1887
Perspective Open Access
Like 0

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.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.2.1800204
2019-01-10
2024-10-31
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.2.1800204
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/2/eurosurv-24-2-4.html?itemId=/content/10.2807/1560-7917.ES.2019.24.2.1800204&mimeType=html&fmt=ahah

References

  1. Crocker-Buque T, Edelstein M, Mounier-Jack S. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. J Epidemiol Community Health. 2017;71(1):87-97.  https://doi.org/10.1136/jech-2016-207572  PMID: 27535769 
  2. Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines. 2017;16(11):1107-18.  https://doi.org/10.1080/14760584.2017.1381020  PMID: 28914112 
  3. World Health Organization Regional Office for Europe (WHO/Europe). A report on the epidemiology of selected vaccine-preventable diseases in the European Region. WHO EpiBrief No. 2. Copenhagen: WHO/Europe; 2017. Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/349062/EpiBrief_2_2017_EN-2.pdf?ua=1
  4. World Health Organization Regional Office for Europe (WHO/Europe). European Vaccine Action Plan 2015–2020. Copenhagen: WHO/Europe; 2014. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/2014/european-vaccine-action-plan-20152020-2014
  5. Strategic Advisory Group of Experts on Immunization (SAGE). SAGE assessment report 2016 – key messages. [Accessed 21 Dec 2017]. Available from: http://www.who.int/immunization/global_vaccine_action_plan/Key_messages_SAGE_assessment_report_2016.pdf?ua=1
  6. Brearley L, Eggers R, Steinglass R, Vandelaer J. Applying an equity lens in the Decade of Vaccines. Vaccine. 2013;31(Suppl 2):B103-7.  https://doi.org/10.1016/j.vaccine.2012.11.088  PMID: 23598470 
  7. Tauil MC, Sato AP, Waldman EA. Factors associated with incomplete or delayed vaccination across countries: A systematic review. Vaccine. 2016;34(24):2635-43.  https://doi.org/10.1016/j.vaccine.2016.04.016  PMID: 27109562 
  8. Sodha SV, Dietz V. Strengthening routine immunization systems to improve global vaccination coverage. Br Med Bull. 2015;113(1):5-14.  https://doi.org/10.1093/bmb/ldv001  PMID: 25649959 
  9. Feiring B, Laake I, Molden T, Cappelen I, Håberg SE, Magnus P, et al. Do parental education and income matter? A nationwide register-based study on HPV vaccine uptake in the school-based immunisation programme in Norway. BMJ Open. 2015;5(5):e006422.  https://doi.org/10.1136/bmjopen-2014-006422  PMID: 25991445 
  10. de Figueiredo A, Johnston IG, Smith DMD, Agarwal S, Larson HJ, Jones NS. Forecasted trends in vaccination coverage and correlations with socioeconomic factors: a global time-series analysis over 30 years. Lancet Glob Health. 2016;4(10):e726-35.  https://doi.org/10.1016/S2214-109X(16)30167-X  PMID: 27569362 
  11. Restrepo-Méndez MC, Barros AJD, Wong KLM, Johnson HL, Pariyo G, França GV, et al. Inequalities in full immunization coverage: trends in low- and middle-income countries. Bull World Health Organ. 2016;94(11):794-805B.  https://doi.org/10.2471/BLT.15.162172  PMID: 27821882 
  12. European Centre for Disease Prevention and Control (ECDC). Let’s talk about protection. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/lets-talk-about-protection-vaccination-guide.pdf
  13. Ganczak M, Dmytrzyk-Daniłów G, Karakiewicz B, Korzeń M, Szych Z. Determinants influencing self-paid vaccination coverage, in 0-5 years old Polish children. Vaccine. 2013;31(48):5687-92.  https://doi.org/10.1016/j.vaccine.2013.09.056  PMID: 24120549 
  14. Hughes A, Mesher D, White J, Soldan K. Coverage of the English national human papillomavirus (HPV) immunisation programme among 12 to 17 year-old females by area-level deprivation score, England, 2008 to 2011. Euro Surveill. 2014;19(2):20677.  https://doi.org/10.2807/1560-7917.ES2014.19.2.20677  PMID: 24457007 
  15. Sinka K, Kavanagh K, Gordon R, Love J, Potts A, Donaghy M, et al. Achieving high and equitable coverage of adolescent HPV vaccine in Scotland. J Epidemiol Community Health. 2014;68(1):57-63.  https://doi.org/10.1136/jech-2013-202620  PMID: 23986492 
  16. Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vaccin Immunother. 2012;8(3):293-301.  https://doi.org/10.4161/hv.19003  PMID: 22327490 
  17. Public Health Wales Vaccine Preventable Disease Programme. Vaccine uptake in children in Wales; COVER Annual report 2017. Cardiff: Public Health Wales; 2017. Available from: http://www2.nphs.wales.nhs.uk:8080/CommunitySurveillanceDocs.nsf/($All)/CC3BE5649EB0B2608025813000471C6B/$File/COVER20162017_v1.pdf
  18. Roberts RJ, McGowan A, Cottrell S. Measuring inequalities in immunization in Wales and the impact of interventions. Hum Vaccin Immunother. 2016;12(10):2704-6.  https://doi.org/10.1080/21645515.2016.1217141  PMID: 27552642 
  19. Doherty E, Walsh B, O’Neill C. Decomposing socioeconomic inequality in child vaccination: results from Ireland. Vaccine. 2014;32(27):3438-44.  https://doi.org/10.1016/j.vaccine.2014.03.084  PMID: 24721529 
  20. Valentine NB, Koller TS, Hosseinpoor AR. Monitoring health determinants with an equity focus: a key role in addressing social determinants, universal health coverage, and advancing the 2030 sustainable development agenda. Glob Health Action. 2016;9(1):34247.  https://doi.org/10.3402/gha.v9.34247  PMID: 27989275 
  21. Whitehead M. A typology of actions to tackle social inequalities in health. J Epidemiol Community Health. 2007;61(6):473-8.  https://doi.org/10.1136/jech.2005.037242  PMID: 17496254 
  22. Sodha SV, Dietz V. Strengthening routine immunization systems to improve global vaccination coverage. Br Med Bull. 2015;113(1):5-14.  https://doi.org/10.1093/bmb/ldv001  PMID: 25649959 
  23. Jackson C, Bedford H, Cheater FM, Condon L, Emslie C, Ireland L, et al. Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation uptake among Gypsies, Travellers and Roma. BMC Public Health. 2017;17(1):254.  https://doi.org/10.1186/s12889-017-4178-y  PMID: 28288596 
  24. Hajizadeh M, Heymann J, Strumpf E, Harper S, Nandi A. Paid maternity leave and childhood vaccination uptake: Longitudinal evidence from 20 low-and-middle-income countries. Soc Sci Med. 2015;140:104-17.  https://doi.org/10.1016/j.socscimed.2015.07.008  PMID: 26210658 
  25. Yuan B, Målqvist M, Trygg N, Qian X, Ng N, Thomsen S. What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review. BMC Public Health. 2014;14(1):634.  https://doi.org/10.1186/1471-2458-14-634  PMID: 24952656 
  26. Gallagher KE, Kadokura E, Eckert LO, Miyake S, Mounier-Jack S, Aldea M, et al. Factors influencing completion of multi-dose vaccine schedules in adolescents: a systematic review. BMC Public Health. 2016;16(1):172.  https://doi.org/10.1186/s12889-016-2845-z  PMID: 26895838 
  27. World Health Organization Regional Office for Europe (WHO/Europe). Review of social determinants and the health divide in the WHO European Region. Final report. Copenhagen: WHO/Europe; 2013. Available from: http://www.euro.who.int/en/publications/abstracts/review-of-social-determinants-and-the-health-divide-in-the-who-european-region.-final-report
  28. Bedford H, Attwell K, Danchin M, Marshall H, Corben P, Leask J. Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine. 2018;36(44):6556-8.  https://doi.org/10.1016/j.vaccine.2017.08.004  PMID: 28830694 
  29. Semenza JC. Strategies to intervene on social determinants of infectious diseases. Euro Surveill. 2010;15(27):32-9.  https://doi.org/10.2807/ese.15.27.19611-en  PMID: 20630143 
  30. Lefevere E, Theeten H, Hens N, De Smet F, Top G, Van Damme P. From non school-based, co-payment to school-based, free Human Papillomavirus vaccination in Flanders (Belgium): a retrospective cohort study describing vaccination coverage, age-specific coverage and socio-economic inequalities. Vaccine. 2015;33(39):5188-95.  https://doi.org/10.1016/j.vaccine.2015.07.088  PMID: 26254978 
  31. Boyce T, Holmes A. Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse. PLoS One. 2012;7(9):e43416.  https://doi.org/10.1371/journal.pone.0043416  PMID: 23028452 
  32. World Health Organization (WHO). Planning guide to reduce missed opportunities for vaccination. Geneva: WHO; 2017. Available from: http://apps.who.int/iris/bitstream/handle/10665/259202/9789241512947-eng.pdf;jsessionid=090F8EFE9AEDDBFCB646F8BFDC977C08?sequence=1
  33. Sinka K, Kavanagh K, Gordon R, Love J, Potts A, Donaghy M, et al. Achieving high and equitable coverage of adolescent HPV vaccine in Scotland. J Epidemiol Community Health. 2014;68(1):57-63.  https://doi.org/10.1136/jech-2013-202620  PMID: 23986492 
  34. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86(2):140-6.  https://doi.org/10.2471/BLT.07.040089  PMID: 18297169 
  35. Partapuri T, Steinglass R, Sequeira J. Integrated delivery of health services during outreach visits: a literature review of program experience through a routine immunization lens. J Infect Dis. 2012;205(Suppl 1):S20-7.  https://doi.org/10.1093/infdis/jir771  PMID: 22315382 
  36. World Health Organization Regional Office for Europe (WHO/Europe). The Guide to Tailoring Immunization Programmes (TIP). Copenhagen: WHO/Europe; 2013. Available from: http://www.euro.who.int/__data/assets/pdf_file/0003/187347/The-Guide-to-Tailoring-Immunization-Programmes-TIP.pdf?ua=
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error