Huda Ahmed Ali|Anna-Maria Hartner|Susy Echeverría-Londoño|Jeremy Roth|Xiang Li|Kaja Abbas|Allison Portnoy|Emilia Vynnycky|Kim Woodruff|Neil Ferguson|Jaspreet Toor|Katy A. M. Gaythorpe
Vaccine equity in low and middle income countries: a systematic review and meta-analysis
Imperial College London|Imperial College London|Imperial College London|Imperial College London|Imperial College London|University of London|London School of Hygiene & Tropical Medicine|Public Health England|Imperial College London|Imperial College London|Imperial College London|Imperial College London
evidence date shown inequality health vaccination coverage particular ramifications wider society however whilst individual studies sought characterise heterogeneities immunisation coverage national level taken broad quantitative view contributing factors heterogeneity immunisation coverage impact ie number cases deaths disabilityadjusted life years averted systematic review aims highlight geographic demographic sociodemographic characteristics qualitative quantitative approach vital prioritise optimise vaccination policiesa systematic review two databases pubmed web science undertaken using search terms keywords identify studies examining factors immunisation inequality heterogeneity vaccination coverage inclusion criteria applied independently two researchers studies including data key characteristics interest analysed metaanalysis produce pooled estimate risk ratio using random effects model characteristicone hundred eight studies included review found inequalities wealth education geographic access affect vaccine impact vaccination dropout estimated living rural areas significantly different terms full vaccination status compared urban areas noted considerable heterogeneity countries found females 3 95ci1 5 less likely fully vaccinated males additionally estimated children whose mothers formal education 28 95ci1847 less likely fully vaccinated whose mother primary level education finally found individuals poorest wealth quintile 27 95ci 1637 less likely fully vaccinated richestwe found nuanced picture inequality vaccination coverage access wealth disparity dominating likely driving disparities review highlights complex landscape inequity need design vaccination strategies targeting missed subgroups improve recover vaccination coverage following covid19 pandemicprospero crd42021261927