Stark inequalities in access to vaccination exist within and between countries, with children living in disadvantaged circumstances having considerably lower uptake. The reasons for these inequalities are complex but ultimately they reduce population immunization coverage, prevent achievement of herd immunity, and increase the chance of continuing or re-emerging epidemics of infectious disease. Another major threat to immunization coverage is an unfounded lack of professional and parental confidence in the safety and effectiveness of immunization.
In industrialized countriesthis usually reflects exaggerated or erroneous fears of adverse reactions, often following media scares. In developing countries this can reflect false beliefs about infectious disease and immunization. Problems in maintaining an adequate supply of vaccine and new developments leading to frequent changes to immunization schedules also impede high coverage.
Developing and delivering an effective vaccination policy is challenging for any country. Issues to consider include having comprehensive documented policies/guidelines, clear lines of responsibility, ensuring an adequate and safe vaccine supply chain, ensuring professionals.
delivering vaccination are adequately trained and supported, and fostering confidence in and engagement with the immunization program.
Many of these issues have been clearly set out by the World Health organization in Immunization in Practice: A Practical Resource Guide for Health Workers.
Interventions to increase vaccination coverage can be patient,
provider, or system orientated. Examples of interventions of proven effectiveness include:
* robust patient call–recall and reminder systems;
* provider prompt systems (for example computer ‘pop-ups’ that flag when a child attending any health care setting is overdue vaccinations);
* multifaceted education programs for professionals and parents;
* generally increasing the accessibility of immunization (including providing accessible immunization clinics and making immunization available in other settings such as hospital outpatients and Accident and Emergency departments);
* ensuring vaccination providers receive regular assessment of and feedback on their performance relative to vaccination targets;
* integrating immunization into general mother and child health programs;
* ensuring parents and providers do not incur costs associated with vaccination.
Making complete vaccination a requirement for children to enter childcare or school is effective in increasing coverage and is used in some countries. This approach has not been adopted in the UK due to the potentially damaging consequences of overriding parental choice. Ensuring the availability of high-quality information on the target population population that would benefit from vaccination is also important in developing effective recall systems and monitoring performance. Achieving and maintaining high vaccination coverage is an important effective measure to reduce health inequalities.
Source: Forfar and Arneil’s Textbook of Pediatrics, 7E