The impact of the COVID-19 pandemic and associated control measures on uptake of preschool immunisations in Scotland

Background Maintaining high levels of immunisation uptake is vital to protect children from vaccine-preventable disease. The COVID-19 pandemic and measures taken to control it, including national lockdowns, threatened to disrupt routine immunisation programmes. Initial reports from the early weeks of lockdowns in the UK and worldwide suggested that preschool immunisation uptake was falling. In Scotland enhanced surveillance databases were set up to monitor and rapidly assess the impact on childhood immunisation uptake rates.

Objectives This aim of this study was to evaluate the impact on timely childhood immunisation uptake (defined as within 4 weeks of becoming eligible for the immunisation according to the national immunisation schedule) before, during and after a national lockdown using data from the entire Scottish population.

Methods This was an observational study using routinely collected data in the year prior to the pandemic (2019), immediately before (January -22 March 2020), during (22 March-31 July 2020) and after (August-September 2020) the first period of the UK ‘lockdown’. Data were obtained for Scotland from the Public Health Scotland ‘COVID19 wider impacts on the health care system’ dashboard (https://scotland.shinyapps.io/phs-covid-wider-impact/). Uptake of the three doses of DTaP/IPV/Hib/HepB vaccine in early infancy and two doses of MMR at age 12 months and 3 years 4 months was evaluated at the four time points. Timely uptake rates were compared using binary logistical regression analysis. Data were also analysed separately by geographical region and indices of deprivation.

Results Vaccination rates in Scotland for all the childhood immunisations rose during lockdown compared to the previous year (table 1). Significant increases in uptake were seen across all deprivation level, though there was evidence of greater improvement for the least deprived for the MMR immunisations.

Conclusions This study demonstrates that the national lockdown in Scotland has had a positive effect on timely preschool immunisation uptake. This provides an excellent opportunity to explore the reasons behind this increase, whether this has been achieved through the removal of barriers, increased motivation or awareness campaigns including those co-ordinated by the Scottish Immunisation programme and sharing of best practice. Promoting immunisation uptake and addressing potential vaccine hesitancy is particularly important in the context of ongoing and repeated lockdown-style control measures and with future of a paediatric COVID-19 vaccination campaigns.