VoICE Immunization Evidence: Health inequity

Key Concept

Key Evidence: The Indian government childhood immunization program, UIP, designed in the 1980s to reduce the high mortality and morbidity in children, resulted in reduced infant mortality by 0.4% percentage points and under-5 mortality by 0.5%. These effects on mortality are sizable as they account for approximately one-fifth of the decline in infant and under-five child mortality rates between 1985-1990. The effects are more pronounced in rural area, for poor people, and for members of historically disadvantaged groups. The 0.5% reduction each year over 5 years (from 15% under-5 mortality in 1985 to 12.3% in 1990), represents an 18% reduction overall in under-5 mortality.

Kumar, S. 2009. Childhood immunization, mortality and human capital accumulation: Micro-evidence from India. University of Houston: Harvard Centre for Population and Development Studies. Working paper.

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Key Evidence: Two years after the introduction of 10-strain pneumococcal conjugate vaccine (PCV-10) in Kenya, the percent of HIV-positive adults who carried pneumococcal bacteria declined significantly (from 43% to 28%), but did not decline in HIV-negative adults. However, the reduction in carriage of pneumococcal strains that are in PCV10 declined significantly in both HIV-positive and HIV-negative adults. This reduction was still four times higher in HI- positive vs. HIV-negative adults (2.8% vs. 0.7%), indicating that HIV positive adults continue to be at considerably higher risk of invasive pneumococcal disease than HIV-uninfected adults.

From the VoICE Editors: Nasopharyngeal carriage is an indicator of the risk for invasive pneumococcal disease and pneumonia. 

Kobayashi M, Bigogo G, Kim L et al. 2019. Impact of 10-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage and antibiotic susceptibility patterns among children aged <5 years and adults with HIV infection, Kenya 2009-2013. Clinical Infectious Diseases.

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Key Evidence: Models based on demographic data from Ghana suggest that immunization would eliminate the childhood mortality risk associated with living in poverty and greatly diminish the increased risk of mortality borne by children whose parents have low levels of education.

Bawah, A.A., Phillips, J.F., Adjuik, M., et al 2010. The impact of immunization on the association between poverty and child survival: Evidence from Kassena-Nankana district of northern Ghana. Scandanavian Journal of Public Health. 38:95–103.

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