Reduction of Childhood Immunization Disparities: Effective Science, Policy and Practice

A case study of the success of the national childhood immunization strategy in reducing and in some situations eliminating vaccination disparities between minority and non-minority populations deserves close scrutiny by health professionals and policy makers in devising programs to meet the Healthy People 2020 objectives for the elimination of health disparities and achievement of health equity. After a measles epidemic of 1989–1991, attack rates among nonwhite children <5 years of age were 4- to 7-fold higher than rates among white children. Because of the epidemic and of the known disparity in vaccine coverage and risk of disease, a dual strategy to eliminate measles in the United States was implemented: universal interventions likely to reach the majority of children and targeted interventions more likely to reach low-income and nonwhite children. In 1992, the gap in coverage between white and nonwhite children was reduced to 6% (from 15% in 1985); the risk of disease among nonwhite children was narrowed to<=-fold the risk of white children. During the 1990s, further implementation of the dual strategy resulted in narrowing the gap in vaccine coverage to 2% and elimination of endemic disease in all racial and ethnic populations. Reduction in the vaccination gap was sustained to the present (2010) and was found for other individual vaccines and the childhood vaccination schedule combining many vaccines. These findings continue to support the use of a dual strategy to reduce and eliminate health disparities