Maternal vaccination in the NHS (MAVIS) Study

Dr Christie Cabral (lead)

Professor Adam Finn

Professor Pete Blair

Professor Jenny Ingram

Acknowledgements:

FUNDING: The MAVIS Study is funded by the National Institute for Health Research (NIHR doctoral fellowship NIHR300914). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.

SPONSOR: The study is hosted jointly across the Centre for Academic Child Health (CACH) and the Health Protection Research Unit in Behavioural Science and Evaluation (HPRU-BSE). The University of Bristol is the study sponsor.

ETHICAL APPROVALS: Projects 1 and 2 have ethical approval from the University of Bristol's Faculty of Health Science Research Ethics Committee (ref 9397). Project 3 has ethical approval from the HRA and Health and Care Research Wales and the London-Fulham Research Ethics Committee (ref 22/PR/1166). Project 4 has approval by contractual agreement between the University of Bristol and The Secretary of State for Health and Social Care acting through the CPRD centre of the MHRA.

This research aims to identify how NHS maternity services can be supported to improve pertussis and other vaccination delivery to pregnant women, aiming to reduce inequities between demographic groups and NHS areas.

Pertussis is widespread, highly contagious and serious for new-born babies. Vaccination is recommended for pregnant women to give newborn babies immunity from birth until they are old enough for their own vaccination. Over a third of pregnant women in the UK do not receive the vaccine and more miss out on the seasonal influenza and COVID-19 vaccines also recommended in pregnancy. Coverage is highly variable across regions of the country, and by demographic, with women of ethnic minorities particularly likely to miss out. The reasons for these differences are not clear, though the pattern indicates this is an inequity issue rather than a matter of personal choice.

More maternal vaccines are being developed nationally and globally. Understanding how to ensure effective and equitable delivery of these programmes is important, including maintaining respectful relationships with women who choose not to be vaccinated.

The MAVIS Study involves several projects designed to explore maternal vaccination in England, to identify what could be improved as shown below.

PROJECT 1: VACCINATION PROVISION IN NHS MATERNITY TRUSTS

This study (now complete) provides a valuable overview of the maternal vaccination provision across England’s NHS maternity trusts. Commissioners completed an online survey between June 2022 and March 2023, providing data for 120 of the 124 NHS maternity trusts in England. The results show an increase in the provision of maternal vaccines by maternity trusts over recent years, despite a negative impact of the pandemic on services, though with huge variability between trusts.

The next steps are to assess in more detail the reasons for the variability between trusts, exploring barriers and facilitators to vaccination. We also need to assess whether the increasing maternity trust provision of vaccines (in addition to GP surgeries continuing to provide them) is helping to reach women who have historically been more likely to miss out on these vaccines.

Read the full paper here: Maternal vaccination provision in NHS maternity trusts across England

PROJECT 2: THE MATERNITY STAFF PERSPECTIVE

This was a national survey with healthcare professionals working at maternity services in NHS areas with the highest and the lowest coverage for maternal pertussis vaccination. Survey development used theoretical frameworks of behavioural determinants, clinical advisory group consultation and think-aloud user-testing.

551 respondents took part between 25/11/22 and 03/05/2023, with 260 respondents (from 20 trusts) representing high vaccinating areas, and 291 respondents (from 19 trusts) representing low vaccinating areas. Most participants were female midwives working in hospital settings. Analysis is currently underway to identify barriers and facilitators to maternity-service delivery of vaccination.

PROJECT 3: THE PARENT PERSPECTIVE

This is a survey study with recently pregnant women in areas of England with the lowest maternal pertussis vaccination coverage. Survey development used theoretical frameworks of behavioural determinants, community advisory group consultation and think-aloud user-testing.

Recruitment closed on 01 June 2024. Analysis of responses will identify potential for how to better meet the needs of women when they are offered vaccination during pregnancy, including information provision, appointment access, and opportunities for respectful discussion.

PROJECT 4: WHO IS MISSING OUT?

This is a retrospective cohort study using national primary care record data (CPRD) of about 2 million women to describe the predictors - or risk factors - for being unvaccinated in pregnancy. The study is designed to update previous knowledge of the social determinants of maternal vaccination, and in particular is exploring whether the shift to maternity trusts providing maternal vaccinations has made a difference in reaching more women from underserved communities. Analysis is currently underway. This work is a collaboration with researchers at the London School of Hygiene and Tropical Medicine.

PATIENT AND PUBLIC INVOLVEMENT (PPI)

Consultation and codesign with the following advisory groups is embedded throughout the project to help design the research and interpret findings:

Clinical advisory group (NHS midwives and maternity professionals)
Parent advisory group (Bristol mothers from underserved communities)

Centre for Academic Child Health