Local authority variation in uptake of the HPV vaccine in Greater Manchester and school-level factors: a cross-sectional ecological study

Background: Human papillomavirus (HPV) is the main cause of cervical cancer and contributes to a number of other cancers that affect both men and women. Vaccines exist that offer protection against the most common cancer-causing HPV types. In England, a school-based vaccination programme for girls has been in place since 2008 but vaccine coverage rates have declined since its introduction. Understanding variation between schools and between local authorities may help to inform quality improvement and guide policy development and commissioning. Methods: Cross-sectional, ecological analysis of vaccine uptake among 164 schools representing 13,127 children in eight out of ten local authorities in Greater Manchester. Logistic mixed effects regression models were used to test for associations between school level factors and vaccine uptake, while allowing for variation between local authorities. Results: In multivariable mixed effects models, lower vaccination rates were associated with: increasing numbers of children eligible for vaccination; increasing proportions of children eligible for free school meals; increasing proportions of children with English as an additional language; Ofsted inadequate ratings; Christian and Muslim faith schools; independent schools and special schools. Conclusions: Consistent with previous studies on vaccine uptake, this study identifies a number of factors that are associated with uptake of the school-based HPV vaccine programme. We also show that local authority variation remains after adjustment for the mix of schools in each area. This evidence may be used to guide vaccine providers, commissioners, and policymakers who want to increase uptake of the school-based HPV vaccine.