Peer-reviewed article
Beyond coverage: Can vaccination reduce child mortality despite structural inequality? A global ecological analysis of routine childhood immunization (2010-2023).
Valeria Rios Montoya, Arlet Yelisse Suarez Alarcon, Shamira Perez Castillo, Trilce Zamudio Raez, Antonio Marty Quispe ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This global study from 2010-2023 examined whether childhood vaccination reduces infant mortality across countries with different income levels. Researchers found that high-income countries had both higher vaccination coverage and lower child mortality, while low-income countries had lower coverage and higher mortality. When accounting for national income level, the relationship between vaccination coverage and mortality became much weaker, suggesting that structural inequality and poverty—not just vaccination gaps—drive differences in child survival. The COVID-19 pandemic disrupted vaccination services in 2020 with only partial recovery by 2023.
Key points
- Routine childhood immunization prevents an estimated 3.5 to 5 million deaths annually globally
- High-income countries showed higher vaccine coverage and lower infant mortality; low-income countries faced reduced coverage and higher mortality rates
- After adjusting for national income level, most vaccine coverage indicators lost statistical significance in relation to infant mortality
- A significant decline in vaccination coverage occurred in 2020, with only partial recovery by 2023 due to COVID-19 disruption
- Structural inequities related to income—not vaccination coverage alone—appear to determine preventable child mortality
Limitations
As an ecological study using national-level data, this analysis cannot explain individual-level mechanisms or identify specific barriers to vaccination within countries. The findings show associations between income and outcomes but cannot definitively establish causation or distinguish the independent effect of vaccination from other income-related factors affecting child health.
Abstract
Routine childhood immunization is still a critical topic to global public health, since it prevents an estimated 3.5 to 5 million deaths annually. However, its access remains uneven, especially in low-income countries, where structural inequalities limit the reach of immunization programs, and the Covid-19 pandemic disrupted routine services, worsening the existing disparities. This ecological study (2010-2023) examined associations between vaccine coverage and infant mortality using the WHO/UNICEF data for six childhood vaccines: BCG, DTP3, HepB3, Hib3, MCV2, and Pol3. Countries were stratified by income level using the World Bank World Development Indicators. Associations between vaccine coverage and infant mortality were evaluated using multivariable linear regression models adjusted for national income level. In addition, non-linear relationships and rank-based associations were explored using LOESS smoothing and Spearman correlation analyses. Results showed higher coverage and lower mortality in high-income countries; meanwhile, low-income countries faced both reduced coverage and higher mortality rates. A significant decline in coverage occurred in 2020, with only partial recovery by 2023. After adjusting for income, most vaccine coverage indicators lost statistical significance in relation to infant mortality. These findings highlight that income-related structural inequities determine immunization coverage and preventable child mortality, emphasizing the need for policies that simultaneously expand vaccine access, reduce structural barriers, and strengthen health systems.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Routine childhood immunization programmes (BCG, DTP3, HepB3, Hib3, MCV2, Pol3)
- Population
- Children aged 0-5 years across countries stratified by income level (high-income, middle-income, low-income)
Key finding
Higher vaccine coverage and lower infant mortality observed in high-income countries
Montoya et al. · PubMed (US National Library of Medicine) · 18 May 2026