The worldwide use of vaccinations for the prevention of diseases like diphtheria, tetanus, pertussis, influenza, and measles prevents roughly two to five million deaths a year amongst all age groups, according to health agencies like the World Health Organization (WHO). Global vaccine expansion strategies that have targeted younger populations and areas that share the highest burden of vaccine-preventable diseases have largely contributed to this, particularly over the last decade. Despite how successful vaccines have been since their inception, WHO has also reported that roughly one and a half million more deaths by vaccine-preventable diseases globally could be avoided if global vaccination coverage could be improved further.

One of the largest and most recent barriers to vaccine promotion and expansion is the COVID-19 pandemic. Through interruptions in healthcare systems and public health interventions, many global vaccination efforts were severely impacted through drastic lapses in staffing and data reporting, gaps in funding, and other barriers to keep existing programs and interventions going or kick-start more novel, better-targeted vaccine strategies and programs. As a result of these setbacks and more from the pandemic, global vaccination coverage overall dropped from eighty-six percent to eighty-one percent in 2021, and the number of completely unvaccinated children increased globally by five million since 2019.

Long before the pandemic, however, certain communities have always faced the largest brunt of these kinds of failures, resulting in systemic disparities in who ultimately receives a vaccine in the first place.

Vaccine disparities in the United States by race, gender, ethnicity, socioeconomic status, and geographical area have been well-documented. These disparities have created an undue disease burden, particularly on African American and Hispanic communities, sexual and gender minorities, rural and urban community members, the uninsured, and neighborhoods and communities hit hardest by poverty and economic hardship. The reality of these disparities has trickled down into higher rates of infection and mortality related to infectious diseases and vaccine-preventable diseases, deeper mistrust in vaccination efficacy, safety, and reporting, more logistical barriers to vaccine access, and lower vaccination rates for all immunizations amongst these communities.

Illegal immigrant communities in the United States, for instance, have reported hesitancy to get vaccinated due to concerns of being deported. African Americans are also less likely to have reliable access to the internet to sign up for vaccine appointments virtually, less likely to live in areas where vaccine hubs and clinics can be easily accessible, face longer driving distances to vaccine centers in comparison to their Caucasian counterparts and have fewer opportunities to request time off to go to the doctor’s office in the first place. These have been magnified especially with the push for Americans to get vaccinated against COVID-19, but these and other issues related to vaccine access have persisted pre-pandemic.

As we deal with new variants of COVID-19 and the re-emergence of diseases like measles and polio, better vaccination access must remain a top priority. Missouri Immunization Coalition members and leadership have key insight into how we can ensure vaccine equity in Missouri.

During her presentation at the 2022 Missouri Immunization Conference, Dr. Kendra Holmes said trust is vital to ensuring vaccine equity. “We have to work to regain that trust in those communities. And it starts [by] not being judgmental and being present. We have to start building trust if we ever want to decrease the disparities with vaccination equity.” At Affinia Healthcare in St. Louis, Missouri, where Dr. Holmes serves as Executive Vice President and Chief Operating Officer, leadership and staff came together to bring vaccination education, events, and information into African American communities in St. Louis, creating a wide reach of intersectional vaccination programming and a renewed desire to stay on top of vaccinations in this population. “Be that in churches, community centers, our organizations or schools, we work to build that trust and community and then discuss vaccine options,” concluded Holmes.

Accurate reporting of vaccination data¹ and ongoing vaccine research are also of great importance to understand which community members are being vaccinated at specific times and which ones are not, the reasons for gaps in vaccination rates, and creating meaningful programming to reach communities better. “If you don’t report it, you can’t measure it. If you can’t measure it, you can’t manage it,” says Lynelle Phillips, President of the Board of Directors at Missouri Immunization Coalition and Assistant Professor of Public Health at the University of Missouri-Columbia. “[We] must do better in reporting all of those indicators that affect distributive justice. Equity has to be out there front and center.”

Lisa Cox, Communications Director for the Missouri Department of Health and Senior Services, emphasizes the importance of vaccine campaigns and efforts with actual Missourians in mind. “Make sure that all of your audiences are in mind. It’s really important for us, especially on the campaign’s side, that we’re also making sure that people were hearing those messages from people that looked like them, and people they can trust and people they can relate to.”

Here at the Missouri Immunization Coalition, media campaigns and educational materials are produced in multiple languages for different platforms and Missouri populations. Collaborating with many different members and communities, all with the same goal of promoting immunizations, preventing disease, and protecting Missourians, allows for many voices contributing to the same goal. “Our collaborating partners know their communities very well. They know the needs of their community and we’re thrilled to be able to work with them and provide equitable access to all vaccinations,” says Nicole Cope, Executive Director of the Missouri Immunization Coalition.

Achieving vaccine equity in the face of the lowest overall childhood vaccination rates on record in thirty years, vaccine-preventable disease re-emergence, the effects of a global pandemic, persistent burnout amongst our workforce, and other systemic barriers to health require intersectional, intentional, and dynamic collaboration on all levels of public health, healthcare, and community work and policy. As leaders that live, work, and make change in the state of Missouri every day, we must ensure that achieving health equity is at the center of our efforts, especially as they relate to vaccination.


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