Addressing Structural Barriers to Childhood Vaccination in Underserved Communities: Insights from Co-Designed Interventions (Monica Lakhanpaul)

The presentation was delivered and recorded during the 10th Lifecourse Prevention Summit, Paris, December 2025.

Prof. Monica Lakhanpaul, Professor of Integrated Community Child Health at the UCL GOS Institute of Child Health, challenges how health systems think about vaccine uptake in underserved communities, arguing that the barriers are structural, emotional, and systemic rather than simply informational.

Low vaccination rates are not evidence of indifference. They are evidence of systems designed for the convenience of providers rather than the realities of families, many of whom face impossible trade-offs between getting to a vaccination appointment and keeping the rest of the family fed, housed, or employed. Three buses to reach a vaccination center costs money that families living in poverty do not have to spare.

Drawing on decades of clinical and research experience in diverse and underserved communities across the UK, India, Brazil, and beyond, the briefing maps the multiple layers that make vaccination difficult to access. Cost and transport are practical barriers. Appointment systems, clinical environments, language, and the implicit biases that shape how health professionals engage with patients are structural ones. For families already navigating poverty, temporary accommodation, refugee status, or domestic violence, each of these layers compounds the others.

The MARKS framework, developed through fieldwork in India, offers a practical lens: meaningful change requires motivation, awareness, resources, knowledge, and skills, all working together. Information alone is not sufficient, and translated leaflets rarely reach the people they are intended for. What consistently works are community navigators, trusted people from within communities who can have the right conversation in the right language int he right setting.

The briefing also reflects critically on the limits of top-down health systems and makes the case for co-creation, cross-sector collaboration, and genuine curiosity about what communities are actually experiencing as the foundations of more effective and equitable vaccination programs.