Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.
Universität Basel, Petersplatz 1, 4003, Basel, Switzerland.
Int J Equity Health. 2017 Jun 7;16(1):95. doi: 10.1186/s12939-017-0587-x.
Equity remains a priority in the international health development agenda. However, major inequities in vaccination coverage jeopardise the achievement of the Sustainable Development Goals. We aim at comprehensively describing how research has addressed equity issues related to vaccination.
We carried out an overview of systematic reviews (SRs) that explicitly explored the effects of interventions to improve vaccination in any context; for any vaccine and, in any language. We followed standard research synthesis methods to systematically search for SR, assess them for inclusion and extracting relevant data, particularly on vaccination related outcomes. To gather evidence on equity issues addressed in the SR, we used the PROGRESS-plus framework.
Our search obtained 2,003 hits which resulted in 54 included SRs, published between 1994 and 2014. The quality of SRs was generally poor, with less than half complying with most of the quality criteria. Reported vaccines included, by order of frequency, influenza and Expanded Programme on Immunisation vaccines. The types of interventions more frequently reported were related to vaccination delivery strategies, financial support and information, education and communication. Most of the SRs suggested effects favouring intervention groups as opposed to comparison groups. The most frequently reported equity attribute was 'place of residence' and the least reported equity attributes were sexual orientation and religion. Very few estimates of effects actually measured differences or changes between groups having those attributes and all of them referred to the place of residence. No data was found about reducing equity gaps for vulnerable groups or minorities, or attributes such as sexual orientation, education or specific religious groups.
Although research on vulnerable populations as a subgroup is abundant, it fails to report on the interventions that will actually reduce inequities and consider how redistribution of health care resources could shrink the gap between the privileged and most vulnerable groups including minorities. Research, if aiming at being responsive to global health policy trends, needs to report not only on specific attributes but also on how a better redistribution of health care resources could contribute to alleviating the unjust situation of the most vulnerable populations.
公平仍然是国际卫生发展议程的重点。然而，疫苗接种覆盖率方面的巨大差距危及可持续发展目标的实现。我们旨在全面描述研究如何解决与疫苗接种相关的公平问题。
我们对明确探讨了在任何背景下改善疫苗接种效果的干预措施的系统评价（SR）进行了概述；对于任何疫苗，并且以任何语言。我们遵循标准的研究综合方法，系统地搜索 SR，评估其纳入标准并提取相关数据，特别是与疫苗接种相关的结果。为了收集 SR 中所解决的公平问题的证据，我们使用了 PROGRESS-plus 框架。
我们的搜索共获得 2003 个结果，其中包括 54 篇纳入的 SR，发表时间为 1994 年至 2014 年。SR 的质量普遍较差，不到一半符合大多数质量标准。报告的疫苗包括流感疫苗和扩大免疫规划疫苗，按频率顺序排列。更频繁报告的干预类型与疫苗接种提供策略、财务支持以及信息、教育和交流有关。大多数 SR 表明干预组的效果优于对照组。报告的最常见公平属性是“居住地”，报告最少的公平属性是性取向和宗教。很少有估计的效果实际上衡量了具有这些属性的群体之间的差异或变化，所有这些都提到了居住地。没有发现关于减少弱势群体或少数群体的公平差距或性取向、教育或特定宗教群体等属性的任何数据。
尽管针对弱势群体的研究很多，但它们没有报告哪些干预措施实际上可以减少不平等，并考虑如何重新分配医疗保健资源可以缩小特权群体和包括少数民族在内的最弱势群体之间的差距。如果研究旨在响应全球卫生政策趋势，不仅需要报告特定属性，还需要报告如何更好地重新分配医疗保健资源可以有助于缓解最弱势群体的不公平状况。
