The CDC recognizes August as National Immunization Awareness Month. Obviously, vaccines should be accessible to all children across the globe. However, even after decades of effort, this still is not the case. In the United States, for example, significant disparities in childhood vaccination continue to exist. In 2017, American Indian/Alaska Native children were 10% less likely to be fully immunized with CDC-recommended vaccines than non-Hispanic white children. Additionally, just 66.5% of Black children aged 19 to 35 months were fully immunized, compared to 71.5% of white children.
Socioeconomic status heavily influences access to vaccines. An article published in Health Equity in January 2021 states that in 2018, infants from families with incomes below the poverty threshold were approximately 30% less likely to receive the seven vaccines recommended for children ages 19 to 35 months. Black infants remain less likely, overall, to be fully vaccinated than white infants, which suggests a complicated connection between race, income and vaccination, as research shows that vaccination rates for high-income Black, white, Asian-American, and Hispanic children are similar (Pfizer).
To address this issue, it’s important to look at barriers to vaccination. In 1994, the United States launched Vaccines for Children, which was a government-funded program which intended to increase vaccination in low-income communities. The program was a response to a resurgence of measles that was “caused largely by widespread failure to vaccinate uninsured children at the recommended age of 12-15 months,” according to the CDC. However, this really didn’t change anything drastically.
According to Pfizer, the persistence of vaccine disparities despite programs specifically designed to address financial barriers suggests that socioeconomic status itself may not be the primary barrier to vaccination for many families. “Inadequate access to healthcare (including inconvenient and limited clinic hours), lack of reliable transportation and childcare, inability to get time off from work to have children immunized, language barriers, and the absence of a reminder system for missed vaccinations all contribute to disparities in childhood vaccination.”
As we observed during the COVID-19 pandemic (and continue to observe), there is also an information gap when it comes to vaccines. Of course, the parental point of view on vaccinations, the medical system, etc. also plays a role in the vaccination of a child. For communities that have historically been mistreated by the medical system, vaccine manufacturers should partner with trusted voices in community-based organizations to create educational materials that are culturally appropriate. Members of local communities can also be trained to disseminate scientifically-sound information as they can better understand the fears and misunderstandings that members of their community face.
Recently, I had the opportunity to participate in a global health internship in Tarija, Bolivia. There, I spent a week in a rural healthcare setting in a small community called San Andres.
Here, I went with a group of nurses who would designate a portion of the morning to walk around the area surrounding the Centro de Salud (local health center) with their backpacks and ice chest of vaccines to homes and shops in search of children under the age of 5 to ensure that everyone was up to date on their vaccinations. They also had a list of vaccination records of children who had come into the Centro once for their vaccinations, but hadn’t returned for their second dose, other necessary vaccinations, etc. They didn’t know particularly where these children lived, but they asked around to anyone who would answer the door, “Sabe dónde viven wawitas que tienen menos de 5 años?” (Do you know where babies who are less than 5 years old live?) (“wawa” is a Quechua word for “baby” that is widely adopted in Bolivia). And, since the community was small enough, usually someone was able to point us in the right direction. Many children were not up to date on polio or flu vaccinations, but were able to receive them right then and there–for free–due to the work of these nurses (flu vaccinations, like in the US, are optional, but highly recommended).
The photo above shows 2 nurses talking to a mother,
and local store owner, about what vaccinations her
child is missing. Soon after, they were able to adminster these vaccines
right there in the store!
This was an extremely successful way of ensuring that local children received their vaccinations. Although many of these children lived less than a 5 minute walk to the Centro de Salud, many parents couldn’t just take off from work to go to the clinic. Instead, trusted health professionals took the responsibility to go out into the communities themselves and deliver vaccines to the children directly. If we could drastically increase efforts such as these in low-income communities in the United States, making this a daily activity for nurses similar to how it is in San Andres, then perhaps disparities in childhood vaccinations could be reduced.