Towards ending immunisation inequity

As the world enters its second year living with COVID-19, much of the public attention and investment has shifted to large scale vaccination efforts. While COVID-19 vaccines have undoubtedly brought renewed hope, they have also once again served to highlight the ever-increasing health disparities and health inequities marginalised populations around the world have faced and continue to face throughout this global race to vaccinate.

Vaccine preventable diseases (VPDs) are responsible for a significant portion of mortality across the life course in low-, medium- and high-income countries. Older people and those with underlying chronic conditions suffer serious and sometimes life-threatening consequences from VPDs such as influenza, pneumococcal pneumonia, pertussis and shingles, yet national immunisation plans do not routinely fund the associated vaccines.

Answering why countries are consistently below the recommended vaccination rate is a pressing issue as suboptimal rates of adult vaccination persist within and among countries, with rates even falling in some areas. Some studies have identified modifiable barriers to vaccination in older adults. However, there is a more silent and insidious issue. In large part, campaigns to inform and encourage older people to have vaccinations appear blind to the inequity caused through standard universal messages that do not consider social determinants.

To address this knowledge gap the International Federation on Ageing (IFA) conducted a mix-method study titled “Towards ending immunisation inequity”, which explores the effects of social determinants on immunisation messages and campaigns through three key phases: a preliminary environmental scan of the vaccine landscape; focus groups; and a cross-sectional survey in five study countries. Key findings from this study have highlighted that while older adults are generally knowledgeable about vaccines a significant percentage think that they do not have enough knowledge to make informed decisions and are unaware of the vaccine recommendations for key target populations, including older adults and those living with chronic conditions.

There was also a clear link between study findings and underlying social determinants. For example, a substantial proportion of respondents reported being unable to communicate with healthcare professionals in their first language. This is a disturbing finding considering the need for a trusted source, of information, usually a healthcare professional, to inform their decision making about vaccination

Also worthy of attention is the finding that many respondents did not have access to a general physician (GP). These older people were not only more likely to be unvaccinated but also to believe that vaccinations were unnecessary and potentially unsafe. Those who did not have a GP were also far less likely to know where they could go to receive a vaccination. This is particularly worrisome because encouragement from a GP is cited in the literature as the most significant motivating factor in seeking vaccinations, and the GP is one of the most influential sources of information for older adults.

There is a pressing need to address the critical role social determinants play in health decisions and the ability for older adults to receive vaccinations. Now more than ever, there is a need to not only protect the progress made in immunisation throughout life but to respond to the significant gaps through targeted education, flexible vaccination pathways with the rapid expansion of pharmacists as vaccinators and efforts that truly end immunisation inequity.

The roadmap for policy change has been created with the UN Decade of Healthy Ageing (2021–2031), the WHO Immunization Agenda 2030, Gavi Phase V (2021–2025) and the Global Roadmap for Defeating Meningitis. We must now invest in the lives of people of all ages with country level immunisation plans that leave no one behind.