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Are people from disadvantaged groups less likely to receive routine vaccinations?


Socioeconomic inequalities in vaccine uptake: a global umbrella review.

Are people from disadvantaged groups less likely to receive routine vaccinations?

Quick-read summary

This work looks at whether inequalities (differences) in education, income, occupation, and deprivation (socioeconomic inequalities) are linked to lower routine vaccination rates.

It also looks to identify any potential reasons that may help explain this association.

Researchers found low vaccine uptake amongst disadvantaged groups in all of the evidence they looked at. However, in some of the evidence, the overall reasons/conclusions about why uptake was low, were mixed, as other reasons were also identified.

The review illustrates that the findings surrounding this topic are complex, but there appears to be evidence for socioeconomic inequalities in vaccination uptake.

The two most frequent reasons given for low vaccine uptake (regardless of socioeconomic factors) were related to vaccination knowledge, and confidence in vaccines themselves or those providing the vaccination.

What is the issue?

Socioeconomic inequalities are present within health and healthcare across the globe. This work sought to understand whether individuals from disadvantaged socioeconomic groups are at risk of low routine vaccination uptake, and what are the potential mechanisms (causes or reasons) that may contribute to this.

Routine vaccines are vaccines that are recommended for everyone (or for most of the population) at various stages in life. This work is focussed on routine vaccines and does not include the Covid-19 vaccine.

How we carried out this research

We conducted an umbrella review to summarise key results from 26 systematic reviews (which included 598 unique primary studies) in an easy-to-understand format.

Plain language explainer

Research methods:

  • A systematic review is a method of making sense of large bodies of information and helps us to understand what works and what doesn’t.
  • An umbrella review brings together and analyses lots of existing systematic reviews and is one of the highest levels of evidence.
  • A primary study is research that is obtained first hand – so the researcher goes directly to the source of the information (for example a community) and collects the information themselves.

Inequalities: When we talk about socioeconomic inequalities, we mean differences in things such as employment, income and education that put one group of people at a disadvantage compared to others – so this can include things like lower levels of income and education, poorer paid work or unstable employment.

Research summary

  • Researchers conducted a thorough search of eight databases and included studies that were relevant.
  • The reviews that were included had relevant information taken out and checked for quality.
  • The findings of each review were grouped according to the income status of the country that the research related to (low/middle-income countries, high-income countries, and mixed-income countries).
  • If there was evidence for lower uptake amongst disadvantaged socioeconomic groups, it was classified as an inequality in vaccine uptake.

What the research found

In all 26 reviews, there was evidence for low uptake for disadvantaged socioeconomic groups.

However, in 17 of these reviews, the conclusions were mixed, as other associations were also identified, namely, lower uptake for advantaged socioeconomic groups, and/or higher uptake for disadvantaged socioeconomic groups.

  • Reviews that explored high-income countries had more mixed findings than those focusing on low/middle-income countries.
  • The ‘mixed-findings’ help to explain lower uptake amongst advantaged socioeconomic groups, and higher uptake amongst disadvantaged socioeconomic groups on some occasions.
  • The two most frequent mechanisms (reasons) for low vaccine uptake (regardless of socioeconomic status) were related to vaccination knowledge, and confidence in vaccines themselves or those providing the vaccination.
  • It was often reported that people in advantaged socioeconomic groups may be more likely to conduct their own research into vaccination, which could, potentially, have both a positive or negative impact on uptake.
  • Even when authors explored lots of different measures of socioeconomic status, such as income, occupation, or deprivation,  levels of education were also a factor which influenced levels of uptake.

Therefore, although researchers found socioeconomic differences in routine vaccination uptake, this did not always follow a clear pattern.

By collating the evidence from several systematic reviews, this work provides a wider perspective which reveals that higher uptake for socioeconomically disadvantaged groups, and lower uptake for socially advantaged groups, can occur.


  • Before designing interventions to increase uptake, policy makers must be aware of the nature of the association between socioeconomic status and specific vaccines within their population.
  • Interventions must target all individuals with low uptake, which may include advantaged groups as well as disadvantaged groups.
  • Level of education was frequently mentioned as a factor which can influence vaccine uptake. Vaccination providers and policy makers should be very aware of how these differences are present in the communities they serve, so they can design effective interventions to increase uptake.
  • Interventions should target any groups where uptake is low, even if this is amongst advantaged groups. Maximising uptake subsequently increases herd immunity which is widely beneficial for those protected from disease, as well as healthcare authorities.
  • The recent pandemic has fuelled an alarming decrease in vaccination uptake globally, action needs to be taken to prevent further decline.

Why is this important?

This research is important to understand the interaction between socioeconomic inequalities and vaccination uptake on a global scale.

  • It can help policy makers and vaccination providers to appropriately target interventions towards patient groups that would benefit the most from support in accessing vaccination services.
  • It provides a concise, accessible guide to socioeconomic inequalities in vaccination uptake at the highest level of evidence synthesis.

Who is this evidence useful for?

It is useful for various professionals involved in delivering, organising, or monitoring immunisation programmes across the world. Some of these individuals may include doctors, nurses, those who work for local or national governments, or allied health and care services.

How were people/community groups/patients involved in this work?

As this is an umbrella review, there were no people/community groups/patients involved.

What’s next?

The next steps are to test the reasons for low vaccine uptake that have been identified by the umbrella review. This could either be done using qualitative methods, involving interviews with practitioners and wider health and care system stakeholders, or through an exploration of vaccination uptake statistics, and linking this to relevant data.

Get in touch about this research

Amber Sacre – email [email protected]

Twitter @AmberSacre

Read the full paper

Socioeconomic inequalities in vaccine uptake: A global umbrella review – published in PLOS ONE, December 2023

Contributing authors:

Prof. Adam Todd

Dr Katie Thomson

Dr Natalie Bennett

Dr Sarah Sowden

Prof. Clare Bambra

Dr Josephine Wildman