Towards equity in immunisation

Abstract

In the World Health Organization (WHO) European Region, differences in uptake rates of routine childhood immunisation persist within and among countries, with rates even falling in some areas. There has been a tendency among national programmes, policymakers and the media in recent years to attribute missed vaccinations to faltering demand or refusal among parents. However, evidence shows that the reasons for suboptimal coverage are multifactorial and include the social determinants of health. At the midpoint in the implementation of the European Vaccine Action Plan 2015–2020 (EVAP), national immunisation programmes should be aware that inequity may be a factor affecting their progress towards the EVAP immunisation targets. Social determinants of health, such as individual and household income and education, impact immunisation uptake as well as general health outcomes – even in high-income countries. One way to ensure optimal coverage is to make inequities in immunisation uptake visible by disaggregating immunisation coverage data and linking them with already available data sources of social determinants. This can serve as a starting point to identify and eliminate underlying structural causes of suboptimal uptake. The WHO Regional Office for Europe encourages countries to make the equitable delivery of vaccination a priority.

Mandate vaccination with care

“…A requirement to vaccinate when the vaccine or primary-care service is difficult or impossible for many people to reach is not justifiable or fair 13 . Thus, before even considering mandates, governments must ensure that people from all sectors of society can get vaccines easily and safely.…”

New immunization strategies: adapting to global challenges

“…Other important preventive interventions are being added, e.g., for adolescents [46]. Improving coordination and collaboration between immunization and other preventive and curative services can result in efficiency gains, save resources by offering one-stop services at the point of delivery, and increase the use of social mobilization to increase demand [16]. In addition, non-governmental and private vaccinators can enhance the ability of programmes to deliver recommended vaccine doses, especially to clients who prefer them over public services.…”

“…Firming up synergies between accelerated disease control efforts and routine immunization can contribute to achieving immunization goals. Using the added attention on outbreaks, vaccination campaigns can also be used to actively look for and refer inadequately immunized persons to regular vaccination sessions, thus reinforcing overall immunization systems [16].…”

“…Within countries, geographical inequalities are apparent with district-level coverage varying substantially between easily accessible and more remote areas [15]. Social determinants of health, such as individual and household income and education, impact immunization uptake [16] and areas of low coverage often overlap with those that are home to ethnic minorities, as well as marginalized or nomadic and migrant populations [17][18][19]. In many situations, governments face challenges in reaching such underserved populations or lack the political will to do so.…”

A qualitative analysis of vaccine decisionmakers’ conceptualization and fostering of ‘community engagement’ in India

“…The Global Vaccine Action Plan 2011-2020 lists equity as one of its six guiding principles [1]. Resonating this ethos, various national vaccination policies and programs have acknowledged vaccines' contribution to preventing high-cost treatments and averting medical impoverishment, while striving to extend the bene ts of immunization to all [2,3]. Correspondingly, community engagement (CE) for vaccinations has increasingly been recognized by decisionmakers [4] as a core component of working toward health equity, with a focus on community-based participatory research [5][6][7].…”