VoICE Immunization Evidence: Poverty
Key Evidence: A study modeling the relationship between disease and poverty in Ethiopia found that among the top 20 causes of death in Ethiopia, diarrhea and lower respiratory infections (LRIs) are the top two drivers of medical impoverishment. It is estimated that in 2013, out-of-pocket direct medical costs for diarrheal disease drove an estimated 164,000 households below the poverty line (representing 47% of all the diarrhea cases), and LRIs led to an estimated 59,000 cases of poverty (17% of LRI cases). Of the top 10 health-associated drivers of poverty, four are at least partially vaccine-preventable (1. Diarrhea, 2. LRI, 4. TB. 10. Pertussis).
Key Evidence: Costs for treatment for rotavirus at a large urban hospital in Malaysia led one third of families to experience catastrophic health expenditures (CHC). When direct and indirect costs of treating rotavirus were considered, almost 9 in 10 families spent more than 10% of their monthly household income on treating rotavirus. In addition, 6% of families were pushed into poverty after paying for treatment.
Key Evidence: In a study modeling the economic impact of immunization in 41 low- and middle-income countries, the authors estimate that 24 million cases of medical impoverishment would be averted through the use of vaccines administered from 2016-2030. The largest proportion of poverty cases averted would occur in the poorest 40% of these populations, demonstrating that vaccination can provide financial risk protection to the most economically vulnerable.
Children living in poverty are less likely to receive their vaccines on time, increasing their vulnerability to infections.
Key Evidence: In Tanzania, poverty was found to have a negative effect on receiving vaccines on time (at the recommended age). Children in the wealthiest quintile experienced 19% fewer delays for BCG vaccination, 23% fewer delays for the third dose of DTP vaccination, and 31% fewer delays for the first dose of measles-containing vaccine compared to children of the poorest quintile.
Vaccines represent a valuable pro-poor intervention that not only improves health but also protects poor households from catastrophic and improverishing health expenditures.
Key Evidence: In 41 Gavi-eligible countries it is estimated that, in the absence of measles vaccination, the occurrence of Medical Impoverishment (MI) or households falling below the poverty line due to medical expenditures to manage measles disease would be 5.3 million. With current coverage rates, 700 thousand households would suffer MI. If Gavi support afforded enhanced coverage, the estimate of households suffering MI would decrease to 500 thousand.
Vaccination can help to diminish or eliminate the increased mortality risk of children living in poverty.
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.
In addition to causing substantial child mortality, pneumonia also pushes many families into poverty; Vaccination can protect against both.
Key Evidence: It is estimated that in 41 Gavi-eligible countries, approximately 6.6 million households would suffer Catastrophic Health Costs (CHC) in the absence of pneumococcal vaccine coverage. Due to the current absence of a pneumococcal immunization plan in many of these countries, the number of CHC cases would only decrease slightly to 6.4 million with current immunization programs. If pneumococcal vaccine programs would be implemented or expanded with Gavi support, the number of households experiencing CHC would decrease to 4.6 million – a decrease of approximately 30%.
Similarly, the estimates of medical impoverishment without vaccine coverage in this model showed that pneumococcal disease would cause 800,000 households to fall under the poverty line.
Key Evidence: Vaccines that can protect against pneumonia – Hib and S. pneumoniae vaccines – can together prevent over 1.25 million cases of poverty over 15 years, found researchers modeling the economic impact of immunization in 41 low- and middle-income countries.
Vaccine-preventable diseases that have long-term health consequences can exacerbate financial hardships.
Key Evidence: Among families participating in a study in Western Cape, South Africa, 35% of mothers who were previously employed stopped working to care for children who had survived tuberculosis meningitis resulting in permanent disabilities. 19% of families reported experiencing financial loss as a result of caring for these disabled children.