Disparities in the offer of COVID-19 vaccination to migrants and non-migrants in Norway: a cross sectional survey study

Abstract

Background Vaccination is key to reducing the spread and impacts of COVID-19 and other infectious diseases. Migrants, compared to majority populations, tend to have lower vaccination rates, as well as higher infection disease burdens. Previous studies have tried to understand these disparities based on factors such as misinformation, vaccine hesitancy or medical mistrust. However, the necessary precondition of receiving, or recognizing receipt, of an offer to get a vaccine must also be considered. Methods We conducted a web-based survey in six parishes in Oslo that have a high proportion of migrant residents and were hard-hit during the COVID-19 pandemic. Logistic regression analyses were conducted to investigate differences in reporting being offered the COVID-19 vaccine based on migrant status. Different models controlling for vaccination prioritization variables (age, underlying health conditions, and health-related jobs), socioeconomic and demographic variables, and variables specific to migrant status (language spoken at home and years lived in Norway) were conducted. Results Responses from 5,442 participants (response rate of 9.1%) were included in analyses. The sample included 1,284 (23.6%) migrants. Fewer migrants than non-migrants reported receiving a vaccine offer (68.1% vs. 81.1%), and this difference was significant after controlling for prioritization variables (OR 0.65, 95% CI: 0.52–0.82). Subsequent models showed higher odds ratios for reporting having been offered the vaccine for females, and lower odds ratios for those with university education. There were few to no significant differences based on language spoken at home, or among birth countries compared to each other. Duration of residence emerged as an important explanatory variable, as migrants who had lived in Norway for fewer than 15 years were less likely to report offer of a vaccine. Conclusion Results were consistent with studies that show disparities between non-migrants and migrants in actual vaccine uptake. While differences in receiving an offer cannot fully explain disparities in vaccination rates, our analyses suggest that receiving, or recognizing and understanding, an offer does play a role. Issues related to duration of residence, such as inclusion in population and health registries and health and digital literacy, should be addressed by policymakers and health services organizers.

Prevalence of COVID-19 vaccine acceptance among migrant and refugee groups: A systematic review and meta-analysis

“…This issue was manifested in the studies among refugee groups in Norway, where one large study from the country involved 1284 immigrant individuals in Oslo. The results revealed that people of migrant status had a lower likelihood of being offered to get vaccinated compared to native Norwegians [28] . This comes in spite of similar rates of COVID-19 vaccine hesitancy in people of migrant status and native citizens as showed in a recent study by Ebrahimi et al in the Nordic country [69] .…”

“…Contributing factors of COVID-19 vaccine acceptance included origin of migrants [59] , [60] , gender [28] , [61] , [62] , [63] , [64] , [65] , [66] , [67] age [63] , [65] , [67] , being enrolled in school [66] and being educated [28] , [63] , [67] , marital status [63] , durations of residence [28] , [67] , having health insurance [66] , political mistrust [59] , [61] and mistrust in vaccinations [65] , [68] , perceived individuals’ physical health [60] , perceived risk of vaccination [69] , [70] , preference to maintain precaution measures, [71] , the belief that COVID-19 vaccines are not essential [71] , superiority of natural immunity [69] , fear of personal infection [59] , being worried about getting COVID-19 infection [72] , fear concerning significant others being infected by the virus [69] , trust in health officials’ dissemination of vaccine-related information [69] , lower logistical barriers and attitudes [15] , physicians’ recommendation, vaccine price, vaccine effectiveness and importance [70] , concerns regarding newness of the vaccines [71] , vaccine safety [62] , [65] , [68] and longer-term adverse effects [62] , and being a physician or advanced practice provider interacting directly with patients from refugee, immigrant, and migrant communities [65] .…”

“…In addition, human displacement is often associated with transmission of infectious diseases [26] . Although vaccination is often required for migration and refugee resettlement, many immigrant communities experience lower immunization rates and a higher burden of vaccine-preventable diseases (VPDs) than host populations [27] , [28] . When migration is forced (refugee) and large-scale, migration can be very disruptive to both the refugee population and the host country, weakening the resilience of the health system and jeopardizing the provision of health services, including vaccination services [26] , [29] .…”

The Relationship of COVID-19 Vaccination Status with Health Literacy of Syrians Living in Istanbul

“…In a study conducted in Australia with a multinational refugee group (the majority of which were Arabic speakers), the vaccination rate was found to be 12% [ 25 ]. Similar to our country, a study in Norway determined that the probability of receiving the COVID-19 vaccine is one-third lower for immigrants than for non-immigrants [ 26 ]. There are other similar studies in which the probability of not being vaccinated in immigrants is 8–11 times higher than in the local population [ 27 ].…”

Migration health research in the Nordic countries: Priorities and implications for public health

“…While the lessons learnt from the COVID-19 pandemic research are still ongoing there is no doubt that inequities in health were unmasked. The research in the Nordic countries concurs with global research exposing migrants’ differential risks and differential clinical outcomes [52]. However, interpretations of the COVID-19-related migrant data and understanding the ‘causes of causes’ still need more research.…”