PCV Booster Coverage Declines After Schedule Change

Key Takeaways:

• An analysis reports a decline in PCV booster-dose coverage following the 2020 schedule change, based on national surveillance data.
• Greater declines were observed in more deprived areas, with widening disparities in uptake across local authorities.
• Findings are based on observational trends overlapping with the COVID-19 period, and authors suggest ongoing monitoring and equity-focused strategies to address coverage gaps.

A longitudinal analysis of pneumococcal conjugate vaccine (PCV) uptake in England examined trends surrounding the January 2020 transition from a 2+1 to a 1+1 infant schedule, focusing on changes in dose completion over time. The analysis reports a decline in booster-dose coverage (referred to as “booster retention”) in the period following the schedule change, with patterns assessed across upper-tier local authorities stratified by 2019 Index of Multiple Deprivation quintiles. The findings describe greater declines in booster coverage in more deprived areas, indicating a widening disparity in uptake patterns over time.

Data were drawn from routine immunisation coverage outputs from the COVER programme, including quarterly and annual data from 2013 through 2025. Coverage was assessed at ages 1 and 2 years, consistent with standard reporting timepoints. The comparison was structured as pre- versus post–January 2020, a period that overlapped with the COVID-19 pandemic and associated disruptions to healthcare access and routine vaccination services. The analysis is therefore based on temporal trends within national surveillance data across upper-tier local authorities.

Results are presented as changes in booster-dose coverage following the schedule transition, with larger declines observed in more deprived local authorities. The deprivation gradient is described as becoming more pronounced over time, based on area-level comparisons rather than individual-level data. These findings reflect associations observed in population-level coverage data and do not isolate the independent effect of the schedule change from other concurrent factors.

In their interpretation, the authors highlight the potential value of monitoring “booster gaps” over time, including stratification by deprivation and geography. They suggest that reducing the number of required doses alone may not be sufficient to address structural barriers to vaccination in more deprived communities. Proposed responses include strengthening immunisation systems, implementing targeted equity-focused interventions, and enhancing call–recall approaches for booster-dose delivery. These are presented as programmatic considerations rather than evaluated interventions within the study.