Inequity in the access to and deployment of the coronavirus disease 2019 (COVID-19) vaccines has brought about great challenges in terms of resolving the pandemic. Aiming to analyze the association between country income level and COVID-19 vaccination coverage and explore the mediating role of vaccination policy, we conducted a cross-sectional ecological study. The dependent variable was COVID-19 vaccination coverage in 138 countries as of May 31, 2021. A single-mediator model based on structural equation modeling was developed to analyze mediation effects in different country income groups. Compared with high-income countries, upper-middle- (β = −1.44, 95% CI: −1.86–−1.02, p < 0.001), lower-middle- (β = −2.24, 95% CI: −2.67–−1.82, p < 0.001), and low- (β = −4.05, 95% CI: −4.59–−3.51, p < 0.001) income countries had lower vaccination coverage. Vaccination policies mediated 14.6% and 15.6% of the effect in upper-middle- (β = −0.21, 95% CI: −0.39–−0.03, p = 0.020) and lower-middle- (β = −0.35, 95% CI: −0.56–−0.13, p = 0.002) income countries, respectively, whereas the mediation effect was not significant in low-income countries (β = −0.21, 95% CI: −0.43–0.01, p = 0.062). The results were similar after adjusting for demographic structure and underlying health conditions. Income disparity remains an important cause of vaccine inequity, and the tendency toward “vaccine nationalism” restricts the functioning of the global vaccine allocation framework. Stronger mechanisms are needed to foster countries’ political will to promote vaccine equity.

Introduction One of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the ‘fast-track countries’ to achieve the health-related Millennium Development Goals, but research on its equity strategies remains inadequate. Methods Using Vietnamese official health statistics, we investigated inequity in four dimensions including health resources, service delivery, service utilisation and residents’ health status from the perspectives of income levels, poverty rates and subnational regions. The Slope Index of Inequality, concentration curve/Concentration Index, absolute difference and Theil Index were used. Results Four indicators showed ‘pro-poor’ inequality in health resources, including the per capita health budget, per capita health personnel, per capita health personnel at the community level and per capita hospital beds at the community level, while provincial hospital beds showed ‘pro-rich’ inequality. Two health service delivery indicators (delivery of antenatal care ≥3 times and proportion of community health service centres with medical doctors) show ‘pro-rich’ inequality, although two health status indicators, mortality and malnutrition rates for children under five, showed ‘pro-poor’ inequality. The Northern Midlands and Mountain Areas, and the Central Highlands were disadvantaged regarding service delivery and health status. Intraregional differences were the main factors contributing to the inequalities in delivery of antenatal care ≥3 times, provincial hospital beds and percentage of community health centres with medical doctors, with the Red River Delta and the South East region experiencing the greatest inequalities. Conclusion The overall level of health equity in Vietnam has increased over the past decade, although inequality in health service delivery has hindered progress towards health equity based on income, poverty and subnational regions. Targeted policies need to be introduced to reduce inequities relating to the health workforce and service delivery capacity.

Malaria is a major public health challenge worldwide, especially in sub-Saharan Africa (SSA), where the malaria disease burden remains the highest globally. In 2022, the SSA region accounted for 95% of total malaria cases; the deaths in this region reached 580 000, and four SSA countries accounted for approximately half of the global mortality [1]. At […]

Background and purpose: Disease burden of non-communicable diseases (NCDs) has been increasing in low- and middle-income countries, especially in African countries. Cardiovascular disease (CVD) is a common NCDs and the leading cause of death in Africa. Yet, evidence on the contribution of CVD to the total NCDs burden is scarce. This study aimed to investigate the contribution of CVD to the total disease burden caused by NCDs in Africa between 1990 and 2019. Methods: Data on NCDs, including CVD, were extracted from the Global Burden of Disease (GBD) database. Disease burden was measured by disability-adjusted life years (DALYs) and deaths. Results: From 1990 to 2019, the share of CVD in the total NCDs burden increased and remained as the first contributor. In 2019, NCDs caused 204 million DALYs and over 2.18 million deaths in the Africa Union, among which 49.1% of the total DALYs and 66.0% of deaths were caused by the traditional five NCDs, including CVD that accounted for the largest burden of NCDs (20.5% of DALYs and 35.2% of deaths). The proportion of CVD to the total NCDs burden was most considerable, reaching up to 32.4% and 52.4% in Northern Africa for DALYs and deaths, respectively. CVD were important contributors to NCDs burden in Africa, including ischemic heart disease (1334 DALYs per 100,000 and 27.79 deaths per 100,000) and intracerebral hemorrhage (632 DALYs per 100,000 and 13.53 deaths per 100,000) that were the top two causes of NCDs in 2019. Conclusions: CVD has been the biggest contributor to NCDs burden in the Africa Union over the thirty years. Given the increase in the share of NCDs burden attributable to CVD, it demands a close attention to implementing cost-effective policies and interventions for CVD to achieve an improvement in population health and reduction of health loss from NCDs.

Adults aged 50 years and older are more likely to experience unmet health care needs for hypertension, particularly given the existence of socioeconomic di