Immunization Coverage, Equity, and Access for Children with Disabilities: A Scoping Review of Challenges, Strategies, and Lessons Learned to Reduce the Number of Zero-Dose Children

Abstract

Background: Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. Methods: This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. Results: Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. Conclusions: Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations.

Keywords: children with disabilities; immunization equity; inclusive healthcare; low- and middle-income countries; vaccination strategies; vaccine barriers.

Figure 1

PRISMA flow chart of the selection of studies included in the analysis.

Figure 2

The flowchart illustrates the tailored immunization pathways for children with disabilities, starting with the central challenge, “Child with Disability Facing Barriers”. It features three main pathways: Specialized Support, Rural Access, and Educational Outreach. The Specialized Support pathway includes referrals to specialized clinics with 80% improved accessibility, leading to tailored care in low-sensory environments, which reduces vaccination refusals by 60%, and culminates in vaccination success, marked by + 24% overall coverage and 45% fewer missed vaccinations. The Rural Access pathway utilizes mobile units in rural areas, achieving a 50% increase in rural vaccination coverage, followed by parent education initiatives, where 70% of parents report being better informed, resulting in similar vaccination success outcomes. The Educational Outreach pathway employs school-based programs, improving vaccination rates in specialist schools from 41% to 63%, coupled with behavioral support that reduces disruptions by 30%, ultimately leading to vaccination success. The pathways converge on the goal of Enhanced Vaccine Equity for Children with Disabilities. Icons enhance clarity, such as a hospital symbol for specialized clinics, a book for parent education, and a school for school-based programs. Metrics, such as “80% improved accessibility” and “70% better informed”, are based on study findings. At the same time, the color coding—blue for specialized support, green for rural access, and orange for educational outreach—helps differentiate pathways visually. The outcome emphasizes significant improvements in coverage and equity for children with disabilities.