The French Covid-19 vaccination policy did not solve vaccination inequities: a nationwide study on 64.5 million people

Abstract

Background To encourage Covid-19 vaccination, France introduced during the Summer 2021 a ‘Sanitary Pass’, which morphed into a ‘Vaccine Pass’ in early 2022. While the sanitary pass led to an increase in Covid-19 vaccination rates, spatial heterogeneities in vaccination rates remained. To identify potential determinants of these heterogeneities and evaluate the French sanitary and vaccine passes’ efficacies in reducing them, we used a data-driven approach on exhaustive nationwide data, gathering 141 socio-economic, political and geographic indicators. Methods We considered the association between vaccination rates and each indicator at different time points: before the sanitary pass announcement (week 2021-W27), before the sanitary pass came into force (week 2021-W31) and 1 month after (week 2021-W35) and the equivalent dates for the vaccine pass (weeks 2021-W49, 2022-W03 and 2022-W07). Results The indicators most associated with vaccination rates were the share of local income coming from unemployment benefits, overcrowded households rate, immigrants rate and vote for an ‘anti-establishment’ candidate at the 2017 Presidential election. These associations increase over time. Consequently, living in a district below the median of such indicator decreases the probability to be vaccinated by about 30% at the end of the studied period, and this probability gradually decreases by deciles of these indicators. Conclusions Our analysis reveals that factors related to poverty, immigration and trust in the government are strong determinants of vaccination rate, and that vaccination inequities tended to increase after the introduction of the French sanitary and vaccination passes.

Lower vaccination coverage against COVID-19 in school-aged children is associated with low socioeconomic status in the Metropolitan Area of Santiago, Chile

“…In general terms, our results are consistent with previous literature, indicating that vaccine coverage is lower in vulnerable populations living in poverty, having lower literacy and with a lesser educational level. 13,26,40 Despite the fact that our results show a statistically significant correlation between the vulnerability of different municipalities and the COVID-19 vaccination coverage-i.e. municipalities with lower SES exhibit lower coverage-, different school types exhibit distinct vaccination coverage.…”

“…In general terms, our results are consistent with previous literature, indicating that vaccine coverage is lower in vulnerable populations living in poverty, having lower literacy and with a lesser educational level. 13, 26, 40…”

“…Among others, the lack of proper information about the importance of vaccination, insufficient incentives for vaccination, religious beliefs, the negative view of pharmaceutical companies, and low trust in the government, may all have played a role in this uneven vaccination rate. 9–11, 13, 26, 42 Additionally, other physically impeding factors such as the availability of doses, ease of access to vaccination centers (determined in turn by location, availability of transport, size of waiting queues and opening hours) may also have an important role in determining the observed results. A more detailed analysis of these factors could be beneficial for designing improved vaccination campaigns and better public policies.…”

“…This association is exacerbated by other factors such as uncontrolled immigration, political instability, and low trust in the government. 9–11, 13, 26…”

Uncovering inequities in Covid-19 vaccine coverage for adults and elderly in Brazil: A multilevel study of 2021–2022 data

“…With regard to COVID-19, concerns have been raised that unequal access to vaccination may exacerbate previous health disparities. Studies conducted in different contexts, mostly in high-income countries, have identified that populations in positions of greater social vulnerability, as well as residents in regions with worse socioeconomic indicators, have lower vaccination coverage [9] , [10] , [11] .…”