Ethnic inequities in childhood influenza vaccination coverage in England 2013-2021: An observational cohort study.

BACKGROUND: Children aged 2-3 years have been eligible for the seasonal influenza vaccination in primary care since its introduction into England's routine childhood immunisation schedule in 2013. Persistent ethnic inequities have been found for all other vaccines in the routine childhood immunisation schedule, so inequities in influenza vaccination coverage must also be explored to facilitate the success of the programme. METHODS: We linked mother and child primary care records using the Clinical Practice Research Datalink Aurum database (CPRD Aurum) and calculated seasonal influenza vaccination coverage in 2-3 year-olds by maternal ethnicity across England and in London between 2013 and 2021. We estimated risk ratios comparing each ethnic group to the White British group using modified Poisson regression. RESULTS: Influenza vaccination coverage in 2-3 year-olds is low in England (<60 % for the majority of influenza seasons) and even lower in London (<50 %). Ethnic inequities in coverage were persistent between 2013 and 2021. Most ethnic groups had lower coverage than the White British group across all influenza seasons, and children born to mothers of Caribbean ethnicity had the lowest coverage (20-27 % across seasons). Other ethnic groups including Any other Black, African or Caribbean background (25-36 %), Pakistani (26-40 %), White and Black Caribbean (28-42 %), Any other White background (30-44 %), Any other ethnic group (31-45 %) and Bangladeshi (31-41 %, except 54 % in 2020-21) also experienced low coverage. Inequities widened over time for various minority ethnic groups, including those already experiencing the lowest coverage. CONCLUSIONS: Place-based and participatory approaches are needed to understand the drivers behind ethnic inequities in childhood influenza vaccination. Top-down and bottom-up action is also urgently needed from policy makers, commissioners, integrated care boards, primary care networks, local public health teams and healthcare staff to redress the inequities identified.