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

Introduction: Childhood immunisation rates in the UK have recently fallen to their lowest level in 14 years. However, there is limited temporal evidence on how parental attitudes have evolved during the COVID-19 pandemic, restricting our understanding of its broader impact. This study explores trends in parental confidence in childhood immunisations between 2020 and 2022 across the UK and how socio-demographic predictors of vaccine perceptions have shifted over time. Methods: This study draws on data from three nationally representative, cross-sectional surveys conducted in 2020, 2021 and 2022 including 14 720 adults responsible for decisions on childhood vaccination. Multiple logistic regression assesses changes in reported childhood vaccine refusal over time, by region, socio-demographic group and vaccine. Additional 2022 analysis explores how parental perceptions of childhood immunisations have changed since the start of the pandemic. Results: UK-wide refusal decreased from 17.3% (16.4 to 18.5%) in 2020 to 14.8% (13.7 to 15.7%) in 2021 before increasing to 21.1% (19.8 to 22.5%) in 2022, largely due to high refusal rates for the COVID-19 vaccine for children. Parents who had not received at least three COVID-19 vaccine doses were more likely to report declining confidence in childhood vaccines, suggesting a spillover of COVID-19 vaccine hesitancy onto routine vaccines. Refusal was higher among younger respondents, London residents, Hindus and Muslims. Interestingly, however, 18-34-year-olds, Hindus, Muslims and Black/Black British respondents reported becoming more positive towards childhood vaccines in 2022 compared with 2020. Conclusions: Parental refusal of routine childhood immunisations decreased between 2020 and 2022 and remains low across the UK. Encouragingly, groups with historically lower confidence reported more positive attitudes in 2022. However, this has not been matched by increased uptake. Parents who received fewer than three COVID-19 doses are more likely to have become less positive over time and represent a key group for targeted outreach to rebuild confidence and support uptake.