Those at Risk
Immunisation protects individuals and populations from many serious and potentially deadly diseases. High vaccination rates provide increased probability of immunity throughout the population (herd immunity), which is particularly important for protecting individuals who cannot be vaccinated and can also lead to the elimination of some diseases. Even when a disease is no longer common in the UK, without sustained high rates of vaccination it is possible for these diseases to return as demonstrated by recent measles outbreaks.
Groups with a higher risk of disease, or more severe disease, benefit even more from vaccination; ensuring high coverage in these groups can narrow inequality in disease outcomes.
National data indicated that individuals diagnosed with schizophrenia were less likely to get vaccinated (30.3 per cent) compared to non-diagnosed (41.2 per cent). Individuals with learning disabilities were also less likely to get vaccinated (28.1 per cent) compared to individuals who were not diagnosed with a learning disability (41.1 per cent).
National evidence suggests that in general, lower socioeconomic status was associated with lower coverage as well as later attainment of vaccination16 . Vaccine coverage data quality is less complete in older individuals, particularly those born before 2000. This potentially masks inequalities as it is difficult to ascertain whether low coverage in these older individuals represents data issues or under-immunisation. This is particularly true for adults born abroad, who are less likely to be vaccinated compared with British born individuals of the same age, and for whom vaccine coverage is not well captured.
Young people show lower intentions to get vaccinated: individuals aged 16-34 were twice as likely to report that they are unlikely to get vaccinated or that they definitely won’t compared to individuals aged 55-75. People aged 30-60 are less likely to get vaccinated compared to people aged 65 and more.
In the adult programmes, shingles vaccine uptake has a small gender difference. It is 45.8% for females and 44.8% for males in the routine cohort for the year to August 2017 11 . More broadly it has been identified that women showed slightly lower intentions to get vaccinated than men. Women from priority groups were found less likely to get vaccinated (39.6 per cent) than men (43.1 per cent).
Evidence nationally, suggests that there is no simple relationship between ethnicity and coverage. However, coverage did appear to be more consistently lower than White-British children in certain ethnic groups, for example Black Caribbean, Somali, White Irish, and White Polish populations.
Inadequate vaccine coverage in under-vaccinated groups is often demonstrated by outbreaks among these communities. There have been measles outbreaks in Europe between 2005 and 2008 in Roma & Sinti, Traveller, and Steiner communities. It is difficult to determine vaccination coverage levels in traveller populations, as many may face barriers to engagement with health services. Estimated uptake rates for MMR and polio vaccines among Gypsy Travellers in 2010 suggested far lower rates than in the England population; possibly below 50% in some areas.
Migrant communities also exhibit more outbreaks of vaccine-preventable disease, suggesting inadequate coverage. In a recent measles outbreak in West Yorkshire, there were more cases in areas with a higher density of new migrants.