How does Socioeconomic Status Impact on Vaccination?

Renata Zgraja

How often have you considered the impact of socioeconomic status on vaccine uptake? You would hope that all children have the same opportunity to be vaccinated, but studies into this area have resulted in some interesting findings.

It has been observed that factors such as having a single parent, being born overseas, low socio-economic status, late birth order, parental unemployment or having a parent under 25 years of age are often correlated with decreased rates of immunisation [1]. Unfortunately, we are unable to choose the life we are born into and being aware of these discrepancies will hopefully allow the gap in immunisation between different socioeconomic groups to be rectified. Fortunately, the Australian government wants to provide equal immunisation opportunity for all and this is achieved by administering all vaccinations on the National Immunisation Schedule for free [2]. However, whilst economic incentives can increase vaccination compliance, this is not the only factor which is responsible for causing disparities in vaccine uptake between various socioeconomic groups. Similarly, the Australian government has actively been trying to increase vaccination rates through routine school-based vaccination programs [3]. It has been found that these programs demonstrate good vaccine uptake ranging from 60- 85%, with the most significant impact occurring in late primary and lower secondary school [3]. It has been found that vaccine uptake in these programs is consistently greater than other techniques use to vaccinate adolescents such as mandates for school entry or GP delivery [3]. These types of programs remove the hassle associated with seeing your general practitioner and serve as a friendly reminder to parents to keep up to date with their child’s vaccination schedule. Improving vaccination-associated health literacy would vastly benefit individuals disadvantaged by lower socioeconomic status. Studies have shown that using simple language when explaining the benefits and risks of vaccination is able to enhance vaccination rates [4]. Despite the fact that the World Health Organisation advocates for vaccination every year, with its week long International Immunisation Week campaign [5], other strategies to promote vaccination would be of benefit. Possible suggestions include more effective posters, pamphlets for all expecting mothers as well as regular television advertising with the goal to instill and educate people about the importance of vaccination in a non-overwhelming way.

Low socioeconomic status isn’t the only factor which contributes to lower vaccine uptake. Affluent and prestige areas have also been found to have decrease rates of immunisation. However, the reasons for decreased vaccine uptake significantly differ from those found in people of lower socioeconomic status. People with higher socioeconomic status are usually associated with higher rates of conscientious objectors. For example, in 2009, the highest levels of conscientious objectors to vaccination were found in coastal areas of South East Queensland, northern New South Wales, the Mount Lofty Ranges region of South Australia and south west Western Australia [6]. Similarly, it has been found that in Perth areas with the lowest vaccine coverage include Cottesloe, Fremantle, Mossman Park and Peppermint – with all these suburbs falling under 5% of the national average [7]. These areas are associated with increased socioeconomic status with Peppermint Grove being regarded as Western Australia’s richest suburb and the fifth most expensive in all of Australia [8]. The prime intervention to increase vaccination uptake in this group would by advocating for vaccination, especially promoting the importance of herd immunity and the severe side effects of diseases that can be prevented through vaccination. Vaccination does not only have individual benefits but can help to protect others. If everyone in the community is vaccinated then diseases can even be eradicated completely, as has been observed with small pox [9]! If you are conscientiously objecting to vaccination for either yourself or your family, please talk to your General Practitioner or read our previous post, Common Vaccination Misconceptions.

Vaccinations have revolutionised the world of medicine and decreased the spread of disease [10]. They play a pivotal role in developing herd immunity. Despite socioeconomic status, it is important that everyone is vaccinated to protect yourself and those around from illness. Remember to keep track of the vaccination schedule (which can be found on this website) and talk to your GP today about vaccination today!

References

1. Hull B, McIntyre P, Sayer G. Factors associated with low uptake of measles and pertussis vaccines – an ecological study based on the Australian Childhood Immunisation Register. Aust NZ J Public Health [Internet]. 2001 Oct [cited 2014 Apr 1]; 25(5):405-410.

2. Australian Government, Department of Health. Immunise Australia Program [Internet]. Canberra, ACT (Australia); 2014 [updated 2014 Mar 6; cite 2014 Apr 5]. Available from: http://www.immunise.health.gov.au/

3. Ward K, Quinn H, Menzies R, McIntyre P. A history of adolescent school-based vaccination in Australia [Internet]. Communicable Diseases Intelligence; 2013 Jun [cited 2014 Apr 2]. 37(2). Available from: https://www.health.gov.au/internet/main/publishing.nsf/Content/cdi3702j

4. Jackson T, Thomas D, Morton F. Use of a low-literary patient education tool to enhance pneumococcal vaccination rates. JAMA [Internet]. 1999 [cited 2014 Apr 1]; 282:646-650.

5. World Health Organisation. World Immunization Week 2014 [Internet]. 2014 Mar [cited 2014 Mar 25]. Available from: http://www.who.int/campaigns/immunization-week/2014/en/

6. Hull B, Dey A, Menzies R, McIntyre P. Annual immunisation coverage report, 2010 [Internet]. Communicable Diseases Intelligence; 2013 Mar [cited 2014 Apr 5]. 37(1). Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdi3701b

7. Government of Western Australia, Department of Health. Western Australian Immunisation Strategy 2013–2015 [Internet]. 2013 [cited 2014 Apr 2]. Available from: http://www.public.health.wa.gov.au/cproot/5225/2/immunisation-strategy-wahealth-2013.pdf

8. Realestate.com.au. Australia’s 25 most expensive suburbs & their houses [Internet]. 2012 Oct [cited 2014 Apr 5]. Available from: http://www.realestate.com.au/blog/australias-25-most-expensive-suburbs-and-their-houses/

9. Omer S, Orenstein W, Koplan J. Go Big and Go Fast – Vaccine Refusal and Disease Eradication. NEJM [Internet]. 2013 Apr [cited 2014 Apr 3]; 368(15):1374-1376.

10. Omer S, Salmon D, Orenstein W, deHart M, Halsey N. Vaccine Refusal, Mandatory Immunisation, and the Risks of Vaccine-Preventable Diseases. NEJM [Internet]. 2009 May [cited 2014 Apr 4]; 360(19):1981-1988.

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