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Background: COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19. Methods: An online cross-sectional survey was completed, between 3rd August-11th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd, 2020. Ten follow-up semi-structured interviews were conducted. Results: Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination; however, access issues were reported. Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19. Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies. Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccines in pregnancy. Conclusion: During the ongoing and future pandemics, healthcare services should prioritise equitable access to routine vaccinations, including tailoring services for ethnic-minority families who experience greater barriers to vaccination.
The data presented here is part of a larger survey aimed at investigating the impact of the COVID-19 pandemic on routine maternal vaccines and also understand COVID-19 vaccine acceptability among pregnant women. The data on COVID-19 vaccine acceptability has been presented elsewhere [27]. A multi-methods approach was taken – using quantitative and qualitative components – with the aim of gaining insight into women’s awareness of pertussis vaccination and access to pregnancy and childhood vaccines during COVID-19. The study comprised of an online survey and semi-structured interviews, to both quantify different experiences of accessing routine vaccines in pregnancy and then explore in greater depth barriers and facilitators to accessing routine vaccines during the COVID-19 pandemic. Due to the timing of the onset of the pandemic and the first national lockdown in the UK, this study focuses on pertussis vaccination in pregnancy. The survey was designed based on previous surveys on pregnancy vaccination [28] and through consultation and piloting among midwives, pregnancy vaccine researchers, paediatricians and public health professionals. The survey gathered optional demographic data including ethnicity, age, number of children, country of residence, region of residence (England participants only), parity, income, pregnancy status, gestation at survey completion for those who were pregnant, and date of delivery for those who had already had their babies. The survey included questions about pertussis vaccine awareness and uptake during pregnancy. Questions also asked about access to antenatal care and the pertussis vaccination during the pandemic, including where they would have preferred to receive their vaccine and what sources of information on pregnancy vaccines they would prefer. Questions also asked about whether the COVID-19 pandemic had restricted their physical access to vaccines or made them feel less safe getting themselves and their baby vaccinated. Women were also asked whether they felt it was important to have their baby vaccinated during the pandemic. See supplementary file A for full survey. Ethical approval This study was approved by Imperial College Research Ethics Committee (ICREC) (Ref: 20IC6188). The survey was advertised and promoted using Facebook with a landing page and paid advertising using Facebook’s ad manager which crossposts to Instagram. The three adverts had a combined reach of 46,146, with 1573 post engagements and 1394 link clicks. Related organisations on Facebook were also contacted individually by study researchers, including pregnancy yoga and birth preparation classes, breastfeeding support groups and toddler groups. The survey was shared and distributed via the research team’s personal twitter accounts, including linking to other researchers and organisations with maternal and vaccine uptake interests. Finally, the survey was also promoted via some Maternity Voices Partnerships [29] who were e-mailed and invited to share the survey, and via a post on the website Mumsnet. By approaching a range of pregnancy and baby community groups such as Maternity Voices which are embedded local peer support networks our recruitment strategy especially sought to recruit from grass roots organisations and therefore reflect a representative sample. Eligible participants were required to have been pregnant at some point between the start of the first UK lockdown (from 23rd March 2020) and the time of survey completion, to be resident in the UK, and to be aged 16 years or over. The survey was live from 3rd August until 11th October 2020. The online survey was prefaced by an information page explaining the study, and how the data was to be used (Supplementary material A). Participants were informed that by taking part in the survey they agreed for their responses to be used for research purposes. Participants were required to confirm (by tick-box) at the start of the survey that they met the eligibility criteria and that they consented to participate in the survey. Descriptive statistics of survey respondents were reported, and statistical analysis undertaken using Stata (version-16). Binary answers, including awareness and uptake of pertussis vaccination, were compared by age group, household income, ethnicity, region and country of the United Kingdom using Pearson’s chi-squared statistic. All data for which there was a response was included in the analysis. For responses to questions on Likert scales (e.g., where responses were scored on a scale of ‘Strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, strongly disagree and not/applicable’), stepwise logistic regression was undertaken to determine factors associated with the responses. To facilitate analysis with the number of responses obtained, the < 20y group was combined with the next age bracket to form < 25y age bracket, the ten income groups were combined pairwise to form five groups, and ethnicity was dichotomised into ‘White’ (i.e., White British, White Irish and White Other participants) and ‘Ethnic minorities’ (i.e., Black, Asian, Chinese, Mixed ethnicities or Other ethnicities). A p value of<0.05 was considered statistically significant. At the end of the survey, participants were invited to take part in a follow-up interview by leaving their contact details. A selection of participants who had left their contact details were contacted by SBa. Participants were purposively selected to prioritise women: 1) from ethnic-minority backgrounds, due to lower representation among survey respondents; 2) who were pregnant when surveyed, due to their proximity to their pregnancy experience compared to those that had already had their babies; 3) who had not completed the open text responses. Informed written and verbal consent was obtained from participants. The participant information sheet and consent form were provided by e-mail (Supplementary material B). Interviews lasted approximately 30 min and were conducted over the telephone and/or using Microsoft Teams and were recorded with permission of the participant. Interviews were conducted by SBa and HS using a topic guide. The topic guide was developed based on the questionnaire (Supplementary material C). The interviews took place between the 7th and 16th of December 2020. Qualitative interviews and free-text survey responses were analysed thematically by SBa using the stages outlined by Braun and Clarke: data familiarisation, coding and theme identification and refinement [30]. To enhance the rigour of the analysis, coding approaches and subsequent theme generation and refinement was discussed between HS, SBa, SBe and BH. All data supporting this research publication is included in the manuscript and supplementary material.
