A study looking at DHS data from 67 countries found that, globally, girls and boys had the same likelihood of being vaccinated. In some countries where there is known gender inequity and son preference, girls were more likely to not be vaccinated.
Equity
Parental education can be one of the most significant drivers of vaccine coverage inequities
In an analysis of immunization coverage in 45 low- and lower-middle income Gavi-eligible countries, researchers found that overall, maternal and paternal education were two of the most significant drivers of coverage inequities in these countries. Pooling the data from all countries, the authors found that “children of the most educated mothers are 1.45 times more likely to have received DTP3 than children of the least educated mothers.” The same held true for measles vaccines with a 1.45-fold likelihood of vaccination in children of the most educated mothers.
Maternal education is a strong predictor of vaccine coverage
Researchers looking at vaccination coverage in 45 low- and middle-income countries found that maternal education is a strong predictor of vaccine coverage. Children of the least educated mothers are 55% less likely to have received measles containing vaccine and three doses of DTP vaccine than children of the most educated mothers.
In general, countries with high levels of gender inequality have lower levels of immunization coverage
To better understand the drivers of vaccination coverage and equity, a 2017 study examined the country-level factors influencing vaccination coverage in 45 low- and lower-middle income Gavi-supported nations. Countries with the least gender equality – as measured by reproductive health, women-held parliamentary seats, educational attainment, and other factors – also had lower rates of vaccine coverage.
Children living in slum conditions have greater risk of illness and less access to immunization
Children in slum settings have higher burdens of vaccine-preventable disease (one study found children in slums in Manila, Philippines were 9 times more likely to have tuberculosis than other urban children) and lower rates of immunization (a study in Niger found 35% coverage in slums vs. 86% in non-slum urban areas).
Children with mothers who have completed some secondary schooling are more likely to be vaccinated
A study conducted in Eastern Uganda found that Ugandan children whose mothers had some secondary schooling were 50% more likely to have received scheduled vaccinations by 6 months of age than children whose mothers had attended school only through primary level. This effect became more pronounced with delivery of the later doses of each vaccine (OPV2, 3 & DPT-HB-Hib 2,3).
Immunization inequity in India was observed based on geography, parental education, gender, and family income
Inequity in vaccination coverage in India was found between states, within states, and in urban vs. rural areas. Lower parental education resulted in lower coverage, girls had lower coverage than boys, and infants born to families with a large number of children also had lower coverage than others. A direct relationship between household wealth and coverage was also found.
Universal vaccination programs can improve health equity in rural and disadvantaged areas
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.
Pneumonia vaccines have large health and financial benefits, especially benefiting the poorest households
A study looking at the impact of pneumococcal vaccine introduction and scaling up pneumonia treatment in Ethiopia found that 30-40% of all deaths averted by these interventions would be expected to occur in the poorest wealth quintile. The greatest resulting financial risk protection would also be concentrated among the bottom income quintile.
Introduction and scale-up of pneumonia vaccines has the great impact for the poorest children
A study looking at the impact of pneumococcal vaccine introduction and scaling up pneumonia treatment in Ethiopia found that 30-40% of all deaths averted by these interventions would be expected to occur in the poorest wealth quintile. Scaling up PCV13 to levels achieved with DTP3 in Ethiopia would be expected to avert nearly 3000 child deaths and 60,000 episodes of pneumococcal pneumonia annually, not including any potential herd benefit. A publicly financed program to scale up pneumococcal vaccines would cost about US$40 per year of healthy life gained.