Pneumococcal vaccination, which can prevent certain, especially severe, types of pneumonia, is recommended for older adults and people in at-risk groups in many countries. Yet, especially in the most deprived groups, uptake remains low, leading to deepening health inequalities.

A global report published by the International Longevity Centre UK highlights that interventions to improve inequities in uptake should be targeted at the following groups: ethnic minorities, indigenous populations or individuals living in areas with poor healthcare infrastructure, those with low incomes or conservative political attitudes and undocumented and homeless people.

• 2020 data from the US finds a 24.3% disparity in uptake between Hispanic adults (48.1%) and White adults (72.4%) and in 2017, a 23.5% disparity in vaccination rates between the lowest and highest income deciles.

   

• In 2018, Australia’s indigenous population accounted for only 3% of the total population, but represented 11% of all instances of invasive pneumococcal disease. And uptake rates for those aged 50-64 declined between 2004-05 and 2012-13, from 30% to 23%.

“Just having clinics nearby with Aboriginal staff and good doctors and nurses and just having the vaccine in the fridge in the clinics is insufficient.” Patrick Cashman, Immunisation Coordinator, Hunter New England Health, Australia

The Moving the margins report, based on interviews with experts across Australia, Canada, Germany, Japan, the Netherlands, Spain, the UK and the US, finds that key barriers to improving access to vaccination for those that need it most are:

1. Suboptimal access to personal health records (this is necessary for individuals to take control of their health)
2. A lack of targeted messaging to marginalised groups
3. Access barriers, including: cost, and being unable to access a primary care facility due to physical disability or living in a resource-poor area
4. A lack of trust in government and the health system

Structural barriers, such as policymakers’ failure to educate the public and a lack of awareness on behalf of healthcare professionals on the value of the pneumococcal vaccine also contribute to suboptimal uptake.

“The most important campaigner is your doctor, but the doctor is not suggesting [the pneumococcal vaccine].” Esther Martinez Almazan, Geriatrician, Spanish Geriatrics Society, Spain

“…Very few older adults know that they are eligible, we generally need to advertise this better. And where there has been some advertisement at the regional level, it needs to be more targeted to subgroups with low uptake.” Dr Igarashi Ataru, Associate Professor, Unit of Public Health and Preventative Medicine, Yokohama City University School of Medicine, Japan

And added to this is inadequate tracking of who is and isn’t receiving their vaccinations, making it harder to target interventions and improve uptake.

The report makes a series of recommendations for the WHO, national governments, public health bodies and local healthcare systems including:

• Implementing a “call and recall” system for adult pneumococcal vaccination.
• Better reporting and data collection at the local and national level.
• National 10-year strategies to reduce health inequalities.
• Introducing accreditation for healthcare providers to indicate those with inclusive and diverse spaces.

Arunima Himawan, Senior Health Research Lead, ILC-UK, said:

“Pneumococcal disease is a fatal illness, but it need not be. We have a vaccine that works, yet uptake, especially marginalised and underserved adults, is unacceptably low. Even small improvements in data monitoring and having a call and recall could significantly improve coverage rates. As can having a system of accreditation for healthcare providers to indicate those with inclusive and diverse spaces. With greater attention at the global and regional level to improve population health, including the EU’s revised Global Health Strategy and WHO’s Immunisation Agenda 2030, there’s an important opportunity to tackle these inequalities.”

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

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Contact

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Notes

The full report Moving the margins: Improving adult pneumococcal vaccine uptake in marginalised groups is available at Moving the margins: Improving adult pneumococcal vaccine uptake in marginalised groups – ILCUK and on our project programme page https://ilcuk.org.uk/moving-the-margins/

The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections. Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, blood poisoning (sepsis) and meningitis.

The ILC conducted 34 stakeholder interviews with experts from: Australia, Canada, Germany, Japan, the Netherlands, Spain, the UK and the US. The stakeholders we interviewed included healthcare professionals (HCPs), as well as experts in healthcare and public health delivery, adult pneumococcal vaccination, adult immunisation, and health inequalities. We also spoke to representatives from a range of organisations, including some who work directly with marginalised and underserved communities.

A blog published on 16 January 2023 summarising the key points of the report is available at Pneumonia: we must protect people in marginalised groups – VaccinesToday

About ILC

The ILC is the UK’s specialist think tank on the impact of longevity on society, and what happens next.

The International Longevity Centre UK was established in 1997 as one of the members of the International Longevity Centre Global Alliance, an international network on longevity.

We work with central government, local government, the private sector, and professional and academic associations to provoke conversations and pioneer solutions for a society where everyone can thrive, regardless of age.