https://orcid.org/0000-0002-0716-3174
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ABSTRACT
Introduction
Social deprivation is associated with poorer healthcare access. Vaccination is among the most effective public health interventions and achieving equity in vaccination access is vitally important. However, vaccines are often reimbursed by public funds only when recommended in national immunization programs (NIPs), which can increase inequity between high and low socioeconomic groups. Invasive meningococcal disease (IMD) is a serious vaccination-preventable disease. This review focuses on vaccination strategies against IMD designed to reduce inequity.
Areas covered
We reviewed meningococcal epidemiology and current vaccination recommendations worldwide. We also reviewed studies demonstrating an association between social deprivation and risk of meningococcal disease, as well as studies demonstrating an impact of social deprivation on uptake of meningococcal vaccines. We discuss factors influencing inclusion of meningococcal vaccines in NIPs.
Expert opinion
Incorporating meningococcal vaccines in NIPs is necessary to reduce inequity, but insufficient alone. Inclusion provides clear guidance to healthcare professionals and helps to ensure that vaccines are offered universally to all target groups. Beyond NIPs, cost of vaccination should be reimbursed especially for disadvantaged individuals. These approaches should help to achieve optimal protection against IMD, by increasing access and immunization rates, eventually reducing social inequities, and helping to protect those at greatest risk.
PLAIN LANGUAGE SUMMARY
According to the World Health Organization, health equity is achieved when every person has access to the highest attainable health standard regardless of socioeconomic status. Achieving health equity in access to vaccination is particularly important, as vaccination is one of the most effective public health measures. However, vaccines are often paid by public funds only when they are recommended in the country's National Immunization Program. This can increase inequity between the rich and poor, as people with fewer resources are less likely to have private insurance and be aware of vaccines that are not suggested by their doctor. Invasive meningococcal disease is uncommon and unpredictable but a serious infection that can result in long-term disability and can kill within 24 hours. Vaccination is the best measure to prevent it.
We reviewed scientific studies to assess the link between socioeconomic status, the risk of having the disease, and the likelihood of being vaccinated against it. We found that the poorest households have the highest risk of getting the disease and the lowest vaccination rates, even in countries with successful vaccination programs.
Achieving universal vaccination against invasive meningococcal disease is challenging for financial reasons and because the disease is uncommon. Key factors identified to improve vaccination uptake and reduce health inequity are the need for publicly funded vaccines, increased parents’ knowledge of available vaccines, and stronger engagement of vaccination recommendation by doctors/nurses (see also Supplementary Figure 1).
Table of abbreviations
| 4CMenB | = | 4 component meningococcal serogroup B vaccine |
| ACIP | = | Advisory Committee on Immunization Practices |
| CI | = | Confidence interval |
| EU/EEA | = | European Union/European Economic Area |
| fHbp | = | factor H binding protein |
| HAS | = | Haute Autorité de Santé |
| HCP | = | Healthcare provider |
| HRSA | = | Health Resources and Services Administration |
| IMD | = | Invasive meningococcal disease |
| JCVI | = | Joint Committee on Vaccination and Immunization |
| MenA | = | Meningococcal serogroup A |
| MenACWY | = | Meningococcal serogroup A, C, W, or Y |
| MenB | = | Meningococcal serogroup B |
| MenC | = | Meningococcal serogroup C |
| MenW | = | Meningococcal serogroup W |
| MenX | = | Meningococcal serogroup X |
| MenY | = | Meningococcal serogroup Y |
| NIP | = | National immunization program |
| OMV | = | Outer membrane vesicle |
| OR | = | Odds ratio |
| RR | = | Relative risk |
| UK | = | United Kingdom |
| USA | = | United States of America |
| WHO | = | World Health Organization |
Article highlights
Communities with low socioeconomic status have the highest risk of invasive meningococcal disease and the lowest uptake of meningococcal vaccines.
Including meningococcal vaccines in national immunization programs is a critical step that helps to ensure that vaccines are offered universally to all target groups.
However, there have been significant challenges in introducing meningococcal vaccines, particularly serogroup B vaccines, to national immunization programs.
Initiatives to improve meningococcal vaccine knowledge might be particularly important to improve uptake among disadvantaged communities with less access to reliable vaccine information.
Plans to promote vaccination should consider equity in access to vaccines at national and regional levels.
Acknowledgments
The authors thank Business & Decision Life Sciences platform for editorial assistance and manuscript coordination, on behalf of GSK. Aurélie Roth (Business & Decision Life Sciences, on behalf of GSK) coordinated manuscript development and editorial support and Mary L Greenacre (An Sgriobhadair, UK, on behalf of GSK) provided medical writing support.
Author contributions
All authors participated in the conception and design of the review article and interpretation of the relevant literature and were involved in writing the review article or revising it for intellectual content. All authors have approved the final version of the manuscript.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Supplementary material
Supplemental data for this article can be accessed here.