Variation in COVID-19 booster uptake in England: An ecological study

  1. Greg Dropkin

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Abstract

Variable and low uptake of the COVID-19 booster is a recognised problem, associated with individual characteristics including age, gender, ethnicity, and deprivation. Are there other relevant predictors at area level?

Methods

Anonymous grouped data was downloaded from the UK Government Coronavirus Dashboard for Middle Super Output Areas (MSOA) in England, along with demographic, employment, and health data from public sources. Mixed models with a random intercept for Upper Tier Local Authority were analysed as quasibinomial Generalized Additive Models. The estimated random effects were then fitted with Bayesian linear mixed models using flu vaccination uptake, change in public health budgets, population proportion of vaccination sites at pharmacies, GP-led, vaccination centres, and hospital hubs, and Region.

Results

Models for the MSOA-level COVID-19 first and second vaccinations and the Third Injection (including the booster), fit well. Index of Multiple Deprivation, proportion Aged 15-24 and 25-44, and ethnicity groupings Other White, Indian-Pakistani-Bangladeshi, and African-Caribbean-Other Black-Other, are highly significant predictors of lower uptake. The estimated random effects vary widely amongst local authorities, with positive impact of flu vaccine uptake and change in public health budgets, and regional impacts which are positive for London and South East (first and second doses only), and negative for North West and North East. The impact of vaccination sites did not reach 90% credibility, in general.

Conclusion

COVID-19 vaccination rates at each stage are very well modelled if local authority random effects are included along with non-linear terms for demographic, employment and health data. Deprivation, younger age, and Other White, South Asian, and African-Caribbean-Other ethnicities are associated with lower uptake. The estimated local effects show strong regional variation and are positively associated with flu vaccination and increasing public health budgets. One simple way to improve COVID-19 vaccine uptake in England would be to increase local public health allocations.

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  1. Version published to 10.1371/journal.pone.0270624
  2. ScreenIT

    SciScore for 10.1101/2022.02.01.22270236: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.02.01.22270236 on medRxiv