Changing socio-demographic determinants of seasonal influenza acceptance in England during the pandemic and a...

To assess seasonal influenza vaccine acceptance in England from 2020 to 2022 and examine evolving socio-demographic determinants of flu vaccine uptake and intent. A secondary objective was to evaluate the potential of predictive modelling for future uptake estimation at national and sub-national levels.

Two cross-sectional online surveys were conducted between September 2020 and July 2022, including 28,748 English adults aged ≥18. Responses were analysed using Bayesian time-series multilevel regression with poststratification to English census data. Key outcomes were: (1) NHS offer of seasonal influenza vaccination in the past 12 months; (2) acceptance of the offer; and (3) intention to vaccinate in the following 12 months.

By the 2021-22 flu season, 56.3% of adults reported being offered the vaccine - an increase of 10.7 percentage points from 2019 to 20. Acceptance rose notably, particularly among those aged ≥50. However, intention to vaccinate declined slightly between the 2020 and 2022 surveys. Vaccine behaviours varied by age, gender, education, ethnicity, and religion. Disparities were especially pronounced between Black/Black British and White respondents, and waning intent was observed among Asian/Asian British groups, Hindus, and Punjabi speakers. Regional differences were evident, with uptake lowest in inner London. Model-based predictions aligned closely with actual uptake reported in the 2022-23 flu season.

Expanded eligibility contributed to increased uptake, particularly among older adults. Persistent demographic and regional disparities highlight the need for more tailored public health strategies. The slight decline in future vaccination intent is concerning and suggests a need for renewed engagement.

While vaccine uptake improved in 2021-22, inequities remain across demographic and regional groups. Predictive modelling shows promise for guiding future vaccination efforts. Addressing intent-to-vaccinate and regional gaps will be critical to sustaining high influenza coverage in England.