Abstract
BackgroundEquitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs). However, it is unclear whether providing equitable access is enough to ensure health equity. Furthermore, disaggregated data on health outcomes and benefits gained across population subgroups are often unavailable. This paper develops a model to estimate the distribution of childhood disease cases and deaths across socioeconomic groups, and the potential benefits of three vaccine programs in LMICs.MethodsFor each country and for three diseases (diarrhea, measles, pneumonia), we estimated the distributions of cases and deaths that would occur across wealth quintiles in the absence of any immunization or treatment programs, using both the prevalence and relative risk of a set of risk and prognostic factors. Building on these baseline estimates, we examined what might be the impact of three vaccines (first dose of measles, pneumococcal conjugate, and rotavirus vaccines), under five scenarios based on different sets of quintile-specific immunization coverage and disease treatment utilization rates.ResultsDue to higher prevalence of risk factors among the poor, disproportionately more disease cases and deaths would occur among the two lowest wealth quintiles for all three diseases when vaccines or treatment are unavailable. Country-specific context, including how the baseline risks, immunization coverage, and treatment utilization are currently distributed across quintiles, affects how different policies translate into changes in cases and deaths distribution.ConclusionsOur study highlights several factors that would substantially contribute to the unequal distribution of childhood diseases, and finds that merely ensuring equal access to vaccines will not reduce the health outcomes gap across wealth quintiles. Such information can inform policies and planning of programs that aim to improve equitable delivery of healthcare services.
Highlights
Equitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs)
Efforts put forward by local governments and international agencies have contributed to raising childhood vaccine coverage in the last decade [5], though high child mortality is still observed in LMICs, with approximately 5.9 million under-five deaths in 2015 [6]
The Global Vaccine Action Plan and Gavi, the Vaccine Alliance, both listed equitable access to vaccination as their top priorities [7,8,9]. It is unclear whether ensuring equitable access to vaccines would lead to health equity, which we define as equality of health outcomes across population subgroups
Summary
Equitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs) It is unclear whether providing equitable access is enough to ensure health equity. The Global Vaccine Action Plan and Gavi, the Vaccine Alliance, both listed equitable access to vaccination as their top priorities [7,8,9] It is unclear whether ensuring equitable access to vaccines would lead to health equity, which we define as equality of health outcomes across population subgroups. To answer this question, one needs to compare how disease burden is distributed across subgroups before and after the introduction of vaccines. The objective of this work is to introduce an analytical approach to estimate the distribution of childhood disease cases and deaths and the benefits of vaccines and treatments by socioeconomic group
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