines. 26,190 (19.7%) received only the COVID-19 vaccine, and 21,630 (16.2%) received only influenza vaccine.
Low uptake and disparities
The analysis presented “low” vaccine uptake during the pandemic and uptake disparities across “various baseline characteristics”, particularly among “different ethnic groups and socioeconomic statuses”.
“Women of lower socioeconomic status had a significantly lower chance of receiving COVID-19 or influenza vaccination. Women in black, mixed, and other ethnic groups had a lower chance of being vaccinated in comparison to women in white or Asian ethnic groups.”
The results of the study align with existing data and highlight disparities in vaccine uptake. Determinants of vaccine acceptance in the study included “being socioeconomically affluent, of white or Asian ethnicity, living in rural areas, and residing in two-person households”. These are aligned with research from other countries. The “suboptimal” uptake during the pandemic can include the following mechanisms:
- Access to transport
- Confidence in vaccination
- Vaccination knowledge
- Trust in healthcare or vaccination providers
Other possible contributing factors to low vaccine uptake could be a language barrier, or over-registration in the UK primary care system.
Implications
The authors state that the importance of a “direct recommendation” from healthcare providers can “significantly increase influenza vaccine uptake in pregnant women”. They also recommend “frequent updates” on evolving vaccine safety evidence. Another implication is that public agencies can “routinely assess the efficacy and inequalities in vaccination delivery” and respond with tailored policies. The research can also inform vaccination strategies for the future, such as the possible rollout of RSV vaccination for pregnant women.
“Disparities in COVID-19 and influenza vaccine uptake among pregnant women underscore the necessity for interventions from the perspectives of healthcare providers, public agencies, and scientists to reduce vaccine hesitancy and improve acceptance in pregnant women.”
For a session on vaccination in pregnancy with Dr Jenny Hendriks of Janssen Vaccine and Prevention BV, join us at the Congress in Barcelona this October. Don’t forget to subscribe to our weekly newsletters here for vaccine updates.
