Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean

Abstract

Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980–2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1

“…Past research suggests that compounding factors, including large subnational disparities in access to vaccines and shifting perceptions of vaccine risk, could have contributed to regional declines. 35 , 36 , 37 By 2019, only 109 of 204 countries and territories reached at least 90% mean estimated coverage for DTP3, while only 11 countries and territories met this threshold across nine of the assessed vaccines.…”

“…Past research suggests that compounding factors, including large subnational disparities in access to vaccines and shifting perceptions of vaccine risk, could have contributed to regional declines. [35][36][37] By 2019, only 109 of 204 countries and territories reached at least 90% mean estimated coverage for DTP3, while only 11 countries and territories met this threshold across nine of the assessed vaccines. Improving and sustaining advances in vaccination requires a constellation of local and global factors, and our analysis further emphasises that progress in routine immunisation is far from inevitable.…”

Impact of the COVID-19 pandemic on routine childhood immunisation in Colombia

“… 26 As such, efforts are needed to guarantee continuity in vaccine uptake, given that lockdown and isolation measures have negatively impacted national coverage during 2020, especially among rural populations. Although there have been successful efforts to reduce rural/urban inequalities, 6 new vaccination agendas (including those proposed for COVID-19 containment) must include special actions to overcome lags in routine childhood immunisation for at-risk regions.…”

“… 3 For low-income and middle-income countries, the effects of these disruption may be even more detrimental to achieving optimal immunisation coverage for poor households and remote or rural areas. 4 5 Although inequities are decreasing in Latin America, 6 infectious outbreaks such as COVID-19 have the potential to affect what has been achieved by diverting health resources from preventive healthcare and through lockdown measures that contribute to reducing normal delivery of vaccines, especially in remote areas.…”

Tracking the impact of the COVID-19 pandemic on routine infant vaccinations in the Dominican Republic

“…Previous studies have identified negative changes in comprehensive vaccination coverage over time among infants from disadvantaged households. 27 Taking into account the decrease in subnational coverage of Penta3 below the threshold recommended by the WHO, the increase in the number of partially and unvaccinated infants and the appearance of sporadic cases of diphtheria, tetanus and pertussis, there is a significant risk of outbreaks of immunopreventable diseases in these provinces that could be exacerbated by the current pandemic. 8,28 Compared to 2019 and until March 2021, the incidence rate of diphtheria (0.38), tetanus (0.34) and pertussis (0.19) per 100,000 inhabitants increased 383%, 45% and 21%, respectively.…”