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Visible gaps between rural and urban COVID-19 vaccination rates highlights the need for tailored health responses, University of Otago researchers argue.

Results of the first study to analyse vaccination uptake in rural versus urban settings during the peak period of New Zealand’s national vaccination roll-out in 2021, found different population groups had varying levels of vaccine uptake.

Talis Liepens image
Talis Liepins

Lead author Talis Liepins, PhD candidate in the Department of General Practice and Rural Health, says the findings suggest opportunities for improvements in vaccination delivery models for rural and urban communities, and further highlights the urban-rural divide when it comes to equitable healthcare.

“It is important we advance general awareness around equity of access for rural populations and how health interactions for rural communities differ from urban communities,” he says.

The study, published in Epidemiology and Infection, used a national dataset of 4.3 million health service users.

“By the end of the study period there was a clear urban-rural gradient apparent for all ethnic groups, with greater rurality associated with lower levels of vaccination uptake,” Mr Liepins says.

“Rurality further exacerbated the lower vaccination rates for Māori.”

The researchers also found “considerable variance” in uptake between rural older and rural younger people; with the rural urban differences much more apparent in those aged less than 45 years.

Co-author Professor Garry Nixon, Head of Rural Section in the Department of General Practice and Rural Health, says these differences, visible across different population groups, suggest perhaps different barriers to access.

“This further emphasises the importance of health policy responses tailored to meet the needs of rural populations.”

Funded by the Ministry of Health COVID-19 and National Immunisation Programme, the study is the first of three exploring the COVID-19 vaccine rollout in rural Aotearoa New Zealand. The studies aim to help show how effective the roll-out was for different rural populations, identify the barriers and facilitators and guide future policy decisions.

“Our ultimate aim is ensuring equitable vaccination programmes, coverage, and population protection in the future.

“Policy makers and programme funders need to be aware of the urban-rural divide and work to address it through policy development, service or programme development, and funding rural services to meet the needs of the communities they know so well,” Professor Nixon says.

Publication details

Rural–urban variation in COVID-19 vaccination uptake in Aotearoa New Zealand: Examining the national roll-out

Talis Liepins, Gabrielle Davie, Rory Miller, Jesse Whitehead, Brandon De Graaf, Lynne Clay, Sue Crengle and Garry Nixon

Epidemiology and Infection

For more information, please contact

Talis Liepins
Department of General Practice and Rural Health
University of Otago

Ellie Rowley      
Communications Adviser
University of Otago
Mob +64 21 278 8200

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