Aim To review studies evaluating the effectiveness of state and national policies or programmes on social inequalities in vaccination uptake, since the 2009 NICE evidence review ‘Reducing differences in the uptake of immunisations in children and young people aged under 19 years’.
Methods Terms related to ‘immunisation’, ‘policy’, ‘programme’, ‘inequality’, and ‘child’ were searched for in: Cochrane Database of Systematic Reviews (CDSR), Scopus, PubMed/Medline, Web of Science (WOS), The Campbell Collaboration, and OvidSp, and limited to quantitative studies of state and national immunisation policies/programmes published 2008–2015, in English, and carried out in the UK and other high-income countries with similar immunisation contexts (Western Europe, USA, Canada, Australia, New Zealand).
The following study characteristics were noted: policy/programme type, target audience, method of assignment to case/control, method of analysis, change in vaccination coverage and its social distribution.
Results 3816 records were initially identified and narrowed down to 214 full-text articles. Of these, 11 studies were identified as relevant i.e. original research evaluating a state or national immunisation policy or programme, and its effects on one or more parameters of social disparity in vaccine uptake.
The majority of studies were North American, and examined inequalities associated with ethnicity and income. The studies evaluated school-entry vaccination requirements (SVR, n=2), school-based delivery/catch-up programmes (SBD, n=2), free vaccination programmes (FVP, n=3), reminder/recall systems and home visitors (RSHV, n=2), the use of vaccination coordinators (VC, n=1), and a multi-system approach (MSA, n=1) involving health visitors, parental support groups and vaccination promotion initiatives.
All policies except MSA showed evidence of increased vaccination uptake. However, only SBD and FVP achieved herd immunity. SBD, FVP and VC were associated with statistically significant reductions in social inequality in uptake, although none removed inequality altogether.
Conclusion A relatively small number of studies were available for review, and their generalisability is limited as health systems and population characteristics vary by country. Nevertheless, the majority of the national and state-level policies/programmes reviewed increased overall vaccination coverage. SBD, FVP and VC led to reduced inequalities in childhood vaccination, although none completely eliminated the inequality in uptake.
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