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Vaccine equity in low and middle income countries: a systematic review and meta-analysis

BACKGROUND: Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad a...

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Autores principales: Ali, Huda Ahmed, Hartner, Anna-Maria, Echeverria-Londono, Susy, Roth, Jeremy, Li, Xiang, Abbas, Kaja, Portnoy, Allison, Vynnycky, Emilia, Woodruff, Kim, Ferguson, Neil M, Toor, Jaspreet, Gaythorpe, Katy AM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194352/
https://www.ncbi.nlm.nih.gov/pubmed/35701823
http://dx.doi.org/10.1186/s12939-022-01678-5
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author Ali, Huda Ahmed
Hartner, Anna-Maria
Echeverria-Londono, Susy
Roth, Jeremy
Li, Xiang
Abbas, Kaja
Portnoy, Allison
Vynnycky, Emilia
Woodruff, Kim
Ferguson, Neil M
Toor, Jaspreet
Gaythorpe, Katy AM
author_facet Ali, Huda Ahmed
Hartner, Anna-Maria
Echeverria-Londono, Susy
Roth, Jeremy
Li, Xiang
Abbas, Kaja
Portnoy, Allison
Vynnycky, Emilia
Woodruff, Kim
Ferguson, Neil M
Toor, Jaspreet
Gaythorpe, Katy AM
author_sort Ali, Huda Ahmed
collection PubMed
description BACKGROUND: Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS: A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS: One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS: We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION: Prospero, CRD42021261927
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spelling pubmed-91943522022-06-15 Vaccine equity in low and middle income countries: a systematic review and meta-analysis Ali, Huda Ahmed Hartner, Anna-Maria Echeverria-Londono, Susy Roth, Jeremy Li, Xiang Abbas, Kaja Portnoy, Allison Vynnycky, Emilia Woodruff, Kim Ferguson, Neil M Toor, Jaspreet Gaythorpe, Katy AM Int J Equity Health Systematic Review BACKGROUND: Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS: A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS: One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS: We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION: Prospero, CRD42021261927 BioMed Central 2022-06-11 /pmc/articles/PMC9194352/ /pubmed/35701823 http://dx.doi.org/10.1186/s12939-022-01678-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review
Ali, Huda Ahmed
Hartner, Anna-Maria
Echeverria-Londono, Susy
Roth, Jeremy
Li, Xiang
Abbas, Kaja
Portnoy, Allison
Vynnycky, Emilia
Woodruff, Kim
Ferguson, Neil M
Toor, Jaspreet
Gaythorpe, Katy AM
Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title_full Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title_fullStr Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title_full_unstemmed Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title_short Vaccine equity in low and middle income countries: a systematic review and meta-analysis
title_sort vaccine equity in low and middle income countries: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194352/
https://www.ncbi.nlm.nih.gov/pubmed/35701823
http://dx.doi.org/10.1186/s12939-022-01678-5
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