Changing parental perceptions to childhood immunisations during the Covid-19 pandemic in the UK: evidence from three cross-sectional surveys between 2020 and 2022

OBJECTIVEChildhood immunisation rates in the UK have recently fallen to their lowest level in 14 years. There is currently a lack of temporal evidence on parental attitudes to childhood immunisations and how they have evolved in response to the Covid-19 pandemic, limiting our ability to assess the impact of the pandemic on population-level attitudes to non-Covid vaccines. This study aims to assess trends in parental confidence in childhood immunisations between 2020 and 2022 at varying spatial scales in the UK, while also identifying the socio-demographic factors associated with vaccine perceptions and how these have shifted over time. DESIGNThree cross-sectional surveys in 2020, 2021, and 2022. SETTINGUnited Kingdom. PARTICIPANTS14,720 adults responsible for decisions surrounding the vaccination of children. MAIN OUTCOME MEASURESThe percentage of parents indicating past or future refusal for the MMR, HPV, and influenza vaccines for their child in 2020, 2021, and 2022 as well as Covid-19 vaccine refusal for their child in 2022. A combined metric (refusal) is created to measure parental refusal for any childhood vaccine. Associations between these primary outcome measures and socio-demographic variables are investigated via multiple logistic regression, with effects reported via odds ratios. Additionally, the extent to which parental and caregiver perceptions in giving children immunisations since the start of the pandemic is examined using data from 2022. RESULTSAcross the UK overall refusal decreased from 16.2% in 2020 to 14.0% in 2021 (p<0.001) before increasing to 20.8% in 2022 (p<0.001 compared to 2020). This loss was driven by relatively high rates of parental refusal of the Covid-19 vaccine for their children in 2022, rather than perceptions towards other childhood vaccines. A marked negative change in perceptions towards giving childhood vaccines is found among parents who had not themselves received at least three doses of a Covid-19 vaccine, signalling a strong spillover effect of Covid-19 vaccine hesitancy onto routine childhood vaccines. Many parental socio-demographic factors were found to be informative of vaccine refusal, with younger age groups, individuals living in Greater London, Hindus, and Muslims exhibiting higher rates of refusal. Interestingly, however, 18-- 34-year-olds, Hindus, Muslims, and Black / Black British respondents report becoming more positive towards giving about giving their children vaccines in 2022 compared to the start of the pandemic. CONCLUSIONSThe available evidence suggests that parental refusal of routine childhood immunisations has decreased between 2020 and 2022 and remains low across the UK. Encouragingly, many socio-demographic groups with historically low confidence in childhood immunisations appear to be more positive about giving their children vaccines in 2022 compared to the beginning of the pandemic. While these findings are cautiously optimistic, there is still a mismatch between these reported increases in vaccine confidence and uptake rates of routine immunisations across the UK. Parents who did not receive at least three doses of a Covid-19 vaccine feel much less positive about giving their children vaccines since the start of the pandemic compared to those who did receive at least three doses. This group represents an important cohort for targeted outreach and tailored interventions to address lingering concerns and support vaccine uptake.