(336) Comparing disparities in uptake of COVID-19 and influenza vaccination among pregnant women, September 2020 and March 2022: English and Welsh national cohorts

Background: COVID-19 is a vaccine administered all year round as part of a centrally managed programme whilst influenza is a seasonal vaccine administered by local health care providers. Given the higher maternal mortality and morbidity associated with COVID-19 and influenza in pregnancy, understanding disparities in vaccine uptake among pregnant women is important.

Objectives: We investigated whether the COVID-19 vaccination achieved different levels of vaccine coverage and uptake disparity in pregnant women compared with the established influenza programme in England and Wales.

Methods: We used routine 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. The COVID-19 and influenza vaccine cohorts included women aged 18 to 49 who were eligible for either COVID-19 vaccination or influenza vaccination during pregnancy between September 2020 and March 2022. We described the uptake of COVID-19 and influenza vaccines in the two cohorts. We used a multivariable fixed-effect logistic regression to look at vaccine uptake disparities in terms of age, ethnicity, socioeconomic status, and rurality and also explored whether household size, obesity and the number of comorbidities had an impact.

Results: There were 133,300 pregnant women in the COVID-19 vaccine cohort and 178,690 in the influenza vaccine cohort. Among the 133,140 pregnant women eligible for both vaccinations, 57,970 (43.5%) did not receive either vaccine, and 27,350 (20.5%) received both vaccines. The uptake for at least one dose of vaccine was 41.8% for influenza and 40.1% for COVID-19. We observed disparities in COVID-19 and influenza vaccine uptake, with socioeconomically deprived and ethnic minority groups showing lower vaccination rates. Pregnant women from a more deprived area are less likely to receive either vaccine (COVID-19 aOR: 0.44, 95% Confidence Interval (CI): 0.43-0.46; influenza aOR: 0.58, 95% CI: 0.56-0.60), compared to those from the least deprived areas. Pregnant women in the black ethnic group were the least likely to receive either vaccine (COVID-19 aOR: 0.48, 95% CI: 0.45-0.51; Influenza aOR: 0.61, 95% CI: 0.57-0.65), while those of other (COVID-19 aOR: 0.69, 95%CI 0.63-0.76; influenza aOR: 0.80, 95% CI: 0.74-0.86) ethnic groups had a slightly higher vaccine uptake, but still much lower than those of white ethnic group (reference group).

Conclusions: The centrally managed COVID-19 vaccination system did not significantly reduce vaccine uptake disparities compared to the locally administered influenza program. Further interventions are needed to boost vaccine coverage and reduce disparities.