Peer-reviewed article
Persistence of major socio-economic inequalities in childhood measles–mumps–rubella vaccination coverage and timeliness under vaccination mandates, France, 2015 to 2024
Dimitri Scronias, Lisa Fressard, Laure Fonteneau, V. Guagliardo, Pierre Verger ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether making 11 childhood vaccines mandatory in France in 2018 improved measles-mumps-rubella (MMR) vaccination coverage and reduced inequality. Tracking 2.1 million children born in 2015, 2017, and 2019, researchers found that despite some improvements, one-third of children still received vaccines late. Children from low-income families experienced delays of at least one extra month compared to higher-income children. Even by 48 months of age, vaccination coverage fell short of the WHO target.
Key points
- 33% of children in the 2019 cohort received MMR vaccines late (mean delay of 7.1 months)
- Mandatory vaccination policy did not eliminate socioeconomic inequalities in vaccine timeliness
- Children from low-income families experienced delays of at least +1 month compared to higher-income families
- The 2019 cohort did not reach the WHO target of 95% coverage for two MMR doses by 24 or 48 months of age
- Vaccination delays and inequalities may contribute to measles epidemic resurgence
Limitations
This study only examines France's health insurance reimbursement database, which may not capture all vaccination records or populations outside this system. The paper does not explore the specific barriers that cause delays or inequalities, such as vaccine hesitancy, access issues, or healthcare provider factors.
Abstract
IntroductionSince the late 2000s, several major measles epidemics have occurred in Europe, including France. In 2017, the French Health Ministry extended from three to 11 the number of mandatory childhood vaccines required for preschool and primary school admission; these included the vaccine against measles, mumps and rubella (MMR).AimOur aim was to assess if this measure helped to improve MMR vaccine timeliness (VT) or reduce socioeconomic inequalities in MMR vaccine coverage.MethodsA nationwide study of three birth cohorts (2015, 2017, 2019) followed up 2.1 million children for 48 months to assess the course of the timeliness of MMR vaccine dispensation, before and after it became mandatory in France (January 2018). Data came from the French national health insurance fund drug reimbursement database.ResultsDespite improvements from 2015 to 2019, pharmacies dispensed MMR vaccines late for 33% of children in the 2019 cohort (mean cumulative delay compared with recommended dates: 7.1 months). Vaccines for children from low-income families were dispensed later (mean delay of at least +1 month) than those from higher-income families. The 2019 cohort did not reach the 95% WHO target of two MMR doses at 24 months of age, nor at 48 months.DiscussionWith measles intensifying worldwide, these vaccination delays and inequalities may contribute to the resurgence of epidemics. In addition to vaccination mandates, an ambitious public health policy is needed to reduce inequalities in access to vaccination and to improve parents' vaccine acceptance through educational strategies.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Mandatory childhood vaccination requirement expanded from 3 to 11 vaccines for school admission (January 2018)
- Population
- Three birth cohorts (2015, 2017, 2019) totalling 2.1 million children followed for 48 months
Key finding
33% of 2019 cohort children received MMR vaccines late (mean delay 7.1 months)