EQUITY-BASED CHILDHOOD IMMUNIZATION POLICY-MAKING IN URBAN PUBLIC HEALTH UNITS ACROSS THE CANADIAN PRAIRIES: A COMPARATIVE STUDY

Abstract

Inequities in childhood immunization coverage rates increase the risk of disease outbreaks among vulnerable populations. This study assessed inequities in childhood measles, mumps and rubella (MMR) immunization coverage of four major cities across the Canadian prairies and the public health practices that were deployed to reduce inequities. One-dose by age-two MMR coverage rate inequities-over-time-measurements, and a policy-based inquiry into public health practices between 2009 and 2015 were conducted for each case study city. The results show that there were substantial differences in inequities between the provinces. The Saskatchewan case cities both exhibited low but increasing coverage rates, and large but reducing coverage inequities, over the study period. The Albertan case cities exhibited high coverage rates throughout the study period, with predominantly low inequities, except at a neighborhood-coverage level, in both cities. These results suggest that there are provincial differences in immunization policy and programming practices. For the Saskatchewan cases, geographically-based epidemiology, visual management initiatives, and targeted interventions led to successful public health efforts to reduce coverage inequities. Reminder-based interventions were reported as successful initiatives to increase coverage rates across all cases. Finally, in Alberta, a measles outbreak occurred during the study period, and the subsequent intensive efforts in Calgary differentially reached high-income and high home-ownership neighborhoods. Overall, the study suggests that when public health units detect local MMR coverage inequities and make intentional evidence-based efforts, they can be successful in reducing MMR coverage inequities.