Explorations of inequality: Childhood immunization, a WHO report launched in July 2018 describes how a child’s likelihood of being vaccinated is affected by socioeconomic, demographic and geographic factors. The report is based on international household health surveys conducted in 10 countries – Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda – between 2012 and 2016. These countries face the most severe immunization challenges, and together account for more than 70% of children who do not get a full course of basic vaccines. We found that the countries face distinct patterns of inequality, from Uganda, where inequality tended to be very small for most of the featured characteristics, to Nigeria, where inequality was pronounced for most characteristics. Across the 10 countries, some common findings prevailed.
Economic status, mother’s education, mother’s age, subnational variation, birth order and child’s sex are all key indicators which have, in one way or another, determined if a child is vaccinated or not. Children who benefit from multiple forms of advantage are more likely to be vaccinated than children who experience a single type of advantage. For example, in Afghanistan, Chad, Nigeria and Pakistan, a child whose mother has secondary school education, is aged 20–34 years, and who is from the richest 20% of the population, had between 7 and 51 times higher chances of receiving the third dose of all DTP-containing vaccines, compared with a child whose mother has no formal education, is aged 15-19 years and who is from the poorest 20% of the population.