TL;DR
The analysis reveals the complex interplay of various factors influencing COVID-19 vaccination decisions, emphasizing the importance of residential areas and urbanization.
ABSTRACT Objective: To evaluate the spatio-temporal variation of childhood immunobiological vaccine coverage in the municipalities of the Northern region of Brazil, comparing cross-sectional data from 2018 and 2022, and its association with socioeconomic and maternal variables. Methods: This is a comparative ecological study with coverage data for seven immunobiologicals in the municipalities of the Northern region for the years 2018 and 2022. Data were obtained from the Department of Informatics of the Unified Health System. Spatial analysis (global, bivariate, and local Moran’s Index) was used to verify the association between vaccine coverage and independent variables (GDP per capita, Brazilian Deprivation Index, maternal schooling, proportion of indigenous people, full-term births, and birth weight). Results: There was a widespread decline in vaccine coverage when comparing the two periods, except for the meningococcal C vaccine. Vaccination was positively associated with GDP per capita and maternal schooling, and negatively associated with the Deprivation Index, with these associations intensifying over the period. The spatial correlation between immunization and the proportion of the indigenous population, previously not significant, became strongly negative in 2022. Clusters of low immunization and socioeconomic vulnerability were identified mostly in the states of Pará and Amazonas, and clusters of high immunization and better indicators in Tocantins and Rondônia. Conclusion: The decline in childhood vaccination in the Northern region is a spatially structured phenomenon that reflects and deepens socioeconomic inequalities. The formation of vulnerability clusters, especially in areas near the Brazilian border, represents a risk for the re-emergence of vaccine-preventable diseases and demands territorially focused public health policies.
Multiple socioeconomic, structural and operational factors were associated with unvaccinated rates, highlighting the relevance of healthcare service organization even in favorable social contexts and classifying municipalities into risk profiles may help guide interventions to improve coverage.
BACKGROUND Trust in vaccines and those who deliver them is often shaped by personal social networks, yet empirical data on these dynamics remain limited in low-and middle-income settings. Social networks shape exposure to information, norms, and reinforcement processes that influence vaccine decision-making. We examined how rural South Africans' social network composition and content influence their willingness to receive a COVID-19 vaccine. METHODS We analysed 2022-23 data from the Sixhumene social network study conducted primarily among young adults in three rural KwaZulu-Natal communities. Our primary outcome was a six-level ordinal measure combining past vaccination and hypothetical willingness. Using multivariable ordinal logistic regression, we evaluated associations between vaccine willingness and social network size, kinship composition, geographic proximity, gender homophily, support received, and respondent characteristics. RESULTS Respondents were predominantly female with median age 21 years (IQR 18-28) and identified a median of three key social contacts, with networks characterised by strong kinship and local ties. Vaccine willingness varied by the geographic composition of networks. Compared with urban respondents whose networks were concentrated within the household, willingness was higher among those with more geographically dispersed networks, including urban respondents with alters in the same village (aOR 2.54, 95% CI 2.40-2.70) or outside the village (aOR 3.26, 95% CI 2.04-5.20). Similarly, among rural respondents, willingness was higher among those with household-based networks (aOR 1.95, 95% CI 1.57-2.41), village-based networks (aOR 1.63, 95% CI 1.40-1.90), and networks extending beyond the village (aOR 1.64, 95% CI 1.50-1.79). Emotional support was positively associated with willingness (per 30 contact-days: aOR 1.15, 95% CI 1.01-1.32), while physical support was inversely associated (aOR 0.84, 95% CI 0.72-0.98). DISCUSSION Vaccine willingness in this rural setting was shaped by both individual factors and network dynamics. Emotional support showed a modest positive association with willingness, suggesting supportive social ties may help promote vaccination willingness.
Despite well-established childhood immunization programs in many high-income countries, vaccination series are often delayed or not completed. Gaps in vaccination coverage are more common among children from socioeconomically disadvantaged households, among whom they are associated with higher rates of related hospitalizations. We aimed to assess the extent of these gaps in Germany, as well as the presence of socioeconomic inequality and the factors accounting for it. Using health insurance claims data from Techniker Krankenkasse for 2016–2019, we examined vaccination coverage for a comprehensive set of STIKO-recommended childhood vaccinations in six birth-year cohorts (2011–2018; approximately 430,000 children; 2.5 million recommended vaccinations). Coverage was defined as completion of the recommended series with all doses administered within the recommended age window. Socioeconomic inequality was quantified using the Erreygers-corrected concentration index and decomposed into contributions from factors such as parental education and travel time to the treating physician. Approximately 80% of vaccination series in the sample were complete and administered within the recommended age window. Vaccination coverage showed a small but statistically significant socioeconomic gradient (concentration index = 0.024, 95% confidence interval: 0.023 to 0.025) favoring children from higher socioeconomic households. In the decomposition analysis, provider type accounted for the largest share of this gradient, with lower completion rates and timeliness among children whose outpatient care was mainly delivered by general practitioners compared with pediatricians. Parental education contributed to a lesser extent, and travel time contributed little to the observed inequality. Childhood vaccination coverage in Germany remains below national targets and shows a small socioeconomic gradient. The gradient appears to be less strongly related to logistical access barriers than to differences in how vaccinations are delivered in outpatient care outside pediatric settings. These provider-type differences in vaccination delivery may therefore be more relevant for narrowing the observed gradient than further reductions in travel time.
While Chile achieved one of the world’s highest and most equitable SARS-CoV-2 vaccination coverages during the pandemic, less is known about the post-pandemic stage. This study examines within-country geospatial disparities in COVID-19 vaccination uptake and their socio-demographic determinants in two urban areas of Chile. A population-based survey conducted in May 2024 collected individual data on vaccination status and socio-demographic characteristics. These were georeferenced and linked to census information at the household block level. Spatial analyses explored clustering and correlations between the number of vaccine doses and variables such as age structure, educational attainment, overcrowding, and proximity to public health facilities. Moran’s Index was used to assess spatial autocorrelation and bivariate relationships, disaggregated by sex and city. The number of vaccine doses inoculated displayed significant spatial concentration, particularly among women. A positive spatial correlation was found between vaccination and higher education, and a negative correlation with overcrowding in one city. Distance to health facilities was not significantly associated with vaccine uptake. Across both cities, a higher proportion of older adults was associated with higher vaccination rates, with gender-specific patterns observed. Despite Chile’s previously homogeneous vaccination performance, post-pandemic findings reveal emerging socio-spatial disparities. The return of demographic and territorial determinants suggests a shift toward structural influences on vaccine uptake. These results underscore the need for territorially tailored public health strategies to reduce intra-country disparities in immunization access over time.
Abstract Compliance with epidemic prevention norms has been found to be higher in developing regions than in developed regions; however, the nature and underlying mechanisms remain unclear. We propose that socioeconomic development of environments changes the adaptive benefits of fundamental social motives, especially disease avoidance and familial motives, which shape variations in compliance during pandemics. To examine the effects of these motives on the relationship between socioeconomic environments and compliance, we conducted three studies measuring environmental socioeconomic development with the Human Development Index (HDI). Study 1 (with two datasets: N = 43,244, 53 countries; N = 94,657, 71 countries) revealed a stable negative correlation between country-level HDI and compliance, even after controlling disease severity, government responses, and individualism. Studies 2 (an analysis of social media text data; N = 22,588, 31 provinces) and 3 (a large-sample survey; N = 6,122, 31 cities) replicated this correlation in China at the provincial and city levels, and identified disease avoidance and familial motives as mediators. These findings provide evidence for how socioeconomic environments shape compliance during pandemics, highlight the importance of familial motives alongside disease avoidance, and offer insights into tailoring public health strategies across diverse environments. Content of image described in text.