DISCUSSION PAPERS

The ERG, with the support of PATH, has developed a series of discussion papers to explore the landscape of inequity in immunization coverage. The papers examine commonly used metrics, available data and guidance, and promising programmatic approaches (from both within and outside of health) to reduce inequity, particularly relating to the thematic priorities of work: urban poor areas, remote/rural areas, children affected by conflict, and gender-related inequities and barriers to immunization.

The papers provide actionable recommendations, focused on community-level change agents, to tackle the key drivers of inequity and improve the immunization of vulnerable and underserved populations.

Two page summaries of the papers are included below when available.

ERG discussion paper 1 Equity metrics for immunisation.pdf

Are the current equity metrics used by immunization programmes adequate?

Equity is a critical outcome of immunisation programmes yet key questions remain regarding how best to measure progress towards equity. This paper presents a review of the most common equity metrics used by governments and partner agencies to monitor performance of immunisation programmes. In particular, the paper provides an analysis of whether current benchmarks used to monitor progress in addressing inequities are sufficient, whether these indicators are adequate to evaluate equity in access to vaccines, and what simple and complex measures have been suggested or used.

ERG discussion paper 2 Potential approaches to better measure equity in immunisation.pdf

Potential approaches to better measure and track equity in immunization using survey and administrative data, and data triangulation

Monitoring immunisation inequalities will likely depend both on national surveys and on routine, administrative data sources. Within low and middle-income countries (LMIC) the relative quality and availability of these two sources of data differ, and both have strengths and weaknesses. This paper describes issues related to the quality and coverage of different data sources in LMICs, and propose potential ways to measure levels and trends in immunisation inequalities.

ERG discussion paper 3 Data innovations and insights for equity.pdf

Data innovations and insights: Novel approaches to using data to inform equity-related decision-making

This paper presents innovative approaches that are shifting how the global health community can use data and digital technologies to highlight progress and challenges and inform decisions to improve equity.

ERG discussion paper 4 Relevance of HRBA and behavioural economics approaches.pdf

Closing equity gaps in immunisation: Relevance of human rights-based and behavioural economics approaches

This scoping review examined literature on human rights-based approaches (HRBA) and behavioural economics approaches, concentrating on ways in which these have helped close equity gaps in health outcomes and other social protections. The value added of each approach is summarised, followed by specific areas and case studies in which the approaches have helped close equity gaps. The paper concludes with a section on the particular relevance of the literature to issues in immunisation.

ERG discussion paper 5 A gender lens to advance equity in immunization.pdf

A gender lens to advance equity in immunization

Various gender-related factors – on both the demand and supply side – can affect the likelihood of childhood and adolescent immunisation and undermine immunisation programmes’ achievements. Gender also interacts with socioeconomic factors such as wealth, education, ethnicity/caste, religion, geographic setting, and migration status to shape disparity and mediate immunization outcomes. This paper presents challenges to ensuring gender equity in immunization programming, promising strategies as well as key recommendations.

ERG Discussion Paper 6 Conflict 24 March 2019.pdf

Tackling inequities in immunization outcomes in conflict contexts

Conflict destabilizes countries and their neighbors, disrupting essential infrastructure and resources needed to provide care and services to the most vulnerable people. A large portion of unimmunized children are affected by conflict. This discussion paper highlights key challenges and promising approaches to improve immunization uptake among children affected by conflict as well as a prioritized set of recommendations by the ERG to improve immunization policies and programs for these children.

ERG discussion paper 7 Tackling inequities_urban.pdf

Tackling inequities in immunization outcomes in urban contexts

By 2050, 68 percent of the world’s population is expected to live in an urban area. The risk of disease transmission and outbreak increases in large, densely populated areas with mobile and transient populations. Whilst average immunization coverage is typically higher in urban areas than rural areas in most countries, deep inequities in immunization coverage in urban areas are present—in most cases affecting the urban poor. In some countries, more than half of unimmunized children live in urban areas. This paper presents key challenges of immunizing children in these contexts, promising approaches and a set of recommendations to improve immunization equity in urban poor settings.

ERG discussion paper 8 Tackling inequities_remote rural.pdf

Tackling inequities in immunization outcomes in remote rural contexts

Geographic inequities in vaccine coverage remain one of the unfinished challenges in immunization equity, with remote rural areas consistently under-immunized. This lack of immunization creates vast inequities for the estimated 3.397 billion people who still live in rural environments. Concerted and immediate global action is needed to redress these inequities and achieve truly universal vaccine coverage. In this report, we outline some of the greatest challenges to immunizing children in remote rural areas, as well as promising novel approaches drawn from a wide variety of actors, sectors, and places. We also present recommendations to address challenges of achieving immunization equity in remote rural settings.

ERG Data-related Recommendations Summary Final.pdf

Immunization equity data gaps and related recommendations

The ERG has identified three broad questions to guide approaches taken to better address inequities in immunization: 1) Is there an equity problem in the country? 2) What are the causes of the problem? 3) What works to improve coverage among disadvantaged groups? In order to support country efforts to identify inequities, ERG members have conducted analyses on existing data and information gaps, and developed recommendations for resolving these gaps with respect to both cross-cutting analyses and analyses of four key thematic areas: urban poor settings, remote rural settings, children affected by conflict and gender-related barriers and inequalities. Existing gaps and related ERG recommendations from all ERG discussion papers to date are summarized in this document.