Health researchers in England say a change to the childhood pneumococcal vaccine schedule has not eliminated inequalities in protection, with children in more deprived areas still lagging behind in booster uptake. The findings, published on 1 April 2026 in The Lancet Regional Health – Europe, suggest that structural barriers continue to shape access to routine vaccination, even after the country moved to a simpler dose schedule.
Coverage gaps remain after England switched to a 1+1 PCV schedule
Researchers from the University of Liverpool analysed Pneumococcal Conjugate Vaccine uptake data from 2013 to 2025 for children aged 1 and 2 years in England’s Cover of Vaccination Evaluated Rapidly programme. They looked at patterns before and after the January 2020 shift from a 2+1 schedule to a 1+1 schedule, which changed the timing of primary and booster doses.
The study found that PCV booster retention has declined in England since the schedule change, and that the drop was more pronounced in more deprived areas. The authors said this risks avoidable disease burden being concentrated in disadvantaged communities and widening health inequalities.
Researchers say national averages can hide local vulnerability
Lead author Praise Ilechukwu said the findings show that national figures can mask local problems, adding that granular data are needed to identify which groups are falling behind in intervention uptake. Co-author Professor Neil French said routine monitoring of booster gaps should be treated as a key performance indicator for vaccination programmes, with reporting by deprivation and place to spot emerging problems earlier.
The team said that fewer required clinic visits were not enough to overcome the broader access barriers faced by marginalised communities. They argued that targeted, equity-focused interventions, stronger call-recall systems and more flexible vaccination access points could help close the gap in pneumococcal protection.
Why the findings matter for child health policy
The researchers said the results are timely as the House of Lords Childhood Vaccinations Committee examines falling childhood vaccine coverage in England and the reasons behind widening inequalities. Their findings align with wider concerns that immunisation inequity is persistent and worsening in key areas, particularly for children at greater risk of pneumococcal diseases such as pneumonia and meningitis.
For public health leaders, the study is a reminder that simplifying vaccine schedules does not automatically deliver equal uptake. The authors said system strengthening and community-based outreach will be needed if England is to improve coverage and ensure that children receive the same level of protection regardless of background.
