A Missed Opportunity to Institutionalise Health Equity: A Qualitative Study on COVID-19 Vaccination for Socially Marginalised Groups in Emilia-Romagna (Italy)

Abstract

Health equity for people who have been socially marginalised (PSM) is still a major challenge for health systems, further exacerbated by the COVID-19 syndemic and vaccination campaign. Nevertheless, the relevance of these events may open windows of opportunity to reorient health policies from an equity perspective. Based on this premise, a qualitative study was conducted in the Emilia-Romagna region (Italy) during the COVID-19 vaccination campaign, with the aim to identify the policies and practices adopted by local health authorities in order to ensure vaccination of PSM. The study involved key informants working in dedicated outpatient clinics for PSM or in primary healthcare (PHC) departments. A short checklist was used to assess local practices, followed by semistructured interviews to further understand areas such as (a) strategies to promote accessibility/access, (b) approaches for vaccination delivery, (c) information system and data collection, (d) planning and governance and (f) opportunities and future perspectives. The findings show that the regional COVID-19 vaccination campaign was based on a tailored approach, promoting multimethod strategies to increase accessibility for PSM. Limitations of the study are the lack of direct experience of PSM and the lack of correlation between the identified strategies and vaccination rates. However, the study confirms the existence of systematic shortcomings and barriers in accessing PHC services, which contribute to the process of social marginalisation that is responsible for health inequalities among PSM. In this respect, the COVID-19 vaccination campaign ensured broader access to a specific intervention without addressing the structural and organisational determinants of health inequalities among PSM, thus representing a failed opportunity to institute health equity. Our findings suggest the need to strengthen political commitment and promote effective participatory health policies capable of identifying and overcoming structural barriers in order to achieve a structural change towards greater health equity.