Coverage and inequalities in COVID-19 and influenza vaccination in Brazil: a nationwide cross-sectional survey

This nationwide cross-sectional survey in Brazil investigated COVID-19 and influenza vaccination coverage and inequalities. Data from 33 250 interviews conducted between March and June 2024 in 133 sentinel cities revealed high overall coverage: 90.2% for at least one dose of COVID-19 vaccine and 82.6% for influenza. However, significant disparities emerged. COVID-19 vaccination coverage increased with age, was higher among women and Whites, and strongly associated with higher education levels and wealth. Influenza vaccine coverage showed a U-shaped pattern by age and was lower among evangelicals compared with Catholics. Geographic variations were observed, with the Southeast region exhibiting the highest coverage and the North and Center-West the lowest. Co-coverage analysis indicated that 76.7% of participants received both vaccines. Reasons for non-vaccination included lack of belief in vaccine efficacy, concerns about side effects, and lack of access to healthcare. The findings highlight the need for targeted public health interventions to address vaccine hesitancy and inequalities in access, particularly focusing on specific subgroups such as evangelicals, Indigenous populations, and individuals with lower socioeconomic status.