Comparative impact of the COVID-19 pandemic on parental behaviour towards childhood vaccination in Israel and the United Kingdom: A self-controlled matched cross-sectional study.

The long-term impact of the COVID-19 pandemic on routine childhood vaccination remains unclear. We aimed to determine whether parents with children born both before and after the pandemic changed their vaccination decisions with regard to Measles-Mumps-Rubella (MMR) and Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines. This self-controlled, matched cross-sectional study compared parental attitudes and behaviors towards childhood vaccination before and after the COVID-19 pandemic in the United Kingdom (UK) and Israel. We included 777 parents in the UK and 1270 in Israel, each with children born both before and after the pandemic. In the UK, Penta/hexavalent coverage declined from 96.5 % in children born pre-pandemic to 94.7 % in those born after and MMR from 97.3 % to 93.6 %, with 5.1 % of parents reporting vaccinating their child before but not after the pandemic for at least one vaccine. In Israel, pentavalent coverage decreased from 95.3 % in children born pre-pandemic to 93.1 % in those born after and MMR from 94.3 % to 91.6 %; 6.6 % reported a change towards non-vaccination for at least one vaccine. Reasons for non vaccination were similar across both countries and did not change after the pandemic. Refusal because of concern for side effects was the main refusal reason in both settings (cited by 83 % and 65 % of refusers pre-pandemic in the UK and Israel respectively, vs 92 and 63 % after). Across both countries, some minority groups were more likely to reduce vaccination. Over a third (37 %, 95 % CI 35-39) of participants reported less trust in vaccines after the pandemic compared to before. These findings suggest that the pandemic's impact on routine immunization is sustained and not context-specific. Interventions to restore trust and reduce concerns surrounding vaccines may help prevent persistent declines, maintain herd immunity, and ensure children remain protected post-pandemic.