Population Inequity

Key Evidence: A study found that children of poor labor migrants living in Delhi, India are much less likely to be fully vaccinated than the general population and thus are at greater risk of vaccine-preventable diseases. Only 31% – 53% of children from migrant families were fully immunized (against 7 diseases) by 12 months of age, compared to 72% in the overall population of Delhi — with recent migrants having the lowest rates. There is therefore a need to focus on the delivery of health services to migrants.

Key Evidence: 69% of children under five with severe acute respiratory infections (ARI) from families recently relocated to urban Bangladesh visited a qualified medical provider as compared to 82% of children from households that have lived there for at least two years. After adjusting for wealth and other socioeconomic factors, recent migrants were still 11% less likely to seek treatment for ARI from qualified providers than longer-term residents, indicating the need for targeted efforts aimed towards children in high turnover communities and to link these households with existing health services.

Key Evidence: Less than half of foreign-born children in New Zealand had immunization records in the National Immunization Register (compared to 95-96% of New Zealand-born children of migrant or non-migrant mothers), and those with records had considerably lower age-appropriate vaccination rates than locally-born children (e.g., 69% for MMR vs. 82-83% for locally-born and 53% for pertussis vs. 78-81%), with refugee children having especially low rates. These findings point to challenges in recording vaccinations given overseas and in reaching migrant children with immunization services, as well as the importance of monitoring vaccination coverage by migrant and refugee background.

Key Evidence: According to a systematic review and meta-analysis, children who are rural-urban migrants in China, India and Nigeria were less likely to be fully-immunized by the age of one year than non-migrant urban residents and the general population. These inequities in vaccination rates — often concealed in national averages — call for special efforts to improve immunization rates in this rapidly growing sub-population to reduce both health inequities and the risk of infectious disease outbreaks in the wider society.

Key Evidence: Population-based surveillance data collected in the state of Tennessee from 1998 – 2016 found that the introduction of PCV13 was associated with reductions in socioeconomic and racial disparities in PCV13-serotype invasive pneumococcal disease (IPD). PCV13 introduction was associated with the prevention of IPD in the overall population as well as substantial decreases in racial disparities in IPD over time between Black and White populations. Before PCV13 was introduced, Black people in the study had an IPD incidence 1.5 times higher than White people – 24.7 and 16.4, respectively. After PCV13 introduction, Black people had an IPD incidence 1.15 times the incidence among Whites: 15 and 13.1, respectively.

Key Evidence: Studies have indicated that the prevalence of risky behaviors associated with Sexually Transmitted Infections (STIs) and HIV is high among incarcerated adolescents. In the US, most adolescents sentenced to serve time in correctional facilities are offered preventive vaccination against hepatitis B. Medical clinics in correctional facilities provide an ideal environment for adolescents in high risk settings to obtain access to preventive health services. In certain cases, these facilities even overcome barriers such as parental consent by making these adolescents wards of the state and followed by which preventive services are obtained by the state providing consent.

Key Evidence: A publicly funded 23vPPV (23 valent pneumococcal polysaccharide vaccine) program in Victoria, Australia not only dramatically increased vaccination coverage among the elderly in the public purchase program, but in other Australian states and territories that did not have a public program, the number of prescriptions issued for 23vPPV actually increased over the same period.