Inequity in routine childhood vaccination coverage is well researched. Pandemics disrupt infrastructure and divert health resources from preventive care, including vaccination programmes, leading to increased vaccine preventable morbidity and mortality. COVID-19 control measures have resulted in coverage reductions. We conducted a rapid review of the impact of pandemics on existing inequities in routine vaccination coverage. PICO search framework: Population: children 0-18 years; Intervention/exposure: pandemic/epidemic; Comparison: inequality; Outcome: routine vaccination coverage. The review demonstrates a gap in the literature as none of the 29 papers selected for full-paper review from 1973 abstracts identified from searches met the inclusion criteria.
Nick J Spencer, Rita Nathawad, Emmanuele Arpin et al.
The Australian Technical Advisory Group on Immunisation (ATAGI) 2023 Annual Statement onImmunisation is the third publication in this series.It highlights the key successes, trends and challenges in the use of vaccines and control of vaccine preventable diseases (VPDs) in Australia in 2022.It also signals ATAGI's priority actions for addressing key issues for 2023 and beyond. SummaryIn 2022, governments across Australia eased coronavirus disease 2019 (COVID-19) pandemicrelated community and border control measures.This was associated with increased rates of some common VPDs, in particular influenza, as social interactions increased.There were also significant outbreaks of two newly emerged diseases, Japanese encephalitis (JE) and mpox (formerly known as monkeypox).The responses to these new Communicable Disease Incidents of National Significance (CDINS) included establishing vaccination programs against these diseases. Key highlights in immunisation in 2022• The national COVID-19 vaccination program continued throughout 2022, including the expansion of vaccine eligibility to all children aged 5 years and over, and to some at-risk children aged 6 months to under 5 years.New variant-based COVID-19 vaccines also came into use.• ATAGI recommended booster doses of COVID-19 vaccines for adults and adolescents in response to emerging evidence on COVID-19 vaccine effectiveness and new variant epidemic waves.By the end of 2022, a total of 69% of people aged 16 years and over had received 3 doses of a COVID-19 vaccine.A first booster dose was recommended for all people aged 16 years and over.• ATAGI worked alongside other key national, state and territory governing bodies to respond to outbreaks of influenza, JE and mpox.ATAGI developed and expanded vaccine recommendations for JE and mpox, and governments delivered these safe and effective vaccines across Australia.• The National Immunisation Program (NIP) maintained high levels of coverage, which is important to ensure continued protection against VPDs as COVID-19 restrictions are lifted.• ATAGI provided advice to the Australian Government on the potential effectiveness and safety of moving from a two-dose to a one-dose human papillomavirus (HPV ) vaccine schedule under the NIP.This underpinned changes to the program that started in February 2023.
Madeline Valeri, Shireen Durrani, Catherine Tran et al.
BACKGROUND: Although a general consensus that vaccines could be a complementary strategy against antimicrobial resistance (AMR), there is still the need for studies investigating the relationship between childhood vaccination coverage and AMR proportions in the overall population. METHODS: We performed an ecological analysis of available Italian data (vaccination coverages, AMR proportions, number of isolates tested, and antibiotic use) to evaluate the relationships between vaccination coverages in children and AMR proportions in the last 2 decades. RESULTS: After adjusting for covariates, we showed that AMR proportions decreased with increasing vaccination coverages, especially for some combinations of vaccines, pathogens, and antimicrobials. Vaccination coverages for pertussis, diphtheria, and tetanus were inversely related to proportions of E. coli resistant to fluoroquinolones and third generation cephalosporins, K. pneumoniae resistant to carbapenems and third generation cephalosporins, and P. aeruginosa resistant to piperacillin and tazobactam. Polio vaccination coverage was inversely related to proportions of E. coli and K. pneumoniae resistant to third generation cephalosporins. CONCLUSIONS: These results, however, should be interpreted cautiously due to the ecological nature of our analysis. For this reason, further studies designed ad hoc should be encouraged to measure the impact of increasing childhood vaccination coverage on AMR.
Andrea Maugeri, Martina Barchitta, Antonella Agodi
OBJECTIVES: Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population. DESIGN AND SETTING: Retrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models. PARTICIPANTS: 2740 children aged 12-23 months living in rural areas. OUTCOME MEASURES: Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout. FINDINGS: 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37). CONCLUSION: Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
Nicole E. Johns, Ahmad Reza Hosseinpoor, Mike Chisema et al.
(1) Background: Immunisation is a crucial and effective method for preventing infectious diseases, with its success dependent on high immunisation rates to protect under-immunised individuals and promote herd immunity. This qualitative descriptive study is part of a larger explanatory sequential mixed method design that aims to explore factors influencing parents’ decision making to complete childhood immunisation in the Eastern Province of Saudi Arabia, a country experiencing disparities in immunisation coverage across its population. (2) Methods: The sample consisted of a subset of participants from the initial quantitative phase, which included a survey on the immunisation attitudes of parents living in Qatif. This initial phase included n = 350 participants, who were over 18, had access to one of the 27 Primary Health Care (PHC) Centres in Qatif, and had a child under 24 months. This paper presents the qualitative–descriptive phase, which used a qualitative survey to gain open-ended responses from parents (n = 20) and analysed using thematic analysis. (3) Results: Participants identified certain vaccines, particularly MMR, as influencing their immunisation practices. Specific factors identified as deterring parents from immunising their children included fear of autism and other developmental delays, concerns about risks and side effects, mistrust in vaccine efficacy, and discouraging information from the media. Parents’ immunisation decisions were evidently affected by policy compliance, family and friends, and social networking sites. These factors are explained through the socio-ecological model. Moreover, the COVID-19 pandemic influenced parents’ decisions on vaccine completion in terms of perceived barriers, perceived benefits, and perceived trust. (4) Conclusions: By examining the social–ecological factors shaping parents’ decisions to immunise their children in the Eastern Province of Saudi Arabia, this research contributes to the literature and informs the Saudi National Childhood Immunisation Programme about factors contributing to childhood immunisation hesitancy, helping to address a critical healthcare issue.
Background Childhood vaccination rates fluctuate over time and do not always meet the levels recommended by the WHO. Objective This study aims to provide an overview of measures countries have introduced to increase vaccination rates. Methods We developed a structured data collection template that was completed by country experts from Europe, Israel, the USA, and Canada. Experts were identified using the European Observatory on Health Systems and Policies' HSPM (Health Systems and Policy Monitor) network. We approached experts from 32 countries and received responses from 22 countries. In the template we asked for measures introduced between 2014 and 2019. The experts were asked to indicate the type of intervention, the target population, possible positive and negative effects, and evidence on effectiveness. The information was collected between September 2019 and January 2020. Results We identified four main types of interventions: restrictive measures for the unvaccinated, financial incentives, measures supporting the logistics of vaccination, and vaccination promotion campaigns. Restrictive measures often involved expanding existing mandatory vaccination policies or limiting access to pre-school activities for unvaccinated children. Financial incentives for healthcare providers showed some positive effects. Regarding logistical support, several countries used schools as alternative vaccination sites, though this presented organisational challenges. Many countries invested in improving knowledge among both healthcare professionals and parents to encourage vaccine uptake. Conclusions Most initiatives implemented in the countries covered focussed on communication and knowledge enhancement. However, there is limited evidence on the impact of these measures on vaccination coverage.
Madelon W. Kroneman, Alfons Fermin, Bernd Rechel et al.
BACKGROUND: In England, coverage for childhood vaccines have decreased since 2012/13 in the context of an increasingly visible anti-vaccination discourse. We determined whether anti-vaccination sentiment is the likely cause of this decline in coverage. METHODS: Descriptive study triangulating a range of data sources (vaccine coverage, cross-sectional survey of attitudes towards vaccination, UK-specific Twitter social media) and assessing them against the following Bradford Hill criteria: strength of association, consistency, specificity, temporality, biological gradient and coherence. RESULTS: Strength of association: compared with well-documented vaccine scares, the decline in childhood vaccination seen since 2012/13 is 4-20 times smaller; consistency: while coverage for completed courses of the hexavalent and meningococcal vaccines decreased by 0.5-1.2 percentage points (pp) between 2017 and 2019, coverage for the first dose of these vaccines increased 0.5-0.7 pp; specificity: Since 2012-13, coverage decreased for some vaccines (hexavalent, MMR, HPV, shingles) and increased for others (MenACWY, Td/IPV, antenatal pertussis, influenza in 2 years of children), with no age-specific patterns. Temporality and biological gradient: the decline in vaccine coverage was preceded by an increase in vaccine confidence and a decrease in the proportion of parents encountering anti-vaccination materials. Coherence: attitudes towards vaccination expressed on Twitter in the UK became increasingly positive between 2017 and 2019 as vaccine coverage for childhood vaccines decreased. CONCLUSIONS: In England, trends in vaccine coverage between 2012/13 and 2018/19 were not homogenous and varied in magnitude and direction according to vaccine, dose and region. In addition, confidence in vaccines increased during the same period. These findings are not compatible with anti-vaccination sentiment causing a decline in vaccine coverage In England.
Michael L. Edelstein, Martin Müller, Shamez N Ladhani et al.
Detailed knowledge about hepatitis B virus (HBV) vaccination coverage and timeliness for sub-Saharan Africa is scarce. We used data from a community-based cross-sectional survey conducted in 2018-2019 in the area of Niakhar, Senegal, to estimate coverage, timeliness, and factors associated with non-adherence to the World Health Organisation-recommended vaccination schedules in children born in 2016 (year of the birth dose (BD) introduction in Senegal) and 2017-2018. Vaccination status was assessed from vaccination cards, surveillance data, and healthcare post vaccination records. Among 241 children with available data, for 2016 and 2017-2018, respectively, 31.0% and 66.8% received the BD within 24 h of birth (BD schedule), and 24.3% and 53.7% received the BD plus at least two pentavalent vaccine doses within the recommended timeframes (three-dose schedule). In logistic regression models, home birth, dry season birth, and birth in 2016 were all associated with non-adherence to the recommended BD and three-dose schedules. Living over three kilometres from the nearest healthcare post, being the firstborn, and living in an agriculturally poorer household were only associated with non-adherence to the three-dose schedule. The substantial proportion of children not vaccinated according to recommended schedules highlights the importance of considering vaccination timeliness when evaluating vaccination programme effectiveness. Outreach vaccination activities and incentives to bring children born at home to healthcare facilities within 24 h of birth, must be strengthened to improve timely HBV vaccination.
Lauren Périères, Fabienne Marcellin, Gora Lô et al.
Abstract This study examines sustainable practices in the child immunisation vaccine supply chain (VSC) in Uttar Pradesh, India, to support the UN’s Sustainable Development Goals (SDGs). This analysis examines the impact of social, economic, and environmental sustainability practices on the VSC’s efficacy and efficiency, as well as their contribution to achieving SDG goals, including improved healthcare access and enhanced community resilience. This study employs Structural Equation Modelling (SEM) to analyse the relationships between sustainability practices and vaccine supply chain performance. Data were collected through a structured survey from different stakeholders, including healthcare workers, supply chain managers, and policymakers involved in vaccine distribution, storage, and delivery. A total of 180 valid responses were analysed to assess the direct and indirect effects of sustainability practices on the VSC. The findings highlight the interrelated nature of sustainability factors across the VSC. Social sustainability emerged as the most influential component (path coefficient: 0.868), emphasising the importance of fair labour practices, community well-being, and ethical leadership. Economic sustainability had a moderate-to-high impact (0.666), highlighting the importance of profit optimisation and cost reduction. Meanwhile, environmental sustainability had a smaller effect (0.542), indicating that, while important, it must be supported by social and economic policies for maximum benefit. The study emphasises the value of external collaboration and integrated sustainable practices in building the VSC. The research provides evidence for developing targeted interventions and policies that improve vaccine supply chain sustainability, supporting broader healthcare goals and sustainable development. Unlike previous research, which has mostly focused on logistical issues in vaccine delivery, this study incorporates sustainability factors into the examination of vaccine supply chains. This study provides policymakers, healthcare professionals, and stakeholders with valuable guidance for developing sustainable immunisation strategies in Uttar Pradesh and other similar regions worldwide, offering a comprehensive framework that connects sustainability practices to improved healthcare outcomes.
Ambuj Kumar, Om Ji Shukla, Shailesh Mani Pandey et al.
We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Cote d'Ivoire.
Romance Dissieka, Marissa Soohoo, Amynah Janmohamed et al.
