402Measles vaccine coverage: The rise of vaccine hesitancy in upper-middle income countries. (2nd September 2021)

• Record Type: Journal Article
• Authors: Cata-preta, Bianca; Santos, Thiago M; Barros, Aluisio JD; Victora, Cesar G; Wehrmeister, Fernando C
• Is Part Of: International journal of epidemiology. Volume 50(2021)Supplement 1
• Publication Date: 2021-09-02
• Subjects: Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyab168.114
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: With the rise of vaccine hesitancy, which is allegedly more frequent among rich families, we hypothesized that the classical pattern of a positive gradient in coverage with rising wealth may no longer be observable in low- and middle-income countries (LMICs). Methods: We analysed DHS and MICS surveys conducted from 2010-2018 in 88 LMICs. We estimated inequality in measles vaccination coverage by wealth quintile for children aged 12-23 months using the Slope Index of Inequality (SII). Negative SII values indicate higher coverage among poor children. We correlated the SII with per capita Gross Domestic Product (GDP), using countries as the units. Results: Pearson's correlation coefficient between SII and log per capita GDP was -0.35 (p < 0.001). The percentages of countries with higher coverage among children from poor families than among those from wealthy families were 14%, 21% and 54% in low, lower-middle and upper-middle income countries (p level for trend=0.001), respectively (Figure 1 ). Conclusions: Our results are consistent with lower vaccination coverage among the wealthy when compared to poor families in countries with higher per capita GDPs. Key messages: Vaccine hesitancy was initially detected in high-income countries, but our analyses show that it is also present in upper-middle income countries.