COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study

Abstract

Study objectivesThe marginalisation of undocumented migrants raises concerns about equitable access to COVID-19 vaccination. This study aims to describe migrants’ hesitancy about the COVID-19 vaccination during the early phase of the vaccination campaign.SettingThis multicentric cross-sectional survey was conducted in health facilities providing care to undocumented migrants in the USA, Switzerland, Italy and France in February–May 2021.ParticipantsEligibility criteria included age >16 years, being of foreign origin and living without valid residency permit in the country of recruitment. A convenience sample of minimum 100 patients per study site was targeted.Primary and secondary outcome measuresData were collected using an anonymous structured questionnaire. The main outcomes were perceived access to the local COVID-19 vaccination programme and demand for vaccination.ResultsAltogether, 812 undocumented migrants participated (54.3% Geneva, 17.5% Baltimore, 15.5% Milano and 12.7% Paris). Most (60.9%) were women. The median age was 39 years (interquartile range 1). Participants originated from the Americas (55.9%), Africa (12.7%), Western Pacific (11.2%) Eastern Mediterranean (7.9%), Europe (7.6%) and South-East Asia (4.7%). Overall, 14.1% and 26.2% of participants, respectively, reported prior COVID-19 infection and fear of developing severe COVID-19 infection. Risk factors for severe infection were frequently reported (29.5%). Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, comorbidity and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media.ConclusionsWe found a mismatch between perceived accessibility and demand for the COVID-19 vaccination. Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants’ hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection.

Drivers and prevalence of COVID-19 vaccine uptake among homeless and precariously housed people in France: a cross-sectional population-based study

“…The effects of peer pressure, reflecting influence of friends, relatives, and others on vaccination intentions is well-described in the literature [24, 25, 27, 28]. Our findings are consistent with others on general vaccine intention among migrants [13, 28], including some data for COVID-19 [22, 23].…”

“…These data underline the importance of awareness-raising and sensitization by trusted third parties such as social workers, mediators, and site managers, in line with qualitative studies [22, 23]. Our data also show the positive impact on vaccine uptake by support mechanisms and follow-up by medical professionals and/or by social organizations.…”

“…Our data illustrates that vaccinated participants hold a variety of beliefs and behaviours; a majority were convinced the vaccine is useful (64%) and protects (66% vaccinated for this reason), but a non-negligible proportion hold sceptical views or felt compelled to accept vaccination; these findings confirm other work on vaccine intentions in PEH [22, 23, 27, 28].…”

“…Misinformation due to rumours, and defiance towards authorities reinforce these barriers, and are well-known in PEH [22,23,24,27,28,29,30].…”

“…We also aimed to describe and understand determinants of COVID-19 vaccination in PEH/PH. Existing evidence has assessed coverage in the general population in relation to income and/or ethnicity [21] or has focused on vaccine intention or hesitancy in PEH [22, 23]. However, little evidence reports on drivers of uptake in the type of population we have studied.…”