Within-Country Inequality in COVID-19 Vaccination Coverage: A Scoping Review of Academic Literature

Abstract

Since December 2020, COVID-19 vaccines have become increasingly available to populations around the globe. A growing body of research has characterised inequalities in COVID-19 vaccination coverage. This scoping review aims to locate, select and assess research articles that report on within-country inequalities in COVID-19 vaccination coverage, and to provide a preliminary overview of inequality trends for selected dimensions of inequality. We applied a systematic search strategy across electronic databases with no language or date restrictions. Our inclusion criteria specified research articles or reports that analysed inequality in COVID-19 vaccination coverage according to one or more socioeconomic, demographic or geographic dimension of inequality. We developed a data extraction template to compile findings. The scoping review was carried out using the PRISMA-ScR checklist. A total of 167 articles met our inclusion criteria, of which half (n = 83) were conducted in the United States. Articles focused on vaccine initiation, full vaccination and/or receipt of booster. Diverse dimensions of inequality were explored, most frequently relating to age (n = 127 articles), race/ethnicity (n = 117 articles) and sex/gender (n = 103 articles). Preliminary assessments of inequality trends showed higher coverage among older population groups, with mixed findings for sex/gender. Global research efforts should be expanded across settings to understand patterns of inequality and strengthen equity in vaccine policies, planning and implementation.

COVID-19 vaccine distribution: A review of strategies in Africa and the USA

“…The global response to the COVID-19 pandemic has brought to the forefront the critical issue of vaccine distribution. This comparative analysis delves into the contrasting strategies and contexts of COVID-19 vaccine distribution in Africa and the USA, extracting valuable lessons, and exploring the broader implications for global vaccine distribution efforts (Bergen et al, 2023).…”

Inequality in Immunization: Holding on to Equity as We ‘Catch Up’

“…The Special Issue features research, reviews, and commentaries that span a range of immunization topics and populations. While there is an emphasis on childhood vaccinations [ 15 , 16 , 17 , 18 ]—exploring inequalities in DTP and measles-containing vaccine (MCV) coverage [ 19 , 20 , 21 , 22 , 23 ] and patterns of inequality in unvaccinated or zero-dose children [ 24 , 25 , 26 , 27 , 28 , 29 ]—contributions also cover inequalities in adult immunization [ 30 ], including protection of pregnant women and their newborns against tetanus [ 31 ] and COVID-19 vaccination [ 32 , 33 ].…”

“…Studies have made use of traditional sources of immunization data like administrative data [ 19 , 23 , 32 ] and population surveys [ 18 , 21 , 22 , 27 , 29 , 30 ] (including Demographic and Health Surveys and/or Multiple Indicator Cluster Surveys [ 15 , 20 , 31 ]), while several other studies explored the potential of novel sources such as geospatial data [ 24 , 25 ], electronic immunization registries [ 34 ], dialogues [ 16 ], country appraisals and reports [ 35 ], and funding proposals [ 26 ]. Three review studies relied on synthesis and structured analyses drawing from a multitude of existing studies [ 17 , 33 , 36 ]. Indeed, the diversity of data sources represented across the articles of this Special Issue points to greater availability of data, and, critically, the innovative use of these data to delve more deeply into inequality analysis and inference.…”

“…As dimensions of inequality present themselves and intersect in dynamic ways, our modes of understanding must keep up. Several studies in this Special Issue examined multiple dimensions of immunization inequality [ 18 , 19 , 21 , 27 , 29 , 31 , 33 , 36 ], while others focused on specific dimensions, such as gender barriers [ 20 , 34 ] or socioeconomic status [ 15 , 30 , 32 ].…”

Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations

“…The COVID-19 pandemic highlighted the extreme inequity in access to diagnostics, treatments, and vaccines, resulting in a per capita death toll 31% higher in low-income countries compared to high-income countries. 4 The pandemic also featured stark within-country inequities, both in access to COVID-19 vaccines and mortality rates due to COVID-19, 5,6 reflecting long-existing health inequities and unequal access to quality health services and other necessities for a long and healthy life. In addition, the world is facing a syndemic of obesity, climate change, and undernutrition, with the worst outcomes experienced by populations in low- and middle-income countries, particularly those living in poverty and minoritized ethnic groups.…”