Global socioeconomic inequalities in vaccination coverage, supply, and confidence

A new global study analyzes socioeconomic inequalities in vaccination coverage, supply disruptions, and public confidence from 2015–2023. Key findings show that inequalities initially decreased post-SDGs but reversed during COVID-19, with 94 countries reporting vaccine stock-outs and lower confidence observed in wealthier nations. Use the insights from these findings to strengthen supply-chain monitoring, prioritize equity-focused interventions, and tailor confidence-building strategies to address context-specific socioeconomic barriers.

Key Findings

  1. Pre-pandemic progress (2015–2019):

  • Global economic/education-related inequalities in coverage (DTP, measles, polio) declined in most regions.
  • Exception: Americas (AMR) saw rising inequalities.

  1. Pandemic disruption (2020–2021):

    • Coverage dropped sharply (e.g., DTP3 from 86% to 81%), while inequalities spiked globally.

  2. Partial recovery (2022–2023):

    • Coverage rebounded but remained below 2019 levels; inequalities improved but persist, especially in AMR.

  3. Supply chain fragility:

    • 94 countries reported ≥1 national DTP vaccine stock-out (2015–2022). Low/middle-income countries (LMICs/UMICs) faced greater stock-out risks.

  4. Vaccine confidence paradox:

    • Higher-income/education countries showed lower confidence (77% globally confident; lowest in Europe).

Practical Implications for MICs

  • Prioritize equity in recovery: Intensify outreach in underserved areas to reverse pandemic backsliding, especially in the Americas.

  • Strengthen supply chains:

    • Implement real-time stock monitoring to prevent national stock-outs.
    • Diversify vaccine procurement sources to mitigate shortages (critical for self-financing MICs).

  • Address confidence strategically:

    • In MICs, tailor messaging: Combat misinformation among higher-income/educated groups (who show lower confidence), while ensuring access for marginalized communities.
    • Leverage mandatory school vaccination policies (where applicable) to stabilize coverage.

Data Gaps & Limitations

  • Stock-out data were self-reported and incomplete (especially from HICs).

  • Confidence data predate COVID-19; current hesitancy may be higher.