Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators

Abba-Aji, Mohammed; Stuckler, David; Galea, Sandro; McKee, Martin

doi:10.1016/j.jmh.2022.100086

Cited by 110 publications

(105 citation statements)

References 58 publications

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“…One of the main ndings from this study is the importance of trust in different authorities and the information surrounding COVID-19; which is in line with the current evidence on the role of trust barriers in COVID-19 vaccine acceptability (44). Our results showed the in uential role of general practitioners' recommendation to get vaccinated, as previously demonstrated in the literature for other vaccines.…”

Section: Comparison With Body Of Evidencesupporting

confidence: 91%

Motives for COVID-19 vaccine hesitancy amongst marginalized groups, including homeless persons and migrants, in France: a mixed-methods study.

Ducarroz

Figueiredo

Scarlett

et al. 2022

Preprint

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Background: Persons experiencing unstable housing – including recently arrived migrants – are at elevated risk of contracting COVID-19 and suffer from high morbidity and mortality. In this context, the COVID-19 vaccine was foreseen as a promising way to control the pandemic and reduce social inequalities in this area. Understanding the motives of COVID-19 vaccine acceptability in people with unstable housing, including migrants, is therefore crucial to tailor public health communication and outreach. Thus, the main objective of our study was to investigate - both quantitatively and qualitatively – the motivations behind vaccine hesitancy in people experiencing unstable housing when vaccines became available in France.Methods: A cross-sectional study was performed in Spring 2021, using convergent mixed-methods approach. Participants were recruited from homeless shelters and day centres and face-to-face interviews were offered, with help, where necessary, from phone-based interpreters. Factors associated with motives for COVID-19 vaccine hesitancy were explored using logistic regression models. Qualitative data – collected through semi-structured individual interviews - were analysed via an inductive thematic approach. Both quantitative and qualitative data were then integrated. Results: Vaccine hesitancy was found to be at an elevated rate (58.0%). The three most reported motives of hesitancy were related to COVID-19 vaccine effectiveness, safety, and trust in information about the vaccine. Factors of elevated hesitancy comprised the interviewees’ age, level of education, French-language aptitude, feeling of worry about COVID-19, and time of residence in France. Generic distrust in official information was a shared associated factor for the 3 motives of hesitancy. This result was expanded upon by the interview data where participants described having differential trust depending on who is recommending the vaccination. Another emerging key theme related to hopes that the vaccine would release them from the burden of the pandemic. Conclusions: Our mixed methods study provides a comprehensive understanding of COVID-19 vaccine hesitancy among persons with unstable housing in France in Spring 2021. Elevated levels of hesitancy remain a public health concern as “No one is safe until everyone is safe”. The already established role of trust in vaccine hesitancy is still to be adequately addressed as a potentially effective route of intervention.

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Section: Comparison With Body Of Evidencesupporting

confidence: 91%

Motives for COVID-19 vaccine hesitancy amongst marginalized groups, including homeless persons and migrants, in France: a mixed-methods study.

Ducarroz

Figueiredo

Scarlett

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The study reported that there was consistent evidence of elevated levels of COVID-19 vaccine hesitancy among Black/Afro-Caribbean ethnic groups in the US and the UK. Asians in the US had the highest intention rate to get COVID-19 vaccine (81%) compared to other ethnic groups (40-68%) [24]. Lack of con dence, mainly due to mistrust of government and health systems coupled with poor communication were the main barriers to vaccination uptake among persons of Black ethnicity and migrant origin populations [24].…”

Section: Discussionmentioning

confidence: 99%

“…Asians in the US had the highest intention rate to get COVID-19 vaccine (81%) compared to other ethnic groups (40-68%) [24]. Lack of con dence, mainly due to mistrust of government and health systems coupled with poor communication were the main barriers to vaccination uptake among persons of Black ethnicity and migrant origin populations [24]. Some other factors associated with lower vaccination intentions in the high-income countries were identi ed, including having no health insurance, unemployment, lower socio-economic position, female gender, younger age, medical mistrust, less con dence in vaccine e cacy, and less trust in pharmaceutical companies producing the vaccines [25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Incidence of SARS-CoV-2 infection and factors associated with complete COVID-19 vaccine uptake among migrant origin persons in Finland.

Bastola

Nohynek

Lilja

et al. 2022

Preprint

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Background: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n=13,223) and MigCOVID (n=3,668) survey data using unique personal identifier. FinMonik and MigCOVID surveys were conducted among adults born outside Finland. Logistic regression was applied to examine the association of age, sex, age at migration, length of stay, level of education, economic activity, Finnish/Swedish language skills, psychological distress, experiences of discrimination, and self-rated health with vaccine uptake.Results: Among the total sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union (OR 0.68, 95% CI 0.61-0.76), Estonia (OR 0.40, 95% CI 0.36-0.46), and rest of Africa (OR 0.63, 95% CI 0.54-0.72) and higher among persons of Southeast Asia (OR 3.34, 95% CI 2.77-4.02), rest of Asia (OR 1.90, 95% CI 1.65-2.19) and the Middle East/North Africa (OR 1.41, 95% CI 1.25-1.60) than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among total sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.

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“…Emerging evidence, including from our pre-engagement work done to inform this study (reported elsewhere (2, 3)) attributes lower COVID-19 vaccine uptake rates in minoritised and migrant populations to a lack of confidence – specifically due to the spread of misinformation and conspiracy theories, mistrust in the medical establishment and government, and concerns about side effects – and access barriers, including physical access, language and communication barriers (9, 24-29). In the UK, community-research partnerships have been mobilised to engage with ethnic communities and address the disparities in COVID-19 vaccine uptake including through outreach and the development of culturally relevant health information and messages, (30, 31) and public bodies and charities have now translated official information and guidance into multiple languages and developed toolkits (32-34).…”

Section: Introductionmentioning

confidence: 90%

Co-designing an intervention to strengthen vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory study protocol

Crawshaw

Hickey²,

Lutumba

et al. 2022

Preprint

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IntroductionAdult migrants are at risk of under-immunisation and are likely to need catch-up vaccination to bring them in line with the UK schedule. The COVID-19 pandemic has highlighted and exacerbated inequities in vaccine uptake, with migrants facing additional barriers to information, low vaccine confidence, and access to vaccine services. There is a need for participatory and theory-based research that meaningfully engages underserved migrant groups to make sense of their experiences and beliefs about vaccination and uses these insights to co-produce tailored interventions which can increase uptake. COVID-19 vaccination provides a unique entry-point and opportunity to explore these issues in tandem with addressing routine immunisation gaps and developing more culturally-sensitive routine vaccination services.Methods and analysisLISOLO MALAMU (‘Good Talk’) is a community-based participatory research study which uses co-design, design thinking and behaviour change theory to engage adult Congolese migrants in developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead and co-design the study. The study will involve i) in-depth interviews with adult Congolese migrants (foreign-born, >18 years), ii-iii) interviews and consensus workshops with clinical, public health and community stakeholders, and iv) co-design workshops with adult Congolese migrants. Qualitative data will be analysed iteratively, using Thematic Analysis, and mapped to the Theoretical Domains Framework, with participation from the coalition in discussing and interpreting findings and selecting intervention functions to guide the co-design workshops. Sociodemographic data of interview participants will be summarised using descriptive statistics. The study will run from approximately November 2021-November 2022.Ethics and disseminationEthics approval has been granted by the St George’s University Research Ethics Committee (REC reference 2021.0128). Study findings will be widely disseminated by the coalition through local community organisations in Hackney and broader academic and policy stakeholders, including a final celebration event. Recommendations for a future larger scale study and testing of prototyped interventions will be made.Strengths and limitations of this studyStrengthsThis study will directly respond to ongoing calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination, by implementing a value-driven and reciprocal approach to conducting a study addressing the needs of an underserved community.The target population was selected following a comprehensive systematic review of the evidence (1) and pre-engagement scoping work conducted with migrant community representatives in London, UK. (2, 3)It aims to co-produce a tailored intervention to address specific barriers to, and strengthen, vaccine uptake for COVID-19 and routine vaccines in adult Congolese migrants (including MMR, Td/IPV, and HPV) as set out by UKHSA guidance (4), and has been co-designed with, and will be co-delivered by, a coalition formed of academic researchers, a council for voluntary service (a local charity which offers services and support for local voluntary and community organisations), and a Congolese community-based organisation.LimitationsAs this study is tailored to the Congolese migrant population, other migrants who also face barriers to vaccine uptake are not included. Whilst we can draw some conclusions about the experiences of other Black migrants who face similar historical and cultural barriers to uptake of routine and COVID-19 vaccines, our ability to generalise the findings to all migrant communities might be limited.Co-designed intervention prototypes will not be formally implemented and evaluated in this study, however recommendations will be made so that this can be done in a future phase.

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Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators

Cited by 110 publications

References 58 publications

Motives for COVID-19 vaccine hesitancy amongst marginalized groups, including homeless persons and migrants, in France: a mixed-methods study.

Motives for COVID-19 vaccine hesitancy amongst marginalized groups, including homeless persons and migrants, in France: a mixed-methods study.

Incidence of SARS-CoV-2 infection and factors associated with complete COVID-19 vaccine uptake among migrant origin persons in Finland.

Co-designing an intervention to strengthen vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory study protocol

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