Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
Vaccine. 2019 Sep 3;37(37):5525-5534. doi: 10.1016/j.vaccine.2019.06.081. Epub 2019 Aug 7.
Extending the benefits of vaccination to everyone who is eligible requires an understanding of which populations current vaccination efforts have struggled to reach. A clear definition of "hard-to-reach" populations - also known as high-risk or marginalized populations, or reaching the last mile - is essential for estimating the size of target groups, sharing lessons learned based on consistent definitions, and allocating resources appropriately. A literature review was conducted to determine what formal definitions of hard-to-reach populations exist and how they are being used, and to propose definitions to consider for future use. Overall, we found that (1) there is a need to distinguish populations that are hard to reach versus hard to vaccinate, and (2) the existing literature poorly defined these populations and clear criteria or thresholds for classifying them were missing. Based on this review, we propose that hard-to-reach populations be defined as those facing supply-side barriers to vaccination due to geography by distance or terrain, transient or nomadic movement, healthcare provider discrimination, lack of healthcare provider recommendations, inadequate vaccination systems, war and conflict, home births or other home-bound mobility limitations, or legal restrictions. Although multiple mechanisms may apply to the same population, supply-side barriers should be distinguished from demand-side barriers. Hard-to-vaccinate populations are defined as those who are reachable but difficult to vaccinate due to distrust, religious beliefs, lack of awareness of vaccine benefits and recommendations, poverty or low socioeconomic status, lack of time to access available vaccination services, or gender-based discrimination. Further work is needed to better define hard-to-reach populations and delineate them from populations that may be hard to vaccinate due to complex refusal reasons, improve measurement of the size and importance of their impact, and examine interventions related to overcoming barriers for each mechanism. This will enable policy makers, governments, donors, and the vaccine community to better plan interventions and allocate necessary resources to remove existing barriers to vaccination.
将疫苗接种的益处扩展到所有符合条件的人，需要了解当前疫苗接种工作难以覆盖哪些人群。明确界定“难以覆盖”的人群（也称为高风险或边缘化人群，或最后一英里）对于估计目标人群的规模、根据一致的定义分享经验教训以及合理分配资源至关重要。我们进行了文献回顾，以确定现有的难以覆盖人群的正式定义是什么，以及它们是如何被使用的，并提出了一些未来可以考虑使用的定义。总的来说，我们发现：（1）需要区分难以覆盖的人群和难以接种疫苗的人群；（2）现有文献对这些人群的定义较差，并且缺乏明确的分类标准或阈值。基于这项综述，我们提出将难以覆盖的人群定义为那些由于地理位置、距离或地形、暂居或游牧式移动、医疗服务提供者的歧视、缺乏医疗服务提供者的建议、不完善的疫苗接种系统、战争和冲突、在家分娩或其他居家移动限制、或法律限制而面临疫苗接种供应方障碍的人群。尽管多种机制可能适用于同一人群，但供应方障碍应与需求方障碍区分开来。难以接种疫苗的人群是指那些可及但由于不信任、宗教信仰、缺乏对疫苗益处和建议的认识、贫困或低社会经济地位、缺乏时间获得可用的疫苗接种服务、或性别歧视而难以接种疫苗的人群。需要进一步的工作来更好地定义难以覆盖的人群，并将其与由于复杂的拒绝原因而可能难以接种疫苗的人群区分开来，改善对其规模和影响重要性的衡量，并研究与克服每种机制障碍相关的干预措施。这将使政策制定者、政府、捐助者和疫苗接种界能够更好地规划干预措施，并分配必要的资源来消除疫苗接种的现有障碍。
