Vaccination remains the primary and most effective preventative strategy for protecting older people against pneumococcal disease. However, uptake is low. Across Australia, Canada, Germany, Japan, the Netherlands, Spain, the UK and the US, our Moving the margins research finds that:

• Marginalised and underserved groups face specific barriers to obtaining pneumococcal and other routine vaccinations including:
  • Suboptimal access to personal health records
  • A lack of targeted messaging to marginalised groups
  • Access barriers, including cost, physical disability or living in a resource-poor area
  • A lack of trust in government and the health system
• Compared to those for other routine adult vaccinations, there are few structures in place to improve pneumococcal vaccination uptake

We know that populations around the world are ageing rapidly. But they’re also become more demographically diverse, in ways that can widen health inequalities. This means there is an urgent and growing need to prioritise tackling health inequalities, especially when these inequalities relate to preventable conditions, such as pneumococcal disease. Along with the significant health benefits for individuals, there are wider national economic benefits to be gained if we invest in increasing adult pneumococcal vaccination uptake.

Nevertheless, this report demonstrates that adult pneumococcal vaccination continues to be under-prioritised. Structural barriers that affect the entire adult population may disproportionately affect marginalised populations and must be addressed at a global and national level. But we must also recognise that these groups face other barriers, specific to them, that prevent them from accessing healthcare and put them at increased risk of being left behind.

Across the eight countries involved in the research, we’ve seen examples of interventions that have improved vaccination uptake. In addition, the COVID-19 pandemic has clearly exposed inequalities in health and access to vaccination, leading to greater awareness of the underlying causes and barriers to health equity.

But awareness needs to be backed by action. Reducing inequalities in adult pneumococcal vaccine uptake will require both accountability at a national governmental level and local targeted approaches. Our report makes a series of recommendations for the WHO, national governments, public health bodies and local healthcare systems.

This research was made possible by an unrestricted educational grant from Pfizer.