Systematic review underscores the value of pro-equity strategies in immunization programs

A new systematic review identifies “pro-equity” strategies to improve vaccination uptake, coverage, and/or timeliness among under-served populations. The authors synthesize evidence on interventions designed to counteract determinants of inequity which hamper immunization among women and gender minorities, migrants and mobile population, people living with disabilities, ethnic minorities and urban and rural population.

Key findings include the following:

• Strategies that tailor delivery to underserved groups, for example, through mobile outreach, community health worker engagement, or culturally adapted messaging, can boost vaccine uptake, coverage, or timeliness in disadvantaged communities.
• Financial incentives or reductions in out-of-pocket costs (subsidies, waiving fees) are used to improve coverage, especially in low-income or remote settings.
• Interventions that involve community participation, co-designing services with local stakeholders, training local peer educators, or using trusted community figures, appear to promote both higher uptake.
• However, the review also highlights important evidence gaps: few rigorous evaluation, including cost-effectiveness or economic evaluation studies were identified, and comparative data across different types of pro-equity strategies are limited.
• Few strategies targeted immunization policy and governance, availability of immunization services, or improvement in service delivery. 

The authors conclude that pro-equity approaches hold promise for narrowing immunization gaps, but emphasize that future research should more systematically assess the economic trade-offs, sustainability and scalability of such interventions. In other words: ensuring that vaccines reach the underserved is not just a technical challenge, it’s an economic, policy, and governance imperative that merits far more attention. The findings will be beneficial to researchers, implementers, and policymakers who are looking to optimize interventions to improve vaccination among those who most need it.

Thumbnail image credit: Gavi/2023/Ashraful Arefin