Exploring the subnational inequality and heterogeneity of the impact of routine measles immunisation in Africa
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Despite vaccination being one of the most effective public health interventions, there are persisting inequalities and inequities in immunisation. Understanding the differences in subnational vaccine impact can help improve delivery mechanisms and policy. We analyse subnational vaccination coverage of measles first-dose (MCV1) and estimate patterns of inequalities in impact, represented as deaths averted, across 45 countries in Africa. We also evaluate how much this impact would improve under more equitable vaccination coverage scenarios. Using coverage data for MCV1 from 2000–2019, we estimate the number of deaths averted at the first administrative level. We use the ratio of deaths averted per vaccination from two mathematical models to extrapolate the impact at a subnational level. Next, we calculate inequality for each country, measuring the spread of deaths averted across its regions, accounting for differences in population. Finally, using three more equitable vaccination coverage scenarios, we evaluate how much impact of MCV1 immunisation could improve by (1) assuming all regions in a country have at least national coverage, (2) assuming all regions have the observed maximum coverage; and (3) assuming all regions have at least 80% coverage. Our results show that progress in coverage and reducing inequality has slowed in the last decade in many African countries. Under the three scenarios, a significant number of additional deaths in children could be prevented each year; for example, under the observed maximum coverage scenario, global MCV1 coverage would improve from 76% to 90%, resulting in a further 363(95%CrI:299–482) deaths averted per 100,000 live births. This paper illustrates that estimates of the impact of MCV1 immunisation at a national level can mask subnational heterogeneity. We further show that a considerable number of deaths could be prevented by maximising equitable access in countries with high inequality when increasing the global coverage of MCV1 vaccination.
Date Issued
2022-11-08
Date Acceptance
2022-09-16
Citation
Vaccine, 2022, 40 (47), pp.6806-6817
ISSN
0264-410X
Publisher
Elsevier BV
Start Page
6806
End Page
6817
Journal / Book Title
Vaccine
Volume
40
Issue
47
Copyright Statement
© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36244882
PII: S0264-410X(22)01157-4
Subjects
Africa
Immunisation impact
Vaccine equity
Child
Humans
Measles
Vaccination
Immunization Programs
Immunization
Africa
Measles Vaccine
Publication Status
Published
Coverage Spatial
Netherlands
Date Publish Online
2022-10-14