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Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic

February 2022: Research published in PLOS Medicine looks at the uptake of routine childhood vaccines in Scotland and England before, during and after COVID-19 pandemic restrictions.

Infographic summarising key findings that preschool immunisation uptake was improved during the pandemic
This image was created by the Usher Institute, The University of Edinburgh to accompany a research study by the EAVE II team funded by the Medical Research Council [MR/R008345/1] and the Data and Connectivity National Core Study [MC_PC_20058], and supported by BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004]. © 2022 Usher Institute, The University of Edinburgh. All rights reserved.

Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic: An observational study of routinely collected data

McQuaid F, Mulholland R, Rai YS, Agrawal U, et al.

Published online: 22 February 2022

Available online at: https://doi.org/10.1371/journal.pmed.1003916

Download the infographic

This infographic was created by the Usher Institute's Graphic Designer, Dawn Cattanach

Summary in Plain English

On 23 March 2020, the UK entered the first COVID-19 ‘lockdown’, restricting people’s movements in order to reduce the spread of the virus.

Early reports from several countries suggested that pandemic lockdowns would disrupt routine vaccination programmes, and might lead to lower uptake of vaccines for children. In the UK it is recommended that children under the age of 5 years have these vaccinations:

Vaccine short name Protects against Recommended age
6-in-1 Diphtheria, tetanus, pertussis, polio, hepatitis B and haemophilus influenzae type b

First dose – 8 weeks

Second dose – 12 weeks

Third dose – 16 weeks
Rotavirus Rotavirus

First dose – 8 weeks

Second dose – 12 weeks
MenB Meningitis B

First dose – 8 weeks

Second dose – 16 weeks
MMR Measles, mumps and rubella

First dose – 1 year

Second dose – 3 years 4 months
Pneumococcal (PCV) Streptococcus pneumoniae

First dose – 12 weeks

Second dose – 1 year
Hib/MenC Haemophilus influenzae type b and meningitis C First dose – 1 year

Find out more about routine vaccines for children [NHS Inform]

Why did we carry out this research?

A fall in uptake for the vaccines listed above can cause outbreaks of preventable diseases, like measles, that might make children and adults very unwell.

We wanted to provide evidence around the longer-term impact of pandemic restrictions on routine immunisations for children.

This information can help healthcare staff, policy makers and the public to:

  • understand factors that influence routine vaccine uptake
  • see how much disruption the pandemic caused for immunisation programmes
  • plan for future pandemics and other healthcare disruptions.

What data did we use?

We looked at uptake of two different vaccines, the 6-in-1 (3 doses) and MMR (two doses). We compared uptake before, during and after lockdown with rates for the year before the pandemic (2019):  

  • 2019: 1 January 2019 – 31 December 2019
  • Pre-lockdown: 1 January 2020 – 22 March 2020
  • Lockdown: 23 March 2020 – 2 August 2020
  • Post-lockdown: 3 August 2020 – 4 October 2020

Data in Scotland was taken from the Public Health Scotland (PHS) “COVID-19 wider impacts on the healthcare system” dashboard, which is accessible to the public and covers the whole of Scotland.

For England we used data from the ImmForm system, which holds information on vaccine uptake for people registered at 92-95% of English GP practices.

Visit the PHS dashboard

What did we find?

We found that in Scotland, the percentage of pre-school children having their vaccines within 4 weeks of the recommended age was higher during lockdown than in 2019. This was across all doses of the two vaccines studied.

The increase in uptake ranged from 1.3% for the first dose of 6-in-1, to 14.3% for the second dose of MMR vaccine.

This is equivalent to an extra 7,508 pre-school immunisations being taken up in a timely manner in Scotland during lockdown, compared to what we would have expected based on 2019 rates.

Uptake rates dipped just before the announcement of the national lockdown in early March 2020, then peaked in June 2020. They stayed higher than 2019 levels in the post-lockdown period.

The percentage uptake for vaccines increased for children across all deprivation levels, measured by postcode. However, it did vary by geographical location, with a small number of areas seeing lower uptake for some vaccines.

Some young children have their vaccines more than four weeks after the recommended age. Final rates for uptake, including these “catch-up” vaccines in young children, varied more than timely uptake in Scotland. There was little change for the 6-in-1 vaccine, but increases for both doses of MMR.

We were able to look at similar final uptake data for England, including all doses of 6-in-1 and the first dose of the MMR vaccine.

In England, there was a small but significant drop in final vaccine uptake in the pre-lockdown and lockdown periods, ranging from 0.5% to 2.1% depending on the vaccine and dose. However, uptake did improve slowly throughout the lockdown. There was also a general trend of lower MMR vaccine uptake in England before the pandemic.

Why is this important?

In this study, we found that routine vaccine uptake for young children increased during the national lockdown in Scotland, and stayed higher in the post-lockdown period than in 2019.

This was the case for all groups in terms of deprivation levels in the area, but uptake did vary by geographical location.

In England, we found a small drop in vaccine uptake during and just before lockdown. This improved slightly towards the end of lockdown.

This study shows that high levels of routine vaccine uptake are possible during significant general healthcare disruption. It provides a useful basis for thinking about what leads to higher or lower uptake of routine vaccines. This could include easier access to appointments, and polices like appointment reminders and publicity campaigns. This information can help plan ways to promote high levels of vaccine uptake in the future.

Next, we hope to investigate what happened to immunisation programmes in Scotland during lockdown by looking in more depth at how vaccines were delivered, and whether the attitudes of healthcare professionals and parents changed during this time. 



This plain English summary was created with the support and feedback of the EAVE II Public Advisory Group (PAG). This particular article was reviewed by PAG members Deb S and Janice C.

To learn more about the PAG, see: Our EAVE II Public Advisory Group (PAG) | The University of Edinburgh