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Childhood, Health Inequalities, and Vaccine-Preventable Diseases

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Childhood, Health Inequalities, and Vaccine-Preventable Diseases Childhood, health inequalities, and vaccine-preventable diseases Factsheet 1 THE MEASLES VACCINE HAS SAVED >20 million lives WORLDWIDE SINCE 2000. 1 in 10 Vaccination is a highly cost effective health intervention. It saves millions of people from certain infectious diseases, disability, and death each year. Vaccines protect health and children in the European region wellbeing and support the achievement of the remain vulnerable to potentially life- Sustainable Development Goals (SDGs)². threatening diseases as they have not received a basic set of vaccinations Europe is a world leader in controlling vaccine usually delivered in infancy9. preventable diseases3. However, there were outbreaks of measles and cases of diphtheria, pertussis, and Inequalities in access to childhood mumps in Europe in 2016, 2017, and 2018. immunisation persist. Like other medical Measles cases in Europe tripled between interventions, vaccination is subject to the 2017 and 20184. social gradient10, contributing to health inequalities11. Wealth distribution, maternal The mid-term review of the WHO/Europe education, place of residence, the sex of Vaccination Plan 2015-2020 found that the the child, and poverty are linked to levels region is not on track to reach its goal of of vaccination coverage12,13. It is important verification of measles and rubella elimination, to consider these factors when designing and is at risk of not reaching vaccination universal vaccination programmes that coverage targets5. respond to the needs of low socio-economic groups. Less than 0.5% of GDP is allocated to disease prevention programs and vaccine expenditure fall below 0.5% of healthcare spending in many of the European countries6. 288% increase Vaccination hesitancy is on the rise7. Some in suspected measles cases parents are deciding not to vaccinate their in the European region 8 14. children due to fears of unproven side IN THE FIRST 3 MONTHS OF 2019, effects, lack of information or underestimating COMPARED TO THE SAME PERIOD IN 2018 consequences for the health of their children and herd immunity. THE PUBLICATION OF EUROHEALTHNET POLICY PRECIS IS SUPPORTED BY THE EUROPEAN COMMISSION, THROUGH THE PROGRAMME FOR EMPLOYMENT AND SOCIAL INNOVATION (EASI 2014-2020). THIS PUBLI- EuroHealthNet CATION DOES NOT NECESSARILY REFL ECT THE POSITION OR OPINION OF THE EUROPEAN COMMISSION EUROPEAN PARTNERSHIP FOR IMPROVING HEALTH, EQUITY & WELLBEING FACT- SHEET The level of vaccination varies between Member States eale vaccination coverage trends 2014-2016 olio vaccination coverage trends 2014-2016 99% 99% unar 99% reee 99% 99% 99% ueour 99% unar 99% ween 97% ueour 99% 97% 99% eliu 96% rane 99% 96% 99% 98% 99% alta 93% eh euli 96% 97% 99% loaia 95% ru 97% 96% 99% etherlan 94% eliu 98% 95% 99% atia 93% alta 97% 94% 96% roatia 90% etherlan 95% 89% 95% oania 86% roatia 93% 90% 94% 94% enar oania 89% 86% 90% 98% ru utria 87% 75% 80% 85% 9 9 100% 75% 80% 85% 9 9 100% 2014 2016 Chart 1. Percentage of children vaccinated against measles in 2014 and 2016 (left); against polio in 2014 and 2016 (right). Source: ECHI Data Tool http://ec.europa.eu/ health/dyna/echi/datatool/index.cfm Migrant and refugee children In 2017 in the EU/EEA area, 87% of people who Migrant and refugee children (c. 25% of the total contracted measles were never vaccinated. 37% of migrant population in Europe) areconsidered the group known cases were in children less than five years of age, at greatest risk for vaccine-preventable diseases19 while 45% cases were in those aged 15 years or older15. because they may not have been vaccinated in their The highest incidence rates16 were reported amongst country of origin or may not have completed the babies less than one year old (367.2 cases per million) vaccination course. Less than one third of EU Member and children from 1 to 4 years of age (161.7 cases per States have specific directives on immunisation million) - too young to have received the first dose or focusing on migrants and refugees, including children. complete the recommended dosage of vaccination17. They are the most at risk of complications and death. Roma children Vulnerable and excluded families Studies show a higher rate of infectious diseases amongst Roma than the majority population20. The little available data on vaccination uptake in the Roma population21 suggests that Roma communities have 65% lower or much lower rates of childhood vaccination NOT VACCINATED uptake. This is especially the case for migrant Roma, AGAINST MMR while some exceptions exist in Croatia, Hungary and the Czech Republic. Some evidence suggests that the 18 probability that a Roma child will be vaccinated against 58% diphtheria, pertussis and tetanus (DPT), polio, and NOT VACCINATED MMR is about 55% - 60% that of a non-Roma child22. AGAINST TETANUS Raising awareness and improving levels of health Due to lack of aggregated European data, it is difficult literacy are important to overcoming vaccine hesitancy to fully examine vaccination rates by socio-economic but are not sufficient. status. However, the information that is already available offers – to some extent – the potential to Equitable access to safe and cost-effective vaccines investigate and predict trends. For example, only 35% of is vital to protect the general child population, and children in families facing multiple health vulnerabilities children from disadvantaged backgrounds in particular. seen by Medecins du Monde International Network18 This includes migrants, ethnic minorities, those with were vaccinated against MMR, while 58% had not low socio-economic status, and from rural communities been vaccinated against tetanus. and underserved urban areas. www.eurohealthnet.eu • [email protected] What international institutions are doing What more can be done31 WHO Europe 2015 - 2020 to the vaccine debate in 2018 - on 1. Grant free of-charge access to specific health European Vaccine Action ‘the Organisation and Delivery services, including national immunisation of Vaccination Services in the schemes for all children residing in Europe. Plan European Union’27, and on ‘The The WHO Europe developed State of Vaccine Confidence in 2. Integrate universal access to childhood a tailored immunisation pro- the EU 2018’28. immunisation into policies designed to gramme approach (TIP). It benefit groups facing multiple vulnerabilities, assists health care profession- The EC Expert Panel on Effective such as the Roma and migrants. als, public health authorities Ways of Investing in Health 3. Revise legislation and policies which and decision-makers in tailor- (EXPH) published a report on restrict access to childhood vaccination for ing services to close immunity ‘Vaccination Programmes and marginalised populations. gaps and reach under served Health Systems in the European groups23. Union’29. 4. Promote appropriate legislation and actions, and provision of a legal commitment to European Commission In 2019 public funding for immunisation. action The Commission’s Directorate General for Health and Food 5. Design childhood immunisation services The European Commission sup- Safety (DG SANTE) workplan with respect to principles of accessibility, ports EU countries to coordinate for 201930 includes action adequacy, and cultural sensitivity. Integrate their immunisation policies and on vaccination issues in line childhood immunisation services into programmes24. It encourages with the Council recommen- a wider child-centred early years and Member States to ensure opti- dation. This describes action transition-to-adolescence system. mal coverage of childhood im- on establishing a European 6. Strong health systems are needed to deliver munisation, and to cooperate Vaccination System, countering and to improve immunisation coverage on cross-border health threats misinformation and developing and equity. Public and health workforce and response preparedness. evidence-based information resilience to vaccine safety fears can be tools, strengthening supply and improved through increased capacity- In 2018 mitigating shortages, creating building within immunisation programmes. A communication on a proposal a European Vaccination Portal for ‘Strengthened cooperation to provide reliable information, 7. Ensure responsive, inclusive, participatory against vaccine preventable and monitoring public opinion and representative decision-making to diseases’ was published by the on vaccines and policy action. boost confidence in childhood immunisation Commission. It was accompa- among the public. Address vaccine hesitancy nied by a public consultation on Joint action on and other barriers in accessing vaccination. the proposal25. Vaccination 8. Invest in health promotion and disease As a result, the Council of EU The EU Joint action on prevention, and in improving health literacy, Ministers for Health and Social Vaccination (EU-JAV) is devel- focusing on those children and families Affairs (EPSCO) adopted a oping and sharing concrete in greatest need. Address underlying Recommendation to explic- tools for stronger national inequalities when addressing vaccine itly tackle vaccine hesitancy, responses to vaccination chal- hesitancy among various population groups. improve coordination on vac- lenges, and supporting long 9. Invest in comparable data at local, cine procurement, support lasting European cooperation regional, and national level that can be research and innovation, and against vaccine preventable used to measure inequalities in childhood boost EU-wide cooperation diseases. The action,
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