In a groundbreaking new study published in the International Journal for Equity in Health, researchers have shed light on a critical and complex public health issue affecting Latin America and the Caribbean: the underperformance of basic child vaccination programs. Drawing from an extensive cross-sectional analysis encompassing 18,136 children across 211 distinct regions in 15 countries, this study unpacks how a constellation of overlapping social, economic, and infrastructural deprivations act as potent barriers to achieving optimal vaccination coverage. By integrating vast household survey data with an equity-focused analytical framework, the investigation goes beyond mere statistical correlation to explore the multifaceted drivers behind vaccination gaps in vulnerable populations.
Vaccination is universally acknowledged as one of the most cost-effective interventions for preventing childhood morbidity and mortality. Yet, in Latin America and the Caribbean—regions often highlighted for their strides in health coverage—significant disparities persist in basic immunization uptake. The study’s lead author, Fene F. and team, recognize that understanding these disparities requires a nuanced approach, one that captures the lived realities of families in heterogeneous socioeconomic landscapes marked by inequality and deprivation. The findings highlight that the confluence of multiple deprivation dimensions—not just income poverty alone—substantially undermines vaccination coverage, signaling a need for multifactorial policy responses.
At the heart of this research is the concept of “multiple deprivations,” which refers to the simultaneous experience of disadvantages across various domains including but not limited to economic status, education level, housing conditions, access to clean water and sanitation, geographic isolation, and health service availability. Instead of isolating a single variable as a predictor, the team employed an integrative framework that accounts for how these interrelated factors compound one another. This multidimensional poverty approach allowed the identification of regions and populations where children are at the greatest risk of falling through the cracks of immunization programs.
One striking technical aspect of the study involved the harmonization of vast and diverse household survey data collected from national and regional databases. The researchers standardized variables related to household assets, parental education, health infrastructure access, and environmental factors to construct composite deprivation indices. These indices were then statistically linked to vaccination outcomes through multilevel regression models, controlling for potential confounders and spatial autocorrelation. This rigorous analytical method ensured that the relationships identified were not only robust but also reflective of localized socioecological contexts.
Moreover, the data underscored significant heterogeneity within and between countries. While some regions demonstrated almost complete basic vaccination coverage, others lagged dramatically behind. These interregional differences corresponded closely with varying profiles of deprivation. For example, rural and remote areas were disproportionately affected by deficiencies in healthcare infrastructure and transportation networks, exacerbating exclusion from immunization services. Likewise, populations enduring inadequate sanitation and unsafe drinking water exhibited lower vaccination uptake, highlighting the complex interplay between environmental health and immunization.
The research also illuminated gender and age dynamics in vaccination disparities. Children born to mothers with limited education were consistently less likely to receive complete basic vaccinations, pointing to the role maternal literacy and empowerment play in health-seeking behaviors and access. This finding echoes broader global health literature emphasizing that women’s educational status is a critical determinant of child health outcomes. Age-related patterns were also observable, with younger children in precarious living conditions showing a higher prevalence of missed vaccinations, suggesting that early-life vulnerabilities are exacerbated by structural deficits.
From a policy perspective, these findings have profound implications. The study argues for an integrated public health approach that moves beyond singular interventions focusing narrowly on vaccine provision. Instead, it advocates for multi-sectoral strategies that simultaneously address water and sanitation improvements, educational access, and infrastructural development to dismantle the systemic barriers affecting vaccine uptake. Tailored, context-sensitive policies are necessary to target the distinct deprivation profiles of different regions, ensuring more equitable health outcomes.
The authors stress the importance of strengthening data systems and surveillance mechanisms to better track vaccination coverage with a granularity that captures socioeconomic and regional disparities. Enhanced monitoring could facilitate adaptive program designs, enabling immunization campaigns to be more responsive to localized deprivation patterns. Additionally, community engagement and empowerment stand out as essential components for sustainable health improvements, especially in marginalized populations where distrust in health systems or lack of information may hinder vaccination.
This comprehensive investigation also touches on the role of pandemics and health crises in disrupting routine immunization services. The COVID-19 pandemic, while not the focus of this study, is mentioned as a contextual factor exacerbating preexisting vulnerabilities. Interruptions in healthcare delivery, supply chain disruptions, and widened inequalities have compounded the challenges for child vaccination programs. Hence, resilience-building within health systems emerges as a critical priority to mitigate the risk of backsliding in immunization achievements.
Importantly, the study does not shy away from the ethical dimensions underscored by these health inequities. It situates vaccination as not merely a biomedical intervention but as a marker of social justice, whereby ensuring equitable access to essential health services reflects broader societal commitments to human rights and child welfare. This framing invites policymakers, international organizations, and civil society advocates to collaborate toward dismantling structural inequalities that manifest in health disparities.
The methodological rigor and scale of the analysis lend weight to the argument that piecemeal approaches cannot adequately address vaccination inequities in the region. Instead, a systems-oriented understanding, informed by interdisciplinary collaboration across epidemiology, social sciences, and public policy, is crucial. The research sets a precedent for future studies seeking to unravel complex health inequity patterns through integrated data and precise spatial analyses.
Furthermore, this work encourages the inclusion of marginalized voices and local expertise in designing vaccination initiatives. Community health workers, indigenous groups, and civil society actors possess nuanced understanding of barriers that may be invisible in broad datasets but critical to intervention success. Incorporation of culturally sensitive practices and decentralized program management could bridge gaps left by conventional top-down health strategies.
Finally, the study stands as a compelling call to action in the wake of Sustainable Development Goals aimed at universal health coverage and health equity. It exemplifies how rigorous, equity-centered research can inform pragmatic interventions that bring vulnerable children from the margins toward full protection against preventable diseases. Continued investment in robust data collection, intersectional analysis, and multisectoral policy frameworks will be pivotal in overcoming the multi-layered deprivations undermining child vaccination in Latin America and the Caribbean.
Subject of Research: Multiple deprivations influencing suboptimal basic child vaccination coverage in Latin America and the Caribbean through a cross-sectional analysis of socio-economic and geographic factors.
Article Title: Multiple deprivations as drivers of suboptimal basic child vaccination in Latin America and the Caribbean: cross-sectional analysis of household survey data for 18,136 children across 211 regions in 15 countries.
Article References:
Fene, F., Johri, M., Michel, M.E. et al. Multiple deprivations as drivers of suboptimal basic child vaccination in Latin America and the Caribbean: cross-sectional analysis of household survey data for 18,136 children across 211 regions in 15 countries. Int J Equity Health 24, 184 (2025). https://doi.org/10.1186/s12939-025-02561-9
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