Inequality dimensions of childhood vaccination coverage in Indonesia: a scoping review

  • Bianda Dwida Pramudita Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta / Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0009-0008-8400-9657
  • Jonathan Hasian Haposan Department of Biostatistics, Epidemiology and Population Health, Universitas Gadjah Mada, Yogyakarta, Indonesia / Department of Pediatrics, Faculty of Medicine, Dentistry, Health Sciences, University of Melbourne, Parkville, Australia / Infection, Immunity and Global Health, Murdoch Children's Research Institute, Parkville, Australia
  • Fulgence Niyibitegeka Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
Keywords: childhood, Indonesia, inequalities, vaccination coverage

Abstract

Purpose: To map existing evidence on inequalities in childhood immunization coverage in Indonesia using the Social Determinants of Health and PROGRESS-Plus frameworks.

Methods: This scoping review included original studies published between 2015 and 2025 that examined inequalities in childhood vaccination coverage in Indonesia. Searches were conducted in PubMed, Scopus, Google Scholar, and Garuda. The review followed PRISMA-ScR with consideration of the PRISMA-Equity extension. Data were charted using a standardized extraction form and synthesized descriptively using narrative and tabular approaches.

Results: Of 910 records identified, ten studies met the inclusion criteria. All were cross-sectional, and most used nationally representative data from household surveys or administrative sources (n = 9). Inequalities related to parental socioeconomic characteristics were most frequently examined. No studies assessed disparities related to race, ethnicity, culture, or language, indicating substantial gaps across key equity dimensions.

Conclusion: Evidence on childhood vaccination inequalities in Indonesia remains limited in scope and depth. Expanding equity-focused research, particularly on underexplored social and cultural determinants, is essential to support targeted policies and advance equitable immunization coverage in Indonesia.

References

Muloiwa R. Closing the equity gap – opportunities and challenges in unlocking the value of immunizing children. International Journal of Infectious Diseases. 2025;152:107822.

Atkinson K, Mabey D. Revolutionizing tropical medicine: point‐of‐care tests, new imaging technologies and digital health. 1st ed. Wiley; 2019. Available from: [Website].

Andre FE, Booy R, Bock H, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death, and inequity worldwide. Bulletin of the World Health Organization. 2008;86(2):140–6.

Turner HC, Thwaites GE, Clapham HE. Vaccine -preventable diseases in lower-middle-income countries. The Lancet Infectious Diseases. 2018; 18(9):937–9.

Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. Smith Fawzi MC, editor. PLoS ONE. 2017;12(8): e0182951.

Talbird SE, Carrico J, La EM, Carias C, Marshall GS, Roberts CS, et al. Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics. 2022;150(3): e2021056013.

Zhou F, Jatlaoui TC, Leidner AJ, Carter RJ, Dong X, Santoli JM, et al. Health and economic benefits of routine childhood immunizations in the era of the vaccines for children program — United States, 1994–2023. MMWR Morbidity and Mortality Weekly Report. 2024;73(31):682–5.

Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the expanded programme on immunization. The Lancet. 2024;403(10441):2307–16.

Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, et al. Vaccine equity in low and middle-income countries: a systematic review and meta-analysis. International Journal for Equity in Health. 2022;21(1):82.

Chang AY, Riumallo-Herl C, Perales NA, Clark S, Clark A, Constenla D, et al. The equity impact vaccines may have on averting deaths and medical impoverishment in developing countries. Health Affairs. 2018;37(2):316–24.

Bell R, Donkin A, Marmot M. Tackling structural and social issues to reduce inequities in children’s outcomes in low- to middle-income countries. 2013. Innocenti Discussion Papers. 2013. Available from: [Website]

Lai X, Zhang H, Pouwels KB, Patenaude B, Jit M, Fang H. Estimating global and regional between-country inequality in routine childhood vaccine coverage in 195 countries and territories from 2019 to 2021: a longitudinal study. eClinicalMedicine. 2023;60:102042.

Tapia-Conyer R, Betancourt-Cravioto M, Saucedo-Martínez R, Motta-Murguía L, Gallardo-Rincón H. Strengthening vaccination policies in Latin America: An evidence-based approach. Vaccine. 2013;31(37):3826–33.

Osborne A, Bangura C, Sesay U, Ahinkorah BO. Trends and inequalities in full immunisation coverage among one-year-olds in Sierra Leone, 2008–2019. BMC Pediatrics. 2025;25(1):320.

Siramaneerat I, Agushybana F. Inequalities in immunization coverage in Indonesia: a multilevel analysis. Rural and Remote Health. 2021;21:6348.

Lyons C, Nambiar D, Johns NE, Allorant A, Bergen N, Hosseinpoor AR, et al. Inequality in childhood immunization coverage: a scoping review of data sources, analyses, and reporting methods. Vaccines. 2024;12(8):850.

Karran EL, Cashin AG, Barker T, Boyd MA, Chiarotto A, Dewidar O, et al. Using PROGRESS-plus to identify current approaches to the collection and reporting of equity-relevant data: a scoping review. Journal of Clinical Epidemiology. 2023;163:70–8.

World Health Organization. A conceptual framework for action on the social determinants of health. 2010;76. Available from: [Website]

United Nations Children's Fund. A snapshot of childhood in Indonesia: progress, challenges and disparities [Internet]. UNICEF. 2025. Available from: [Website]

Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan. Survei Kesehatan Indonesia (SKI) 2023 dalam angka. Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan. 2023. Available from: [Website]

World Health Organization. Leading from the frontlines: navigating disease outbreaks and immunization challenges in Indonesia. 2024. Available from: [Website]

The Global Goals. Goal 10: Reduced inequalities. Available from: [Website]

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine. 2018;169(7):467–73.

Welch V, Petticrew M, Tugwell P, Moher D, O'Neill J, Waters E, et al. PRISMA-Equity 2012 Extension: Reporting Guidelines for Systematic Reviews with a Focus on Health Equity. Equator-network. 2012. Available from: [Website]

World Health Organization. Inequality monitoring in immunization: a step-by-step manual. 2019. Available from: [Website]

Schlotheuber A, Hosseinpoor A. Summary measures of health inequality: a review of existing measures and their application. International Journal of Environmental Research and Public Health. 2022; 19(6):3697.

Chu H, Rammohan A. Childhood immunization and age-appropriate vaccinations in Indonesia. BMC Public Health. 2022;22(1):2023.

Machmud PB, Gayatri D, Astutik E. Complete dose of hepatitis B vaccination among children in Indonesia and factors associated: a community-based study. Kesmas. 2024;19(3):178–86.

Herliana P, Douiri A. Determinants of immunisation coverage of children aged 12–59 months in Indonesia: a cross-sectional study. BMJ Open. 2017; 7(12):e015790.

Setiawan MS, Wijayanto AW. Determinants of immunization status of children under two years old in Sumatera, Indonesia: a multilevel analysis of the 2020 Indonesia national socio-economic survey. Vaccine. 2022;40(12):1821–8.

Efendi F, Pradiptasiwi DR, Krisnana I, Kusumaningrum T, Kurniati A, Sampurna MTA, et al. Factors associated with complete immunizations coverage among Indonesian children aged 12–23 months. Children and Youth Services Review. 2020; 108:104651.

Hardhantyo M, Chuang YC. Urban-rural differences in factors associated with incomplete basic immunization among children in Indonesia: A nationwide multilevel study. Pediatrics & Neonatology. 2021;62(1):80–9.

Hargono A, Megatsari H, Artanti KD, Nindya TS, Wulandari RD. Ownership of mother and children's health book and complete basic immunization status in slums and poor population. Journal of Public Health Research. 2020;9(2):1809.

Harapan H, Shields N, Kachoria AG, Shotwell A, Wagner AL. Religion and measles vaccination in Indonesia, 1991–2017. American Journal of Preventive Medicine. 2021;60(1 Suppl 1):S44–52.

Holipah H, Maharani a, sujarwoto s, hinoura t, kuroda y. trends, spatial disparities, and social determinants of DTP3 immunization status in Indonesia 2004–2016. Vaccines. 2020;8(3):518.

Hodge A, Firth S, Marthias T, Jimenez-Soto E. Location matters: trends in inequalities in child mortality in Indonesia. Evidence from repeated cross-sectional surveys. PLoS ONE. 2014;9(7): e103597.

Fernandez R, Rammohan A, Awofeso N. Correlates of first dose of measles vaccination delivery and uptake in Indonesia. Asian Pacific Journal of Tropical Medicine. 2011;4(2):140–5.

Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43): 6486–93.

Braveman P, Arkin E, Orleans T, Proctor D, Acker J, Plough A. What is health equity?. Behavioral Science & Policy. 2018.

Gao Y, Kc A, Chen C, Huang Y, Wang Y, Zou S, et al. Inequality in measles vaccination coverage in the “big six” countries of the WHO South-East Asia region. Human Vaccines & Immunotherapeutics. 2020;16(7):1485–97.

Alfian SD, Abdulah R, Hak E. Development of a prediction rule for incomplete vaccination among children in Indonesia. BMC Public Health. 2025; 25(1):1915.

Fahriani M, Anwar S, Yufika A, Bakhtiar B, Wardani E, Winardi W, et al. Disruption of childhood vaccination during the COVID-19 pandemic in Indonesia. Narra J. 2021;1(1).

Sinuraya RK, Nuwarda RF, Postma MJ, Suwantika AA. Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in Indonesia. Global Health. 2024; 20(1):11.

Published
2026-01-29
How to Cite
Pramudita, B. D., Haposan, J. H., & Niyibitegeka, F. (2026). Inequality dimensions of childhood vaccination coverage in Indonesia: a scoping review. Berita Kedokteran Masyarakat, 42(01), e28048. https://doi.org/10.22146/bkm.v42i01.28048
Section
Articles