Vaccines have the greatest mortality and economic benefit amongst the poor. – VoICE
Key Concept

Key Evidence: Rates of vaccination in all studied countries were highest and risk mortality lowest in the top two wealth quintile’s coverage. Countries differed in the relative inequities in these two underlying variables. Cost per DALYs averted is substantially greater in the higher quintiles. In all countries, the greatest potential vaccine benefit was in the poorest quintiles; however, reduced vaccination coverage lowered the projected vaccine benefit.

Rheingans, R., Atherly, D., and Anderson, J. 2012. Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness. Vaccine. 30(1).
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Key Evidence: A cost-effectiveness analysis of rotavirus vaccination in Pakistan found that, if rotavirus vaccination coverage was equally high across regions and income groups, the percent reduction in deaths due to rotavirus would be 4 times greater in the highest risk regions than in the lowest-risk regions, and would be 3-4 times greater among children in the poorest versus the wealthiest households.

From the VoICE Editors: Expanding vaccination coverage among the poorest and most vulnerable children would substantially increase the overall impact of rotavirus immunization in Pakistan. 

Rheingans R, Anderson JD, Bagamian KH et al. 2018. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 36(51).
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Key Evidence: A study of measles vaccine in Bangladesh found that children from the poorest quintile were more than twice as likely to die than those from the least quintile in the absence of measles vaccination. The difference in mortality between unvaccinated and vaccinated was statistically significant (p<0.10) and robust across alternative measures of socioeconomic status.

Bishai, D., Koenig, M., and Khan, M.A. 2003. Measles vaccination improves the equity of health outcomes: evidence from Bangladesh. Health Economics. 12(5).
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Key Evidence: A modeled analysis of the potential impact of pneumococcal conjugate vaccine (PCV) in India estimated that the greatest reduction in deaths due to PCV vaccination would be among the poorest segments of the population. Assuming a vaccination coverage rate of 77% (the current DTP3 coverage rate), PCV would prevent nearly 2.5 times as many deaths per 100,000 children under five in the 2 poorest income quintiles than in the 2 wealthiest groups (313 vs. 134), and nearly 3 times as many deaths per 100,000 if coverage reaches 90% (446 vs. 167).

From the VoICE Editors: The model used was specific to the epidemiology, health system situation, and population characteristics of India. 

Megiddo K, Klein E, Laxminarayan R 2018. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic epidemiological analysis using data from India. BMJ Global Health. 3(3).
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Key Evidence: A package of 5 vaccines was delivered, and it was found that children from poorer households benefited more in terms of health outcomes from immunization than did those from relatively wealthier households. Results suggest that most of the risk of dying before age five can be eliminated with full immunization in the severely health-deprived setting.

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(1).
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