The inequalities gap in uptake rates of pneumococcal vaccine for vulnerable groups is widening and simplifying the vaccine schedule has not reduced this, researchers from the University of Liverpool have found.
Vaccine uptake data has been examined to assess the impact of moving from a '2+1' to a '1+1' Pneumococcal Conjugate Vaccine (PCV) dose schedule on vaccine coverage and health inequalities among infants in England.
Persistent inequalities remain a major barrier to achieving universal protection against life-threatening infections - reflecting findings from the UK Heath Security Agency National Immunisation Programme Health Equity Audit 2025.
The findings from an interdisciplinary research team including data scientists, infectious disease epidemiologists and physicians from the University of Liverpool are published today (1 April 2026) in the journal The Lancet Regional Health - Europe.
By performing a data analysis, researchers from the Institute of Population Health and the Institute of Infection, Veterinary & Ecological Sciences at the University of Liverpool have examined the trends in timely vaccine uptake before and after England changed its PCV dose schedule in January 2020 - transitioning from a "2+1" PCV schedule (two primary doses at 8 and 16 weeks, with a booster dose at 12 months) to a "1+1" PCV schedule (single primary dose at 12 weeks and a booster dose at 12 months).
In a longitudinal study, the researchers analysed Pneumococcal Conjugate Vaccine (PCV) uptake data from 2013-2025 for children aged 1 and 2 years from the Cover of Vaccination Evaluated Rapidly (COVER) programme. COVER collects quarterly and annual data on childhood immunisation coverage in England for children at 1, 2 and 5 years of age.
Looking at pattens for upper-tier local authorities in England linked to 2019 Index of Multiple Deprivation quintiles, the study found that PCV booster retention has dropped in England since the schedule change, which coincided with the start of the COVID-19 pandemic. This deterioration disproportionately affected children in more deprived areas, risking avoidable disease burden concentrated in the most disadvantaged communities and widening health inequalities. The findings agree with evidence from a BMJ article by the wider research team and the UK Heath Security Agency National Immunisation Programme Health Equity Audit 2025, reporting immunisation inequity in England is not only persistent but it is worsening in critical areas.
The number of required clinic visits may be insufficient to overcome the systemic barriers to vaccination faced by marginalised communities. Immunisation system strengthening, targeted, equity-focused interventions and enhanced call-recall systems for post-infant vaccine delivery could help address the identified PCV coverage gaps. These outputs are timely as the House of Lords - Childhood Vaccinations Committee is holding an inquiry to examine childhood vaccination coverage in England, why there has been a gradual decline in coverage over the past decade and what the Government should do to reverse this decline and reduce inequalities in childhood vaccination coverage.
Dr Edward Hill from the University of Liverpool is the corresponding author on the paper. He said: "National averages and patterns can often mask local vulnerabilities. This research highlights the importance of using granular data to identify exactly which groups are falling behind in intervention uptake. Public health interventions can then be more precisely targeted."
Lead author Praise Ilechukwu from the University of Liverpool commented: "Our study shows that while the UK's move to a 1+1 schedule was evidence-based and efficient, we are still seeing a consistent lag in protection for children in deprived areas. These deprivation-associated inequalities in pneumococcal vaccine coverage in children leaves children in deprived areas more vulnerable to pneumococcal diseases like pneumonia and meningitis."
Co-author Professor Neil French from the University of Liverpool commented: "Addressing the PCV booster retention issues can be aided by establishing routine monitoring of booster gaps as a key performance indicator for the vaccination programme. This should include regular reporting by deprivation and place to enable early identification of emerging problems."
Co-author Dr Dan Hungerford from the University of Liverpool commented: "Inequalities persist even with fewer required vaccination appointments for PCV. We need to look at the wider social determinates of inequalities in child health and structural access factors-like flexible vaccination access points and tailored community outreach-to ensure every child is protected regardless of their background."
The research, published today in The Lancet Regional Health - Europe, was supported by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections.
The paper Inequalities in childhood pneumococcal conjugate vaccine uptake in England before and after the change from a 2+1 to 1+1 schedule: a longitudinal study is available here: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(26)00079-7/fulltext
