Persistent inequalities remain a major barrier to achieving universal protection against life-threatening infections – reflecting findings from the UK Heath Security Agency National Immunisation Programme Health Equity Audit 2025.

The findings from an interdisciplinary research team including data scientists, infectious disease epidemiologists and physicians from the University of Liverpool are published today (1 April 2026) in the journal The Lancet Regional Health – Europe. 

By performing a data analysis, researchers from the Institute of Population Health and the Institute of Infection, Veterinary & Ecological Sciences at the University of Liverpool have examined the trends in timely vaccine uptake before and after England changed its PCV dose schedule in  January 2020 – transitioning from a “2+1” PCV schedule (two primary doses at 8 and 16 weeks, with a booster dose at 12 months) to a “1+1” PCV schedule (single primary dose at 12 weeks and a booster dose at 12 months).

In a longitudinal study, the researchers analysed Pneumococcal Conjugate Vaccine (PCV) uptake data from 2013-2025 for children aged 1 and 2 years from the Cover of Vaccination Evaluated Rapidly (COVER) programme. COVER collects quarterly and annual data on childhood immunisation coverage in England for children at 1, 2 and 5 years of age.

Looking at pattens for upper-tier local authorities in England linked to 2019 Index of Multiple Deprivation quintiles, the study found that PCV booster retention has dropped in England since the schedule change, which coincided with the start of the COVID-19 pandemic. This deterioration disproportionately affected children in more deprived areas, risking avoidable disease burden concentrated in the most disadvantaged communities and widening health inequalities. The findings agree with evidence from a BMJ article by the wider research team and the UK Heath Security Agency National Immunisation Programme Health Equity Audit 2025, reporting immunisation inequity in England is not only persistent but it is worsening in critical areas.

The number of required clinic visits may be insufficient to overcome the systemic barriers to vaccination faced by marginalised communities. Immunisation system strengthening, targeted, equity-focused interventions and enhanced call-recall systems for post-infant vaccine delivery could help address the identified PCV coverage gaps. These outputs are timely as the House of Lords – Childhood Vaccinations Committee is holding an inquiry to examine childhood vaccination coverage in England, why there has been a gradual decline in coverage over the past decade and what the Government should do to reverse this decline and reduce inequalities in childhood vaccination coverage.

Dr Edward Hill from the University of Liverpool is the corresponding author on the paper. He said: “National averages and patterns can often mask local vulnerabilities. This research highlights the importance of using granular data to identify exactly which groups are falling behind in intervention uptake. Public health interventions can then be more precisely targeted.”

Lead author Praise Ilechukwu from the University of Liverpool commented: “Our study shows that while the UK’s move to a 1+1 schedule was evidence-based and efficient, we are still seeing a consistent lag in protection for children in deprived areas. These deprivation-associated inequalities in pneumococcal vaccine coverage in children leaves children in deprived areas more vulnerable to pneumococcal diseases like pneumonia and meningitis.”

Co-author Professor Neil French from the University of Liverpool commented: “Addressing the PCV booster retention issues can be aided by establishing routine monitoring of booster gaps as a key performance indicator for the vaccination programme. This should include regular reporting by deprivation and place to enable early identification of emerging problems.”

Co-author Dr Dan Hungerford from the University of Liverpool commented: “Inequalities persist even with fewer required vaccination appointments for PCV. We need to look at the wider social determinates of inequalities in child health and structural access factors—like flexible vaccination access points and tailored community outreach—to ensure every child is protected regardless of their background.”

The research, published today in The Lancet Regional Health – Europe, was supported by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections.

The paper Inequalities in childhood pneumococcal conjugate vaccine uptake in England before and after the change from a 2+1 to 1+1 schedule: a longitudinal study is available here: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(26)00079-7/fulltext

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Their work is published in the Journal of Epidemiology on May 5, 2025.

Pneumonia is one of the leading causes of death in Japan. Each year about 74,000 people die from pneumonia with 98 percent of these deaths occurring in people aged 65 and older. The bacteria Streptococcus pneumoniae is the primary cause of pneumonia.

In October 2014, Japan began a nationwide routine vaccination program for the elderly under the National Immunization Program with the 23-valent pneumococcal polysaccharide vaccine (PPSV23).

Sera Town, a mountainous municipality in eastern Hiroshima Prefecture, jointly planned and implemented a pneumococcal vaccination support program with a research team at Hiroshima University in October 2010—well before the nationwide rollout. The program, which ran until March 2015, aimed to promote community health and provided PPSV23 vaccination to all residents aged 65 and older. The vaccine used in the project was approved in Japan at the time for elderly individuals. As part of this collaborative initiative, a five-year follow-up survey was conducted to assess the vaccine’s preventive effect against pneumonia.

“Specifically, we sought to understand the impact of the PPSV23 vaccine on pneumonia incidence and mortality among the elderly population in a rural setting with a high aging rate,” said Aya Sugiyama, a lecturer in the Department of Epidemiology Disease Control and Prevention at the Graduate School of Biomedical and Health Sciences, Hiroshima University. The Sera Town residents who took part in the project ranged in age from 70 to 114 years old, with a median age of 84.

To assess changes in mortality following the introduction of the vaccination program, the researchers used aggregated demographic data from Japan’s vital statistics covering the years 2000 to 2016. They applied an interrupted time series analysis to quantify the level and trend changes in mortality rates over time, specifically looking at the mortality rates before and after the vaccination project was introduced in the town. The study aimed to generate real-world evidence on the effectiveness of vaccination support programs in super-aged societies.

Their analysis of the data showed them that the pneumococcal vaccination support program for older residents in Sera Town was associated with a 25 percent reduction in pneumonia-related mortality. “Notably, it reversed the previously increasing trend in pneumonia mortality in the community,” said Sugiyama.

The study also provided valuable data on the actual incidence of pneumonia among vaccinated older adults, with an incidence rate of 20.3 cases per 1,000 person-years. Scientists use the person-year method in studies where they follow individuals over a period of time. A person-year is one person being followed for one year. “These findings underscore both the public health significance of local vaccination efforts and the burden of pneumonia in aging populations,” said Sugiyama.

The research team sees the findings as particularly relevant for Japan, which has the most aged population in the world. “With the completion of this evaluation, the next step is to share these findings to inform future discussions on community-based vaccination strategies. While further research is needed, we hope that our results will serve as a reference for regions exploring effective approaches to pneumonia prevention in older adults,” said Sugiyama.

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The research team includes Aya Sugiyama, Kanon Abe, Hirohito Imada, Bunlorn Sun, Golda Ataa Akuffo, Tomoyuki Akita, Shingo Fukuma, Junko Tanaka, and Noboru Hattori from Hiroshima University; Masaaki Kataoka from Sera Central Public Hospital; and Kentaro Tokumo from Sera Central Public Hospital, Hiroshima University, and Hiroshima University Hospital.

The research is funded by the Sera Town municipality.

This paper received partial funding from Hiroshima University to cover open access fees.

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The findings from the landmark REGARD-VAP trial, published in Lancet Respiratory Medicine, and the accompanying economic analyses published in Lancet Global Health, highlight how prudent antibiotic use can curb resistance, effectively safeguarding patients as well as combatting the global threat of antimicrobial resistance while reducing healthcare costs.

Led by the NUS Medicine research team, the clinical trial examined over 450 patients across intensive care units (ICUs) in Singapore, Thailand, and Nepal. Results revealed that short-course antibiotics—carefully tailored to individual patients’ recovery—are just as effective as traditional longer treatments in preventing death and recurrence of pneumonia. “By shortening the duration of antibiotics, we can reduce the risks of side effects and resistance without compromising patient outcomes,” added Dr Mo Yin, Junior Academic Fellow at the Department of Medicine, NUS Medicine, and principal investigator of the clinical trial, and co-author of the economic analysis.

The economic analyses, led by the Duke-NUS research team, accompanying the trial were just published in the prestigious journal Lancet Global Health. They demonstrated that adopting short-course antibiotics offers significant value for healthcare systems. In Singapore, the strategy is cost-saving, reducing hospital expenditure while maintaining excellent outcomes for patients. In Thailand and Nepal, short-course antibiotics were highly cost-effective, with health gains outweighing the modest additional costs incurred. “Short-course antibiotics are a pragmatic solution that benefits patients and healthcare systems alike, particularly in resource-limited settings,” said Assistant Professor Yiying Cai, lead researcher from the Health Services and Systems Research Programme at Duke-NUS.

The REGARD-VAP study’s findings have practical implications for hospitals worldwide. Short-course antibiotics can streamline treatment in ICUs, where managing infections efficiently is vital. The approach is effective across high-income (Singapore), middle-income (Thailand), and low-income (Nepal) settings, making it a scalable solution for diverse healthcare systems. These results provide robust evidence including cost-effectiveness data for policymakers to adopt short-course antibiotics into national and institutional guidelines.

The team hopes to disseminate their findings globally to encourage the adoption of short-course antibiotics, particularly in regions with limited resources. They also advocate for integrating cost-effectiveness studies into future clinical trials to strengthen both clinical and economic decision-making processes. By reducing unnecessary antibiotic exposure, short-course treatments help preserve the effectiveness of existing drugs for future generations. Every additional day of antibiotic use increases the risk of drug resistance by 7%. Reducing treatment duration is a critical step in combating this silent epidemic. “Prudent antibiotic use is essential to combat antimicrobial resistance and optimise healthcare outcomes. Our findings[1] make a strong case for adopting short-course antibiotics as the new standard of care,” concluded Dr Mo Yin.

The REGARD-VAP trial was supported by the UK Medical Research Council, the Wellcome Trust and National Research Foundation, Singapore, under its Central Gap Fund (Award ID: CTGIIT18may0005). The trial, which combines clinical and economic data, sets a new benchmark for trials that evaluate healthcare interventions.

[1] Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views of National Research Foundation, Singapore.

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The University of Sydney led study found many antibiotics recommended by the World Health Organization (WHO) had less than 50 percent effectiveness in treating childhood infections such as pneumonia, sepsis (bloodstream infections) and meningitis. The findings show global guidelines on antibiotic use are outdated and need updates.

The most seriously affected regions are in South-East Asia and the Pacific, including neighbouring Indonesia and the Philippines, where thousands of unnecessary deaths in children resulting from antibiotic resistance occur each year.

The WHO has declared antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. In newborns, an estimated three million cases of sepsis occur globally each year, with up to 570,000 deaths: many of these are due to lack of effective antibiotics to treat resistant bacteria.

The findings, published in Lancet South East Asia, adds to mounting evidence that common bacteria responsible for sepsis and meningitis in children are often resistant to prescribed antibiotics.

The research reveals the urgent need for global antibiotic guidelines to be updated, to reflect the rapidly evolving rates of AMR. The most recent guideline from The World Health Organization was published in 2013.

The study found one antibiotic in particular, ceftriaxone, was likely to be effective in treating only one in three cases of sepsis or meningitis in newborn babies. Ceftriaxone is also widely used in Australia to treat many infections in children, such as pneumonia and urinary tract infections.

Another antibiotic, gentamicin, was found likely to be effective in treating fewer than half of all sepsis and meningitis cases in children.

Gentamicin is commonly prescribed alongside aminopenicillins, which the study showed also has low effectiveness in combating bloodstream infections in babies and children.

Lead author Dr Phoebe Williams from the University’s School of Public Health  and Sydney Infectious Diseases Institute is an infectious disease specialist whose research focuses on reducing AMR in high-burden healthcare settings in Southeast Asia.

She also works as a clinician in Australia. Dr Williams says there are increasing cases of multidrug-resistant bacterial infections in children around the world.

AMR is more problematic for children than adults, as new antibiotics are less likely to be trialled on, and made available to, children.

Dr Williams says the study should be a wake-up call for the whole world, including Australia.

“We are not immune to this problem – the burden of anti-microbial resistance is on our doorstep,” she said.

“Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year.”

The study analysed 6,648 bacterial isolates from 11 countries across 86 publications to review antibiotic susceptibility for common bacteria causing childhood infections.

Dr Wiliams said the best way to tackle antibiotic resistance in childhood infections is to make funding to investigate new antibiotic treatments for children and newborns a priority.

“Antibiotic clinical focus on adults and too often children and newborns are left out. That means we have very limited options and data for new treatments.”

Dr Williams is currently looking into an old antibiotic, fosfomycin, as a temporary lifeline to treat multidrug-resistant urinary tract infections in children in Australia.

She is also working with the WHO’s Paediatric Drug Optimisation Committee to ensure children have access to antibiotics to treat multidrug-resistant infections as soon as possible, to reduce deaths due to AMR among children.

“This study reveals important problems regarding the availability of effective antibiotics to treat serious infections in children,” says senior author Paul Turner, director of the Cambodia Oxford Medical Research Unit at Angkor Hospital for Children, Siem Reap and professor of paediatric microbiology at the University of Oxford, UK.

“It also highlights the ongoing need for high quality laboratory data to monitor the AMR situation, which will facilitate timely changes to be made to treatment guidelines.”

IMAGE: DR PHOEBE WILLIAMS IS AN INFECTIOUS DISEASE SPECIALIST WORKING TO REDUCE ANTIMICROBIAL RESISTANCE. IN THE PHOTO SHE IS WORKING IN KENYA. CREDIT: HAMISH GREGORY

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CREDIT: HAMISH GREGORY

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In the modern intensive care unit, these bacteria or viruses are usually controlled either by antibiotics or by the body’s immune system within the first few days of the illness.

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But in a study published in Nature on January 11, investigators at Northwestern Medicine show COVID-19 pneumonia is different.

Instead of rapidly infecting large regions of the lung, the virus causing COVID-19 sets up shop in multiple small areas of the lung. It then hijacks the lungs’ own immune cells and uses them to spread across the lung over a period of many days or even weeks, like multiple wildfires spreading across a forest. As the infection slowly moves across the lung, it leaves damage in its wake and continuously fuels the fever, low blood pressure and damage to the kidneys, brain, heart and other organs in patients with COVID-19.

The severe complications of COVID-19 compared with other pneumonias might be related to the long course of disease rather than more severe disease, the study authors said.

This is the first study in which scientists analyzed immune cells from the lungs of COVID-19 pneumonia patients in a systematic manner and compared them to cells from patients with pneumonia from other viruses or bacteria.

Drug trial to treat newly discovered targets in COVID-19 pneumonia

As a result of the detailed analysis, researchers identified critical targets to treat severe SARS-CoV-2 pneumonia and lessen its damage. The targets are the immune cells: macrophages and T cells. The study suggests macrophages – cells typically charged with protecting the lung – can be infected by SARS-CoV-2 and can contribute to spreading the infection through the lung.

Northwestern Medicine will test an experimental drug to treat these targets in COVID-19 pneumonia patients in a clinical trial early in 2021. The drug to be tested quiets the inflammatory response of these immune cells, thus enabling initiation of the repair process in the injured lung.

Aim to make COVID-19 like a bad cold

“Our goal is to make COVID-19 mild instead of severe, making it comparable to a bad cold,” said study co-senior author Dr. Scott Budinger, chief of pulmonary and critical care medicine at Northwestern University Feinberg School of Medicine and Northwestern Medicine.

“This effort truly represents a ‘moonshot’ in COVID-19 research,” said study co-senior author Dr. Richard Wunderink, professor of pulmonary and critical care medicine at Feinberg and medical director of Northwestern Medicine’s ICU.

COVID-19 unlikely to completely disappear

COVID-19, like influenza, is unlikely to ever go away, even if much of the population is vaccinated, said senior co-author Dr. Ben Singer, assistant professor of pulmonary and critical care medicine at Feinberg and a Northwestern Medicine physician.

“Already, researchers at Northwestern and elsewhere are anticipating mechanisms by which this RNA virus, which mutates quickly, will evade current vaccines,” Singer said. “This study will help us develop treatments to reduce the severity of COVID-19 in those who develop it.”

Mortality in COVID-19 patients on ventilators lower than regular pneumonia patients

The study also revealed why the mortality among patients on a ventilator for COVID-19 was lower than patients on a ventilator due to regular pneumonia, the study reports. An intense conflagration in the lungs (regular pneumonia) has a higher risk of death. Those with COVID-19 pneumonia are sick for a long time, but the inflammation in their lungs is not as severe as regular pneumonia.

“If patients with COVID-19 are carefully managed and the health care system isn’t overwhelmed, you can get them through it,” Budinger said. “These patients are very sick. It takes a really long time for them to get better. But If you have enough beds and health care providers, you can keep the mortality to 20%. When health systems are overwhelmed mortality rates double up to 40%.”

For the study, scientists performed a high-resolution analysis of the lung fluid of 86 COVID-19 patients on a ventilator and compared it with lung fluid from 256 patients on a ventilator who had other types of pneumonia. Because of the safety concerns, only a handful of groups around the world performed analysis of the immune response in the lungs of patients with COVID-19. As a result, important information about what was killing patients with severe COVID-19 was missing.

Northwestern scientists, studying pneumonia for years, poised for COVID lung research

The study performed at Northwestern Medicine is unique because Wunderink and colleagues have been studying pneumonia for years before the pandemic. As a result, when the COVID-19 pandemic hit, they were prepared to collect fluid from the lungs of these patients in a safe and systematic manner and compare it with fluid collected from other ICU patients with pneumonia collected before the pandemic. This research infrastructure allowed them to show that pneumonia in patients with COVID-19 is different from other pneumonia, and more importantly, how it is different.

Scientists took cells from patients’ lung fluid and looked at the RNA and the proteins those cells express, enabling them to identify how these immune cells drive inflammation.

“This level of resolution could never be achieved without directly sampling lung fluid,” said study co-senior author Dr. Alexander Misharin, an assistant professor of pulmonary and critical care medicine at Feinberg and a Northwestern Medicine physician.

The complex nature of the study, in which samples from patients were analyzed with the most sophisticated technologies available in Northwestern’s state-of-the art research labs, required the concerted effort of more than 100 researchers.

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