Bridging the Gaps: Overcoming System-Level Failures in Vaccination Equity (Michael Edelstein)

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

Prof. Michael Edelstein, Professor of Public Health at Bar-Ilan University, examines why vaccination programs continue to fall short of equity goals despite vaccines being widely available, and what health systems need to do differently to reach the populations they are currently missing.

A foundational distinction runs through the briefing: equality and equity are not the same thing. Offering the same service to everyone is not equivalent to ensuring that every individual has the same chance of being fully vaccinated. Different population groups face distinct barriers, and without tailoring services to their needs, coverage stagnates. Global DTP3 coverage has barely moved in the last decade, and the Immunization Agenda 2030 is the first WHO strategy document to explicitly name equity as a priority.

Research from the River EU project, which specifically examined communities that are socioeconomically deprived yet achieve high vaccination rates, challenges the assumption that deprivation and low vaccination uptake are inseparable. Bangladeshi communities in London, Arab communities in Israel, and Somali communities in Finland all demonstrate that high coverage is possible regardless of socioeconomic status. Common enablers include strong cultural norms around vaccination, information in accessible languages, culturally aware healthcare workers, welcoming clinical environments, and providers who treat families with genuine respect.

The briefing also challenges how programs measure their own performance. Aggregate coverage figures obscure two critical gaps: whether vaccines are being delivered on time, and whether courses are being completed. A country can report 98% MMR coverage and still experience measles outbreaks. Dropout data from London shows that groups with lower initial uptake are also less likely to complete vaccination courses, meaning that standard figures underestimate the true scale of inequity.

A related problem is treating minority communities as uniform. Within-group variation in vaccination behavior is often greater than between-group variation, making broad-brush interventions poorly matched to the actual diversity of the populations they target.

The overarching message is that better data, substratified, timely, and qualitative, is a prerequisite for more equitable vaccination programs.