lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

A Standardized Approach for Measuring Multi-Dimensional Equity in Vaccination Coverage, Cost-of-Illness, and Health Outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) Project

18 Pages Posted: 26 Oct 2021

See all articles by Bryan Patenaude

Bryan Patenaude

International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health

Deborah Odihi

Johns Hopkins University - Bloomberg School of Public Health

Salin Sriudomporn

International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health

Joshua Mak

Johns Hopkins University - Bloomberg School of Public Health

Elizabeth Watts

Johns Hopkins University

Gatien de Broucker

Johns Hopkins University - Department of International Health

More...

Abstract

Background: Following a call from the World Health Organization in 2017 for a dashboard to monitor immunization coverage equity in line with the 2030 Agenda for Sustainable Development, this study proposes a new methodology and toolkit for measuring and tracking multi-dimensional equity in vaccine coverage, economic impact, and health outcomes.  

Methods: The Vaccine Economics Research for Sustainability & Equity (VERSE) composite vaccination equity assessment metric is derived from literature on the measurement of socioeconomic equity combined with measures of direct unfairness in healthcare access. The metric takes the form of a concentration index of vaccination coverage, where instead of ranking individuals by income, individuals are ranked by multi-dimensional unfairness in access. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon multiple dimensions of fair and unfair sources of variation in vaccination coverage. Fair sources of variation in coverage may include whether the child is underage to receive the vaccine according to the national immunization schedule. Unfair sources of variation may include sex of the child, maternal education, or socioeconomic status. Regression decomposition is applied to determine the relative share each unfair dimension has on overall inequality in vaccination status. These methods are applied to the most recent National Family Health Survey (NFHS) from 2015-2016 in India to assess the equity in fully immunized for age vaccination coverage and zero-dose status. Equity results are computed by state and nationally and compared with coverage to produce an equity-coverage plane.  

Results: The multi-dimensional equity measure in is 0.105 (SE: 0.003) and 0.068 (SE: 0.005) for zero-dose status and fully immunized for age respectively. The most disadvantaged quintile is therefore 10.5% more likely to be zero-dose than the most advantaged quintile or 6.8% less likely to be fully immunized. The primary driver of unfair disadvantage in zero-dose status and fully immunized status, respectively, is maternal education accounting for 31.4% and 18.9% of observed inequality, followed by socioeconomic status contributing 15.9% and 14.9%, and health insurance coverage contributing 7.0% and 4.16%.  

Conclusions: Our work builds upon existing methods and toolkits by providing a standardized method for measuring equity across multiple dimensions. It also allows policymakers to determine the relative magnitude of drivers of overall equity in vaccine outcomes rather than only the drivers of socioeconomic or unidimensional equity. Additionally, the toolkit expands the available outcomes for inequity analysis from coverage to include financing and health outcomes. This framework could be adapted to track equitable progress toward Universal Health Coverage (UHC) beyond the vaccine space.

Funding: The Vaccine Economics Research for Sustainability & Equity (VERSE) project is funded by the Bill & Melinda Gates Foundation under award INV-003813

Declaration of Interest: None to declare.

Ethical Approval: The Vaccine Economics Research for Sustainaability & Equity (VERSE) project, under which this study falls, obtained IRB approval from the Johns Hopkins Bloomberg School of Public Health IRB (IRB00014999).

Keywords: health equity, equity measurement, monitoring and evaluation, health economics, vaccines, GLOBAL HEALTH, child health

Suggested Citation

Patenaude, Bryan and Odihi, Deborah and Sriudomporn, Salin and Mak, Joshua and Watts, Elizabeth and de Broucker, Gatien, A Standardized Approach for Measuring Multi-Dimensional Equity in Vaccination Coverage, Cost-of-Illness, and Health Outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) Project. Available at SSRN: https://ssrn.com/abstract=3945450 or http://dx.doi.org/10.2139/ssrn.3945450

Bryan Patenaude (Contact Author)

International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health ( email )

Baltimore, MD
United States
21231 (Fax)

Deborah Odihi

Johns Hopkins University - Bloomberg School of Public Health ( email )

Wolfe Street
Baltimore, MD 21205
United States

Salin Sriudomporn

International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health ( email )

Baltimore, MD
United States
21231 (Fax)

Joshua Mak

Johns Hopkins University - Bloomberg School of Public Health ( email )

Wolfe Street
Baltimore, MD 21205
United States

Elizabeth Watts

Johns Hopkins University ( email )

Baltimore, MD 20036-1984
United States

Gatien De Broucker

Johns Hopkins University - Department of International Health ( email )

Click here to go to TheLancet.com

Paper statistics

Downloads
119
Abstract Views
649
PlumX Metrics