How Can We Advance Vaccination Equity in Europe?

Join us for this live written panel discussion to explore how we can advance vaccination equity in Europe, and address disparities in coverage amongst people affected by income poverty, severe material deprivation or social exclusion.

LIVE Panel

Wednesday 25 January, 10 to 11am EST / 3 to 4 pm GMT

Background

Vaccinations throughout a person’s life, have proved to be one of the most important public health tools in history - saving lives and simultaneously bringing significant social and economic benefits. They remain a vital tool in the fight against antibiotic resistance and there are exciting developments in the pipeline with more vaccinations that can prevent cancers as well as combined flu and COVID jabs.

However, the benefits vaccinations can bring are not being felt equally by all groups in society. For example, in the UK the lowest uptake of the flu, shingles, whooping cough and PPV vaccines are in the most deprived areas. During COVID-19, poor, black and ethnic minority and migrant populations consistently experienced lower rates of vaccination.

There are also disparities in confidence in vaccinations - with a recent EU-wide study finding that younger people have less confidence than older people.

Business Fights Poverty is being supported by MSD to better understand the links between immunisation and poverty in 5 European countries: France, Spain, Italy, Germany and the UK. As part of this we are particularly keen to explore the role of women in supporting greater vaccination uptake amongst vulnerable communities, given their care-giving links to both children and the elderly.

Panel

  • Gustav Ando, Managing Director, Healthcare Economics and Market Access, Global Data
  • Alison Crawshaw, PhD Candidate in Migrant Health and Participatory Research, St George’s, University of London
  • Rachel Eagan, Researcher, The Vaccine Confidence Project, London School of Hygiene and Tropical Health and Medicine
  • Ciara O’Rourke, Global Public Policy Director – Vaccination Confidence & Equity, MSD
  • Stefan Swartling Peterson Health Expert Advisor, Swedish Committee, UNICEF.
  • Ignacio Peña Ruiz, Director, Salud entre Culturas, Asociación para el Estudio de Enfermedades Infecciosas (Spain)
  • Marium Qaiser, Global Health Strategist & Policy Consultant
  • Ramazan Salman, Executive Director, Ethno Medical Centre, (Germany)
  • Natalina Sutton, Public Health Programme Officer, Southwark Council, London
  • Jaime Jesus Pérez Martín, President of the Spanish Association of Vaccination Regional General VP on Prevention, Health Promotion and Addictions in Murcia, Spain
  • Mariano Votta, Director, Active Citizenship Network (EU)

Moderator: Alice Allan, Collaboration Director, Business Fights Poverty

Questions

  1. Why are those living in poverty, or with severe material deprivation or socially excluded groups, less likely to be vaccinated?

  2. What are the main barriers to vaccination for people living in poverty - are there any urban-rural variations to this?

  3. What examples are you aware of that have successfully reached those living in poverty or social exclusion with vaccinations?

Format

This is a text-based discussion which remains open, so please do continue to share your insights.

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Hi, I’m Alice Allan, Collaboration Director here at Business Fights Poverty. Very much looking forward to our discussion next week. We have a great line up of academics, community networks, NGOs and business, with expertise across Europe.

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Hello All, My name is Rachel. I am a researcher at the Vaccine Confidence Project and with the London School of Hygiene & Tropical Medicine. My work focuses on tracking the levers and trends of vaccine confidence globally, overtime, and among different socio-demographic groups. Vaccine confidence is a trusted predictive measure for vaccine uptake and thus can serve as an early warning system. Outside of my primary research, you can also talk to me about demography, migration, health policy & governance, climate change, race & social justice and equitable health outcomes, and implementation science & costing. Looking forward to today’s discussion!

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HI, I’m Stefan Swartling Peterson - a Professor of Global Transformations for Health at Karolinska Institutet, and a Health Specialist with UNICEF Sweden. My past job was as the Global CHief of Health for UNICEF

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Looking forward to our online chat today - here my LinkedIn page: (9) Stefan Swartling Peterson | LinkedIn

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Hello, I’m Alison Crawshaw from the Migrant Health Research Group at St George’s, University of London. I’m a public health professional and final year PhD student working on strengthening vaccine uptake among migrant populations. I’m really pleased to be part of this discussion today.

A few things before we get started. My contributions today will focus on migrant populations. There’s no universally agreed definition of a migrant but for today’s discussion I will be referring to anyone born outside of their country of residence (foreign-born) as a migrant. This definition is broad and encompasses people from a range of socioeconomic positions. Not all migrants will experience poverty, deprivation and social exclusion, nor will they all experience vaccination inequities, but many will and do. I’ll expand on these nuances in the discussion.

I’d also like to acknowledge my colleagues, particularly Anna Deal and Sally Hargreaves, who have contributed to the work I’ll be talking about today.

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Hello, I am Mariano Votta, responsible for EU Affairs at the Italian NGO Cittadinanzattiva and Director of its EU branch called “Active Citizenship Network” (ACN), committed at the EU level to increase the protection of patients’ rights and their involvement in the decision-making process. In my activity at the EU level, I led the political initiative to launch at the European Parliament in 2015 the MEP Interest Group “EU Patients’ Rights & Cross-Border Healthcare,” endorsed by nearly 100 organisations across Europe, now at his second term! Many thanks for the invitation!

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Here you are my Linkedin profile: https://www.linkedin.com/in/mariano-votta-b854a92a/, to know more about my latest publications, please visit my ORCID profile: ORCID and researchgate profile: https://www.researchgate.net/profile/Mariano-Votta/research

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Hello, I am Marium Qaiser, Global health consultant with 15+ years’ experience in strategy, operations, forging public-private partnerships in the Lifesciences & Global healthcare sector. Creating innovative solutions to strengthen health systems and local capabilities for better global health outcomes. I work organisations to develop solutions to complex problems centred around insights and communities to have an impactful and sustainable outcome that instigates change for the better.
I work on problems related to respiratory, vaccines and anti-infectives across Africa, Europe, Middle East, and Asia Pacific, working with govts, ministries of health and national regulatory bodies.

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Hello, I am Ciara O’Rourke, Global Public Policy Director for Vaccination Equity at MSD, a global healthcare company. I have been working in the vaccines area for over 7 years and in public health for over 20 years. MSD is committed to advancing vaccination equity, supporting more equitable access to resilient vaccination services as well as vaccines across the world. We have a specific interest in addressing challenges experienced by Urban Poor populations. Looking forward to this discussion.

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Hello, we are Marek and Natalina, Public Health Programme Officers at Southwark Council in London. As a local authority public health team we are involved in both providing assurance that our vaccination programmes are reaching all our communities equitably and designing interventions to address this.

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Hi, my name is Gustav Ando, VP/MD at GD which is a global business services company. Our company collects data, analysis and consulting, and my group focuses on healthcare economics, pharma pricing and access on a global scale. We look at any and all barriers to access to healthcare services, pharmaceuticals and vaccines, so of course this topic is of particular interest to me and us. This is me and feel free to reach out to me!

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You are all so very welcome. Lets get started. The first question is as follows : Why are those living in poverty, or with severe material deprivation or socially excluded groups, less likely to be vaccinated?

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A1. Knowledge may be an issue, but more so lack of ability to overcome barriers. For instance, can you take off time from work to go to get your kid vaccinated when the health centre is open?

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A1: Supply-side and demand-side barriers impact vaccination rates for all populations and may be felt most acutely by people living in poverty or socially excluded groups. On the supply-side, vaccines need to be available, affordable, and accessible. Affordability, particularly where universal healthcare is not provided, like the U.S., can be an insurmountable barrier for people living in poverty and for those on the cusp, accessing care can mean making the choice between maintaining health or going into severe debt. Where affordability isn’t a barrier, accessibility can be. Vaccination services need to be within reach of the people who need them. In rural areas, it can be easy to visualize breakdowns in accessibility. However, the same holds true in urban areas. Vaccination centers and health services may not be located near people living in poverty or socially excluded groups. Transportation, including bus fare, may be unaffordable or services may be in areas that don’t feel welcoming to socially excluded groups. Additionally, vaccination services need to be linguistically and culturally accessible. Health literacy can be a major barrier to accessing relative information and care.

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From our experience working in Southwark, people living in deprived areas are less likely to be vaccinated against COVID-19 and flu than the local average. Similar patterns may exist for childhood immunisations, however data quality for these is poorer and so making this link definitively is challenging.

Poverty can present barriers to access; for example during the recent polio vaccination campaign, engagement with voluntary sector stakeholders that worked with families living in areas experiencing deprivation found that time was a barrier to vaccination, with booking vaccine appointments often deprioritised in favour of work and childcare, a problem exacerbated by the pressures of the cost of living crisis.

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Economically and socially marginalized groups are often un- or under-vaccinated, and even
countries with high rates of vaccination can have pockets of significant disparity. Many context specific factors contribute to inequity across the vaccine development life-cycle. Social determinants of health, or the conditions in which people are born, grow, live, work and age, play a key role in vaccination inequity.

People affected by poverty have unique barriers, requiring tailored, context-specific solutions. Immunization information systems, including those that can monitor disease and safety surveillance, are needed for accurate data on who is un- or under-vaccinated, to understand barriers at a national and local level, and to track the progress of interventions. Systems should be able to capture demographic and socioeconomic characteristics and disaggregate data.

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A1: Evidence shows that many migrant populations are under-vaccinated for routine vaccinations, including MMR and DTP. The reasons for this are multiple and complex. Because of differences in health systems and vaccination programmes worldwide - and within Europe itself - many migrants arrive in host countries without having received all the recommended vaccinations, leaving them at risk of becoming seriously ill. Many migrants then remain un- or under-vaccinated because European health systems are not designed to facilitate catch-up vaccination of migrants across all age groups. Migrant children tend to be caught up with missing vaccinations when they enter the school system in their destination country. However, adult and adolescent migrants, who may also require catch-up vaccination to bring them in line with vaccine recommendations that they missed as children, are typically missed, due to low awareness of health professionals of this need and the absence of unified policies and incentives in this area. Many migrants also have protracted and complex migration journeys, and continue to live in precarious situations whereby they are socially excluded and/or do not engage with health and other services due to fear of authorities and legal repercussions.

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Very simply, it’s all about access. Access to healthcare services and advice, access to information, access to transport, access to affordable treatment or vaccines.

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A1: On the demand-side, complacency is often referred to as part of the 3Cs Model to determine vaccine hesitancy. Complacency refers to the perception that the risk of a disease is too low to justify the hassle of seeking vaccination services, or that vaccine side-effects outweigh the disease itself. I might argue that for people living in poverty, complacency isn’t appropriate. Rather, people living in poverty or socially excluded groups may feel that they don’t have a choice. There may be competing needs that take precedence over vaccination, like securing food and shelter. Getting vaccinated may feel more like a luxury than a necessity. For socially excluded groups, I am thinking of migrant groups in particular, it may also be that the risk of the disease is too low to justify risking personal safety.

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