Vaccines are effective to reduce COVID-19 related outcomes, but universal vaccination campaigns can reveal within-country access inequities. Mexico City has had high rates of COVID-19 related morbidity and mortality and a population survey warned that vaccine acceptance was lowest in older adults. Since February 2021, Mexico started a universal and free vaccination campaign prioritizing older adults. By April 17, every older adult in Mexico City had been eligible to receive the first dose. A week later, we conducted a telephone survey representative of older adults residing in Mexico City (n = 503). We asked if they received their first dose and, if they haven’t, we followed-up with an open question to register their reasons. In addition to sociodemographic characteristics and food insecurity, we also inquired about vaccine hesitancy, health concerns related to COVID-19, self-rated health, comorbidities, frailty, and depression. The objective of the study was to identify the main barriers to receive the first dose of the vaccine. We estimated descriptive statistics and logistic regression models. Results show that 7.6% of older adults in Mexico City did not receive their first dose. Barriers for not receiving it were vaccine hesitancy (60.4%), not having COVID-19 health concerns (46.4%), poor self-rated health (46.7%), a previous diagnosis of depression (35.7%), low socioeconomic status (65.4%), and household food insecurity (59.8%). Responses to the open question clustered in four themes: misinformation about the process (30%), distrust of the vaccine (24%), personal health problems (24%), and difficulties to get an appointment (22%). Logistic regression models adjusted for vaccine hesitancy and revealed two distinct reasons for not having their first dose: 1) vaccine hesitancy and misinformation on COVID-19, and 2) household food insecurity. Reaching these two groups requires active and differentiated public-health measures; the first with additional information from trusted sources, and the second by facilitating vaccination in neighborhoods with high levels of food insecurity and informal labor, where missing a day’s work is a strong disincentive. Vaccination campaigns need an equity lens to reach universal coverage; ensuring full access demands thorough and carefully tailored new interventions.

The Baby-Friendly Hospital Initiative (BFHI) has been shown to increase breastfeeding rates, improving maternal and child health and driving down healthcare costs via the benefits of breastfeeding. Despite its clear public health and economic benefits, one key challenge of implementing the BFHI is procuring funding to sustain the program. To address this need and help healthcare stakeholders advocate for funds, we developed a structured method to estimate the first-year cost of implementing BFHI staff training, using the United States (US) and Mexico as case studies. The method used a hospital system-wide costing approach, rather than costing an individual hospital, to estimate the average per birth BFHI staff training costs in US and Mexican hospitals with greater than 500 annual births. It was designed to utilize publicly available data. Therefore, we used the 2014 American Hospital Association dataset (n = 1401 hospitals) and the 2018 Mexican Social Security Institute dataset (n = 154 hospitals). Based on our review of the literature, we identified three key training costs and modelled scenarios via an econometric approach to assess the sensitivity of the estimates based on hospital size, level of obstetric care, and training duration and intensity. Our results indicated that BFHI staff training costs ranged from USD 7.27–125.39 per birth in the US and from PPP 2.68–6.14 per birth in Mexico, depending on hospital size and technological capacity. Estimates differed between countries because the US had more hospital staff per birth and higher staff salaries than Mexico. Future studies should examine whether similar, publicly available data exists in other countries to test if our method can be replicated or adapted for use in additional settings. Healthcare stakeholders can better advocate for the funding to implement the entire BFHI program if they are able to generate informed cost estimates for training as we did here.

The size of the foreign-born population living in the United States makes migrants’ health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants’ health.