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Comparative Distributional Impact of Routine Immunization and Supplementary Immunization Activities in Delivery of Measles Vaccine in Low- and Middle-Income Countries


  • Although evidence shows that inequalities in under-5 mortality in low- and middle-income countries are decreasing, large disparities still persist and highlight the need to prioritize inequality reduction and equity in decision-making at the global and national levels.
  • We studied the differential coverage impact of routine delivery versus supplementary immunization activities (ie, campaign) for the delivery of measles vaccine in defining and comparing an equity impact number across the 2 distinct vaccine delivery modes.
  • This analysis can enable better description of the real-world impact of different delivery platforms in reducing health inequalities and improving equity at the global and local levels and can further highlight the important role that measles supplementary immunization activities can play in reaching children from poorer households.


In many countries, measles disproportionately affects poorer households. To achieve equitable delivery, national immunization programs can use 2 main delivery platforms: routine immunization and supplementary immunization activities (SIAs). The objective of this article is to use data concerning measles vaccination coverage delivered via routine and SIA strategies to make inferences about the associated equity impact.


Across 20 countries, the equity impact number summarized across wealth quintiles was greater (and hence less equitable) for routine delivery than for SIAs in the survey rounds (years) during, before, and after an SIA about 65% of the time. The equity impact numbers for routine measles vaccination averaged across wealth quintiles were usually greater than for SIA measles vaccination across country-year observations.


This analysis examined how different measles vaccine delivery platforms can affect equity. It can serve to elucidate the impact of immunization and public health programs in terms of comparing horizontal to vertical delivery efforts and in reducing health inequalities in global and country-level decision-making.

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