Peer-reviewed article
Keep calm and carry on vaccinating: Is anti-vaccination sentiment contributing to declining vaccine coverage in England?
Michael L. Edelstein, Martin Müller, Shamez N Ladhani, Joanne Yarwood, Marcel Salathé et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study investigates whether anti-vaccination sentiment caused the decline in childhood vaccine coverage in England since 2012/13. Using vaccine coverage data, survey data on attitudes, and Twitter analysis, the researchers applied Bradford Hill criteria to test this hypothesis. The findings show that vaccine coverage changes were inconsistent across different vaccines and doses, and that vaccine confidence actually increased during the period when coverage declined. The authors conclude that anti-vaccination sentiment did not cause the observed decline in vaccine coverage.
Key points
- Childhood vaccine coverage declines since 2012/13 are 4-20 times smaller than those from well-documented vaccine scares
- Coverage changes were inconsistent: some vaccines decreased (hexavalent, MMR, HPV) while others increased (MenACWY, Td/IPV, influenza)
- Vaccine confidence increased during the same period when coverage declined, contrary to what would be expected if anti-vaccination sentiment was driving the decline
- First doses of hexavalent and meningococcal vaccines increased by 0.5-0.7 percentage points between 2017 and 2019, while completed courses decreased by 0.5-1.2 percentage points
- Twitter sentiment towards vaccination in the UK became increasingly positive between 2017 and 2019 while coverage declined
Limitations
The study does not identify what factors actually caused the observed declines in vaccine coverage if not anti-vaccination sentiment. The analysis relies on aggregate data and does not examine individual-level reasons for vaccination decisions or non-completion of vaccine courses.
Abstract
BACKGROUND: In England, coverage for childhood vaccines have decreased since 2012/13 in the context of an increasingly visible anti-vaccination discourse. We determined whether anti-vaccination sentiment is the likely cause of this decline in coverage. METHODS: Descriptive study triangulating a range of data sources (vaccine coverage, cross-sectional survey of attitudes towards vaccination, UK-specific Twitter social media) and assessing them against the following Bradford Hill criteria: strength of association, consistency, specificity, temporality, biological gradient and coherence. RESULTS: Strength of association: compared with well-documented vaccine scares, the decline in childhood vaccination seen since 2012/13 is 4-20 times smaller; consistency: while coverage for completed courses of the hexavalent and meningococcal vaccines decreased by 0.5-1.2 percentage points (pp) between 2017 and 2019, coverage for the first dose of these vaccines increased 0.5-0.7 pp; specificity: Since 2012-13, coverage decreased for some vaccines (hexavalent, MMR, HPV, shingles) and increased for others (MenACWY, Td/IPV, antenatal pertussis, influenza in 2 years of children), with no age-specific patterns. Temporality and biological gradient: the decline in vaccine coverage was preceded by an increase in vaccine confidence and a decrease in the proportion of parents encountering anti-vaccination materials. Coherence: attitudes towards vaccination expressed on Twitter in the UK became increasingly positive between 2017 and 2019 as vaccine coverage for childhood vaccines decreased. CONCLUSIONS: In England, trends in vaccine coverage between 2012/13 and 2018/19 were not homogenous and varied in magnitude and direction according to vaccine, dose and region. In addition, confidence in vaccines increased during the same period. These findings are not compatible with anti-vaccination sentiment causing a decline in vaccine coverage In England.