Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage
Introduction: Following a call from the World Health Organization in 2017 for a methodology to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study applies the Vaccine Economics Research for Sustainability and Equity (VERSE) vaccination equity too...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Vaccines |
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| Online Access: | https://www.mdpi.com/2076-393X/11/3/536 |
| _version_ | 1797608729650135040 |
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| author | Bryan N. Patenaude Salin Sriudomporn Deborah Odihi Joshua Mak Gatien de Broucker |
| author_facet | Bryan N. Patenaude Salin Sriudomporn Deborah Odihi Joshua Mak Gatien de Broucker |
| author_sort | Bryan N. Patenaude |
| collection | DOAJ |
| description | Introduction: Following a call from the World Health Organization in 2017 for a methodology to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study applies the Vaccine Economics Research for Sustainability and Equity (VERSE) vaccination equity toolkit to measure national-level inequity in immunization coverage using a multidimensional ranking procedure and compares this with traditional wealth-quintile based ranking methods for assessing inequity. The analysis covers 56 countries with a most recent Demographic & Health Survey (DHS) between 2010 and 2022. The vaccines examined include Bacillus Calmette–Guerin (BCG), Diphtheria–Tetanus–Pertussis-containing vaccine doses 1 through 3 (DTP1–3), polio vaccine doses 1–3 (Polio1–3), the measles-containing vaccine first dose (MCV1), and an indicator for being fully immunized for age with each of these vaccines. Materials & Methods: The VERSE equity toolkit is applied to 56 DHS surveys to rank individuals by multiple disadvantages in vaccination coverage, incorporating place of residence (urban/rural), geographic region, maternal education, household wealth, sex of the child, and health insurance coverage. This rank is used to estimate a concentration index and absolute equity coverage gap (AEG) between the top and bottom quintiles, ranked by multiple disadvantages. The multivariate concentration index and AEG are then compared with traditional concentration index and AEG measures, which use household wealth as the sole criterion for ranking individuals and determining quintiles. Results: We find significant differences between the two sets of measures in almost all settings. For fully-immunized for age status, the inequities captured using the multivariate metric are between 32% and 324% larger than what would be captured examining inequities using traditional metrics. This results in a missed coverage gap of between 1.1 and 46.4 percentage points between the most and least advantaged. Conclusions: The VERSE equity toolkit demonstrated that wealth-based inequity measures systematically underestimate the gap between the most and least advantaged in fully-immunized for age coverage, correlated with maternal education, geography, and sex by 1.1–46.4 percentage points, globally. Closing the coverage gap between the bottom and top wealth quintiles is unlikely to eliminate persistent socio-demographic inequities in either coverage or access to vaccines. The results suggest that pro-poor interventions and programs utilizing needs-based targeting, which reflects poverty only, should expand their targeting criteria to include other dimensions to reduce systemic inequalities, holistically. Additionally, a multivariate metric should be considered when setting targets and measuring progress toward reducing inequities in healthcare coverage. |
| first_indexed | 2024-03-11T05:48:47Z |
| format | Article |
| id | doaj.art-ee250763e61c4ff6b34af329b2113fbd |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-03-11T05:48:47Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj.art-ee250763e61c4ff6b34af329b2113fbd2023-11-17T14:17:26ZengMDPI AGVaccines2076-393X2023-02-0111353610.3390/vaccines11030536Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination CoverageBryan N. Patenaude0Salin Sriudomporn1Deborah Odihi2Joshua Mak3Gatien de Broucker4International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USAInternational Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USAInternational Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USAInternational Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USAInternational Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USAIntroduction: Following a call from the World Health Organization in 2017 for a methodology to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study applies the Vaccine Economics Research for Sustainability and Equity (VERSE) vaccination equity toolkit to measure national-level inequity in immunization coverage using a multidimensional ranking procedure and compares this with traditional wealth-quintile based ranking methods for assessing inequity. The analysis covers 56 countries with a most recent Demographic & Health Survey (DHS) between 2010 and 2022. The vaccines examined include Bacillus Calmette–Guerin (BCG), Diphtheria–Tetanus–Pertussis-containing vaccine doses 1 through 3 (DTP1–3), polio vaccine doses 1–3 (Polio1–3), the measles-containing vaccine first dose (MCV1), and an indicator for being fully immunized for age with each of these vaccines. Materials & Methods: The VERSE equity toolkit is applied to 56 DHS surveys to rank individuals by multiple disadvantages in vaccination coverage, incorporating place of residence (urban/rural), geographic region, maternal education, household wealth, sex of the child, and health insurance coverage. This rank is used to estimate a concentration index and absolute equity coverage gap (AEG) between the top and bottom quintiles, ranked by multiple disadvantages. The multivariate concentration index and AEG are then compared with traditional concentration index and AEG measures, which use household wealth as the sole criterion for ranking individuals and determining quintiles. Results: We find significant differences between the two sets of measures in almost all settings. For fully-immunized for age status, the inequities captured using the multivariate metric are between 32% and 324% larger than what would be captured examining inequities using traditional metrics. This results in a missed coverage gap of between 1.1 and 46.4 percentage points between the most and least advantaged. Conclusions: The VERSE equity toolkit demonstrated that wealth-based inequity measures systematically underestimate the gap between the most and least advantaged in fully-immunized for age coverage, correlated with maternal education, geography, and sex by 1.1–46.4 percentage points, globally. Closing the coverage gap between the bottom and top wealth quintiles is unlikely to eliminate persistent socio-demographic inequities in either coverage or access to vaccines. The results suggest that pro-poor interventions and programs utilizing needs-based targeting, which reflects poverty only, should expand their targeting criteria to include other dimensions to reduce systemic inequalities, holistically. Additionally, a multivariate metric should be considered when setting targets and measuring progress toward reducing inequities in healthcare coverage.https://www.mdpi.com/2076-393X/11/3/536equityvaccineimmunizationglobal healthLMICshealth equity |
| spellingShingle | Bryan N. Patenaude Salin Sriudomporn Deborah Odihi Joshua Mak Gatien de Broucker Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage Vaccines equity vaccine immunization global health LMICs health equity |
| title | Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage |
| title_full | Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage |
| title_fullStr | Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage |
| title_full_unstemmed | Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage |
| title_short | Comparing Multivariate with Wealth-Based Inequity in Vaccination Coverage in 56 Countries: Toward a Better Measure of Equity in Vaccination Coverage |
| title_sort | comparing multivariate with wealth based inequity in vaccination coverage in 56 countries toward a better measure of equity in vaccination coverage |
| topic | equity vaccine immunization global health LMICs health equity |
| url | https://www.mdpi.com/2076-393X/11/3/536 |
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