Subject(s)
COVID-19 , Emigration and Immigration , Healthcare Disparities , Humanities , Immunization Programs , Minority Health , COVID-19/ethnology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Healthcare Disparities/ethics , Healthcare Disparities/ethnology , Humanities/ethics , Humanities/trends , Humans , Immunization Programs/ethics , Immunization Programs/legislation & jurisprudence , Minority Health/ethics , Minority Health/ethnology , SARS-CoV-2 , United States/epidemiology , Vaccination Coverage/ethics , Vaccination Coverage/organization & administrationSubject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Mass Vaccination/organization & administration , Centers for Disease Control and Prevention, U.S. , Clinical Trials as Topic , Contact Tracing , Humans , Mass Vaccination/ethics , Mass Vaccination/ethnology , Pandemics/prevention & control , Politics , SARS-CoV-2 , United States/epidemiology , Vaccination Coverage/ethicsABSTRACT
The urgent drive for vaccine development in the midst of the current COVID-19 pandemic has prompted public and private organisations to invest heavily in research and development of a COVID-19 vaccine. Organisations globally have affirmed the commitment of fair global access, but the means by which a successful vaccine can be mass produced and equitably distributed remains notably unanswered. Barriers for low-income countries include the inability to afford vaccines as well as inadequate resources to vaccinate, barriers that are exacerbated during a pandemic. Fair distribution of a pandemic vaccine is unlikely without a solid ethical framework for allocation. This piece analyses four allocation paradigms: ability to develop or purchase; reciprocity; ability to implement; and distributive justice, and synthesises their ethical considerations to develop an allocation model to fit the COVID-19 pandemic.
Subject(s)
Coronavirus Infections/prevention & control , Global Health , Health Care Rationing/ethics , Health Equity/ethics , Pandemics/ethics , Pneumonia, Viral/prevention & control , Social Justice , Viral Vaccines , Betacoronavirus , COVID-19 , COVID-19 Vaccines , Coronavirus Infections/virology , Developing Countries , Ethical Analysis , Health Resources , Humans , International Cooperation , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/virology , Poverty , SARS-CoV-2 , Social Values , Vaccination Coverage/ethicsSubject(s)
Health Knowledge, Attitudes, Practice , Parents/psychology , Vaccination , Child , Child, Preschool , France , Health Policy , Humans , Immunization Programs/organization & administration , Infant , Vaccination/ethics , Vaccination/psychology , Vaccination/statistics & numerical data , Vaccination Coverage/ethics , Vaccination Coverage/statistics & numerical dataABSTRACT
OBJECTIVES: (1) To conduct a systematic analysis of inequalities in childhood vaccination coverage in Gavi-supported countries; (2) to comparatively assess alternative measurement approaches and how they may affect cross-country comparisons of the level of inequalities. METHODS: Using the most recent Demographic and Health Surveys (2005-2014) in 45 Gavi-supported countries, we measured inequalities in vaccination coverage across seven dimensions of social stratification and of vulnerability to poor health outcomes. We quantified inequalities using pairwise comparisons (risk differences and ratios) and whole spectrum measures (slope and relative indices of inequality). To contrast measurement approaches, we pooled the estimates using random-effects meta-analyses, ranked countries by the magnitude of inequality and compared agreement in country ranks. RESULTS: At the aggregate level, maternal education, multidimensional poverty, and wealth index poverty were the dimensions associated with the largest inequalities. In 36 out of 45 countries, inequalities were substantial, with a difference in coverage of 10 percentage points or more between the top and bottom of at least one of these social dimensions. Important inequalities by child sex, child malnutrition and urban/rural residence were also found in a smaller set of countries. The magnitude of inequality and ranking of countries differed across dimension and depending on the measure used. Pairwise comparisons could not be estimated in certain countries. The slope and relative indices of inequality were estimated in all countries and produced more stable country rankings, and should thus facilitate more reliable international comparisons. CONCLUSIONS: Inequalities in vaccination coverage persist in a large majority of Gavi-supported countries. Inequalities should be monitored across multiple dimensions of vulnerability. Using whole spectrum measures to quantify inequality across multiple ordered social groups has important advantages. We illustrate these findings using an equity dashboard designed to support decision-making in the Sustainable Development Goals period.
