A systematic review of approaches to achieving equitable childhood immunization (0–5 years) among First Nations populations in high income OECD countries

Despite long-standing immunization programs, inequities in vaccination coverage persist for First Nations children in high-income countries. Previous reviews identified coverage gaps but rarely assessed intervention quality through a First Nations–specific lens. This review examined strategies to improve vaccination coverage and timeliness for First Nations children aged 0–5 years in Organisation for Economic Co-operation and Development (OECD) member countries and evaluated study quality from methodological and cultural perspectives. Peer-reviewed literature was systematically searched, yielding 1,142 records; 14 studies met inclusion criteria. Interventions were categorized by component purpose. Quality was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) and the Effective Public Health Practice Project (EPHPP) tool. Studies were from Australia (n = 6), Canada (n = 4), New Zealand (n = 3), and the United States (n = 1). None achieved high quality on both cultural and methodological criteria. Some reported improved coverage, but overall evidence was weak, and sustained population-level gains were rare. “Remind-recall” systems and strengthened service infrastructure showed the greatest potential. This first review to integrate cultural and methodological appraisal highlights the need for culturally grounded, co-designed research to advance equitable vaccination outcomes for First Nations children in OECD nations.