By Claire Thomas and co-author
At the mid-point of the Sustainable Development Goals period, with just seven years left until 2030 and in order to deliver on the central commitment to ‘Leave No One Behind’, clear data about which groups are at risk of being left furthest behind is essential. This brief assesses the available data regarding childhood routine vaccinations and ethnicity, language and religion. It offers suggestions on the relation between childhood vaccinations and ethnic, linguistic and religious diversity across several countries.
Decision-makers need data and statistics that are precise, timely, disaggregated, relevant, accessible and simple-to-use in order to execute and track the Sustainable Development Goals (SDGs) as well as the transformative promise to ‘Leave No One Behind’. Planning, monitoring and reviewing the 2030 Agenda for Sustainable Development necessitates the gathering, processing, analysis and distribution of a vast quantity of data and statistics at the local, national, regional and global levels by numerous stakeholders. We advise that data accessibility, quality and indicators for minority groups that are categorized by religion, language and ethnicity must be taken into consideration and enhanced in order to properly monitor the implementation of the SDGs and the ‘Leave No One Behind’ campaign. The goal of this brief is to persuade decision-makers to recognise the gaps of inclusiveness in each of the following categories: planning, information gathering and data distribution to enable the Expanded Programme on Immunisation (EPI), which ensures that children in all countries receive life-saving vaccinations.
Summary
The 2030 Immunisation Agenda envisions a society in which ‘everyone, everywhere and at every age fully benefits from vaccinations for good health and wellbeing.’ ((WHO, 2021), p. 48). Data is required to guarantee that the commitment to ‘Leave No One Behind’ is upheld. This research reveals that roughly three quarters of household surveys used to gather the relevant data did not provide enough information to allow for disaggregation on three key categories, namely religion, ethnicity and language. In short, data gaps exist in survey preparation, data collection and analysis.
Amongst countries analysed for each category, Angola had the highest difference in language. Indonesia and Madagascar had the greatest difference in religion. Indonesia and Côte d’Ivoire had the biggest difference in ethnicity, while Nepal had the largest difference in caste.
Minorities in 58.6% of the countries included in the SDG database had lower vaccination rates than the majority populations. In some countries, minorities overall had higher rates of vaccination than the majority population but in the same countries there were often other individual minority groups that have lower rates than average. When country specific vaccination rates from all sampled surveys with available data were combined, minorities have lower rates than majorities. Language and caste minorities have a higher degree of disparity in vaccination rates than religious and ethnic minorities do.
The disparities in terms of vaccination rates within countries and sub-regions are masked by aggregate data. Data at national level falls short of offering a thorough overview. The authors of this research strongly believe that ethnicity, religion and language should be considered as a basic minimum for disaggregation connected to ‘vaccines for all’ monitoring (SDG Target 3.8). Data must be acquired, and surveys must target potentially disadvantaged groups that are currently invisible in the available statistical data. It is critical that sample sizes for these groups be increased in order to assess efficacy and ensure services that reach all groups and address all potential barrier factors. Policies relating to more and higher quality data collecting must be adopted. For optimum results and data safety and security, National Statistical Offices must be autonomous, authoritative and responsible. Furthermore, data collection, analysis, publication and dissemination must follow human rights principles.
Key Points
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2021 saw the highest number of missed basic childhood vaccinations since 2009. Data from particularly disadvantaged people can be used to improve care, strategic planning and resource optimisation.
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We found that only 29.8% of all 67 countries with vaccination data and questions on religion, ethnicity and language included questions that collect information needed for disaggregation of religion, ethnicity and language. Furthermore, in only 14% of the total number of surveys were these disaggregated findings actually published. Out of the three minority types listed above, linguistic minorities are least likely to have a meaningful question, a sizeable sample for further analyses and published results.
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The largest difference between majority and minority groups was observed in Angola for language, Indonesia and Madagascar for religion, Indonesia and Côte d’Ivoire for ethnicity and Nepal for caste.
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In 34 (58.6%) of the 58 countries selected for analysis, minorities had lower rates of full basic immunisation than the majority population. While religious and ethnic minorities had modestly lower immunisation rates of 1.8% and 1.4%, respectively, caste-based and linguistic minorities had 5% and 5.9% lower immunisation rates.
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Because current survey statistics lack data for potentially disadvantaged groups, it is difficult to draw conclusions, monitor SDGs and track who, where and why specific groups are falling behind. Within data collection, there must be synchronised equity. Data for all ethnic, religious and linguistic groups must be collected on sufficiently large samples, analysed and publicised.
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To accomplish the LNOB principle, along with rates of vaccinations, it is necessary to look deeper into service availability, vaccine hesitancy and vaccination attitudes.
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Data must be gathered and published for all communities wherever feasible to avoid information suppression, but this must be done in accordance with best practice (including OHCHR’s Human Rights-Based Approach to Data).
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National Statistical Offices (NSOs) should be given additional autonomy and authority, and they should be the leaders in ensuring inclusion of disaggregation factors, accountability and compliance with the Human Rights-Based Approach to Data.
Inequalities have been identified between minority populations within a country, including some where minorities had higher overall total immunisation rates. An aerial view of the data has masking effects and aggregated averages overlook important disparities. The Nuristani minority in Afghanistan, for example, has a full basic vaccination rate of 0.7%, despite the fact that ethnic minorities in Afghanistan as a whole have a higher vaccination rate than the national average of 46.3%. As a result, we recommend policymakers, governing bodies and academics to evaluate data by community rather than relying on averages.
