Improving vaccine equity: Addressing barriers and building capacity to improve vaccine uptake
- The problem: Not everyone has equal access to vaccines and reliable vaccine information.
- Why it matters: Suboptimal vaccination coverage leads to preventable illness and death, and increases health inequalities.
- The way forward: A combination of local, national and international actions will help address determinants of unequal access and improve vaccine communication.
Improving vaccine equity
Addressing barriers and building capacity to improve equitable vaccine uptake across the EU
Vaccination remains one of the most essential and cost-effective tools available to ensure population health and wellbeing. As a cornerstone of primary and preventive health care, vaccines have been directly responsible for saving millions of lives.
However, vaccination programmes face enduring challenges, namely inequalities in vaccine access and vaccine hesitancy.
Vaccine inequalities are avoidable differences in immunisation coverage between population groups that arise because vaccine barriers among disadvantaged groups are not addressed through policies, structures, governance or programme implementation.
Vaccine inequalities continue to exist, and are even getting worse
While the COVID-19 pandemic demonstrated the power of vaccines to protect health and wellbeing, it also exposed and exacerbated significant vaccine inequalities. It provoked a large regression in routine immunisation coverage, with inequalities between and within countries worsening.
Within the first year of distribution of the COVID-19 vaccine, high-income countries across the world were able to vaccinate 80% of their populations, while low-income countries were able to vaccinate less than 10%. (Source)
Since the pandemic, influenza vaccination rates among older adults in Estonia and Latvia have decreased to 15% and 12% respectively. In other EU countries, over 50% of older adults are vaccinated. (Source)
However, even before the pandemic, vulnerable groups often had lower vaccine coverage than the general population.
This drop in coverage also comes in the context of the war in Ukraine, where coverage for measles and polio vaccines is now well below the level required to prevent outbreaks. Such gaps in routine immunisation coverage are contributing to a spike in global measles outbreaks.
The determinants of vaccine inequalities
While much emphasis is put on vaccine hesitance and individual choices, evidence shows that suboptimal vaccine coverage is due to many factors, including social determinants and health system barriers.
Such factors affect lower income communities, as well as ethnic, religious or cultural minorities across Europe, more. They include structural barriers, such as the geographical distance to healthcare centres, limited service hours, and administrative barriers related to required documentation.
While addressing global vaccine inequalities requires important structural and political solutions at the highest level (such as the proposed WHO ‘pandemic treaty’), addressing many of the vaccine inequalities within European countries requires ‘local solutions to local challenges’.
How can EU and international policies and programmes foster vaccine equity?
In the EU, delivery of vaccination programmes is a competence of Member States. However, a rise in outbreaks of emerging infectious and vaccine-preventable diseases and in recorded vaccine hesitancy has put the issue of vaccination on the European agenda.
EU actions included:
- The 2018 Council Recommendations on strengthened cooperation against vaccine-preventable diseases
- The 2022 Council Conclusions on combatting vaccine hesitancy and preparing for upcoming challenges through cooperation
- The adoption of the EU Vaccines Strategy to help develop COVID-19 vaccines
- The launch of the EU Joint Action on Vaccination (EU-JAV)
- Expansion of the mandate of the European Centre for Diseases Control (ECDC)
- Establishment of the European Health Preparedness and Response Authority (HERA)
The Coalition for Vaccination brings together European associations of healthcare professionals and relevant student associations in the field, and was created by the European Commission in 2019. The Coalition aims to support the delivery of accurate information to the public, combatting myths around vaccines and vaccination, and exchanging best practices on vaccination.
Making it happen through EU-funded initiatives
IMMUNION (2021-2023)
IMMUNION (“Improving IMMunisation cooperation in the European UNION”) works to increase vaccine confidence, equity and uptake by delivering better vaccine communication education to health professionals and better information to the general public.
Coordinated by EuroHealthNet, the project brings together members of the Coalition for Vaccination as well as partners across the EU.
Four countries investigated the factors contributing to low vaccine uptake in selected regions and populations. An online communication toolbox was developed to support health professionals and health authorities to raise awareness about the importance of vaccination. The four countries also co-developed pilot activities with health stakeholders.
RIVER-EU (2021-2026)
RIVER-EU (“Reducing Inequalities in Vaccine uptake in the European Region – Engaging Underserved communities”) is a Horizon 2020 project that collects evidence on the ‘barriers’ and enablers’ of vaccine uptake in seven underserved communities.
The evidence will be used to co-design, implement, and evaluate interventions that address barriers and improve trust in the health system. The lessons learnt will be collected in a set of evidence-based guidelines and implementation recommendations.
Pathways to progress
To foster vaccine equity, policymakers and health authorities should consider the following actions to reduce vaccine inequalities.
- Build capacities to design and implement evidence-based, people-centred and tailored practices.
- Understand and address determinants of unequal access to vaccines to help strengthen overall primary healthcare.
- Encourage collaboration between health professionals, health authorities, civil society, media, and wider communities.
- Support health professionals to communicate with confidence and cultural competence about vaccination.
- Intensify catch-up and outreach campaigns to immunise those who may have missed their scheduled vaccinations to reduce risks of outbreaks of vaccine-preventable diseases.
