Programme providers’ perceptions of local variation in childhood vaccination uptake in a socioeconomically disadvantaged UK region: a qualitative study

Introduction: Within a global context of declining vaccination uptake, particularly in more socioeconomically disadvantaged communities, this study examined for the first time what, if anything, can be learnt from the North East of England, which, despite being the most socioeconomically disadvantaged English region, has consistently achieved high coverage of childhood vaccinations. Methods: This study aimed to explore programme providers' perceptions of how the organisation, delivery, commissioning, support and monitoring of childhood vaccination may contribute to comparatively high uptake in the North East of England. Between June 2023 and December 2023, we conducted online semi-structured interviews with 15 professionals from across the health and care system. The transcripts were analysed using a framework approach. Results: Overall, interviewees felt that the high childhood vaccination coverage in the North East of England was explained not by the approach to provision but by the region's sociocultural, demographic and healthcare system characteristics. The North East region was hypothesised to be more stable and less mobile in terms of both its population and healthcare workforce; conditions under which trusting parent-vaccinator relationships are more easily built and maintained. Despite this, general practice staff working in areas of high socioeconomic disadvantage described challenges, including families with complex personal circumstances and parents not viewing vaccination as a priority. In these areas, it was felt more resources were required to achieve and maintain uptake levels. Interviewees offered broader reflections on the growing complacency regarding the potential health impact of vaccine-preventable diseases and the importance of trusted voices in addressing parents' vaccination concerns. Conclusion: Action must be taken to improve healthcare workforce stability, as a prerequisite to repairing parent-vaccinator trust. Trust is important for ensuring that parents view vaccination as a priority and for addressing vaccine hesitancy. Vaccination uptake patterns appear to be substantially influenced by social processes external to, but not independent of, healthcare delivery.