National approaches to the vaccination of recently arrived migrants in Europe: A comparative policy analysis across 32 European countries

Ravensbergen, Sofanne J; Nellums, Laura B; Hargreaves, Sally; Stienstra, Ymkje; Friedland, Jon S.

doi:10.1016/j.tmaid.2018.10.011

Cited by 29 publications

(19 citation statements)

References 19 publications

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“…These barriers have been exacerbated in many cases by increasing digitalisation of healthcare services during the pandemic (17, 18). Adult migrants are widely excluded from vaccination services on arrival to the UK and Europe, due to structural and policy shortfalls in engaging them in catch-up vaccination campaigns (19, 20), even though ensuring high levels of coverage and equitable access are key priorities of the European Vaccine Action Plan and the Sustainable Development Goals (SDGs) (21). Specifically, undocumented migrants or those with limited leave to remain, asylum seekers and refugees, those residing in temporary asylum accommodation, detention centres, and other high-risk settings, as well as several groups of low-skilled labour migrants, are also often highly marginalised and excluded from health and vaccination systems, yet their views are rarely sought to inform policy and practice.…”

Section: Introductionmentioning

confidence: 99%

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

Deal

Hayward

Huda

et al. 2021

Preprint

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Introduction Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. Methods We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old; <10 years in the UK) to the UK with precarious immigration status between September 2020 and March 2021, seeking their input into strategies to strengthen COVID-19 vaccine delivery and uptake. We used the Three Cs model (confidence, complacency and convenience) to explore COVID-19 vaccine hesitancy, barriers and access. Data were analysed using a thematic framework approach. Data collection continued until data saturation was reached, and no novel concepts were arising. The study was approved by the University of London ethics committee (REC 2020.00630). Results We approached 20 migrant support groups nationwide, recruiting 32 migrants (mean age 37.1 years; 21 [66%] female; mean time in the UK 5.6 years [SD 3.7 years]), including refugees (n = 3), asylum seekers (n = 19), undocumented migrants (n = 8) and migrants with limited leave to remain (n = 2) from 15 different countries (5 WHO regions). 23 (72%) of 32 migrants reported being hesitant about accepting a COVID-19 vaccine and communicated concerns over vaccine content, side-effects, lack of accessible information in an appropriate language, lack of trust in the health system and low perceived need. Participants reported a range of barriers to accessing the COVID-19 vaccine and expressed concerns that their communities would be excluded from or de-prioritised in the roll-out. Undocumented migrants described fears over being charged and facing immigration checks if they present for a vaccine. All participants (n = 10) interviewed after recent government announcements that COVID-19 vaccines can be accessed without facing immigration checks remained unaware of this. Participants stated that convenience of access would be a key factor in their decision around whether to accept a vaccine and proposed alternative access points to primary care services (for example, walk-in centres in trusted places such as foodbanks, community centres and charities), alongside promoting registration with primary care for all, and working closely with communities to produce accessible information on COVID-19 vaccination. Conclusions Precarious migrants may be hesitant about accepting a COVID-19 vaccine and face multiple and unique barriers to access, requiring simple but innovative solutions to ensure equitable access and uptake. Vaccine hesitancy and low awareness around entitlement and relevant access points could be easily addressed with clear, accessible, and tailored information campaigns, co-produced and delivered by trusted sources within marginalised migrant communities. These findings have immediate relevance to the COVID-19 vaccination initiatives in the UK and in other European and high-income countries with diverse migrant populations.

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Section: Introductionmentioning

confidence: 99%

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

Deal

Hayward

Huda

et al. 2021

Preprint

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“…Outbreaks of measles and hepatitis A have been documented in migrant populations in Europe. Migrants in the EU and European Economic Erea (EEA) are a diverse group, including both internal EU migrants -moving from one country in Europe to another -and external non-EU migrants [10]. As our group of Brazilian migrants in Portugal had a high level of education (90.9% had undergraduate or postgraduate degree), it is possible that they were more up to dated to vaccines than the general population [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

Attitudes on vaccination among Portuguese travelers and Brazilian migrans: A pilot study in Portugal

Igreja¹,

Barros²,

Teodósio

2019

Acta Med Sal

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Introduction: Anti-vaccination movements exist in Europe and it may reduce adherence to international vaccination. Objectives: To evaluate attitudes on vaccination among Portuguese travelers and Brazilian migrants in Portugal. Subjects and Methods: Between May and June 2019 a cross-sectional survey was carried out in the Travel Clinic of the Institute of Hygiene and Tropical Medicine of Lisbon. A self-administered questionnaire was applied after medical consultation.Travelers were asked about their attitudes to vaccines. An anonymous web-based survey was sent to Brazilian migrants living in Portugal for at least 6 months. Results: 55 Portuguese (P) travelers and 22 Brazilian (B) migrants answered the questionnaire. 47.3% of Portuguese travelers were male; the mean age was 33 years; reason for travel: tourism (43.6%) or business (30.9%). 31.8% of Brazilian migrants were male and the mean age was 44 years; 71.4% were living in Portugal for ≤ 2 years. Attitudes towards vaccines: 64.8% P and 68.2% B prefer to vaccine even when the risk of acquire a disease is low; 64.1% P and 95.5% B consider that the resistance acquired by disease is better than resistance acquired by vaccine; 75.5% P and 77.3% B prefer to vaccine even when diseases are not severe; 5.6% P and 13.6% B don't take vaccines because they are afraid of side effects. About the reasons to accept a vaccine, travelers/ migrants consider very important to trust in the doctor (100% P, 95.4% B), and the excellent protective effect of a vaccine (98.1% P, 90.9% B). Conclusions: Portuguese travelers and Brazilian migrants in Portugal seem to have a favorable attitude towards vaccination, despite the anti-vaccination movements in Europe. They believe that trust in the doctor and excellent protection of the vaccines are reasons to accept it. The quality of traveler's advice may maintain/increase adherence to vaccination.

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“…Ensuring poliovirus immunity among refugees remains a priority until polio has been eradicated worldwide. 31 Ravensvergen et al 32 analyzed vaccination policies for migrants in Europe, and there is considerable variation in policies. In 2018, the main strategies for migrant vaccination are in place in nearly all European countries, and the strategies are generally in line with international recommendations and mainly focused on children.…”

Section: Meningococcal Vaccinesmentioning

confidence: 99%

Meningococcal infections among refugees and immigrants: silent threats of past, present and future

Dinleyici

Borrow

2020

Human Vaccines & Immunotherapeutics

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Globally, there is an increasing number of international migrants. The majority are forced displaced refugees and children unaccompanied by a caregiver, and have limited access to essential public health interventions. Routine vaccination might be interrupted or be incomplete due to conflict areas with limited public health services or a long-unplanned journey. Refugees and migrants may bring infectious disease risks to their country of destination and may be exposed to new risk factors during transit or at their destination. There are lessons learned strategies among refugees and asylum seekers in different countries (vaccination campaign during outbreak, maintain vaccination systems for refugees and medical screening and/or vaccination on arrival) against vaccine-preventable diseasesother than meningococcal infections. Since the 1980s, invasive meningococcal disease (IMD) has been reported as a critical healthcare issue in places of humanitarian crisis such as Thailand and African's meningitis belt. Refugees and migrants are at increased risk of IMD compared with the overall population due to sero-epidemiology in their country of origin, specific characteristics of the IMD, and a number of contacts during the journey. Recently, IMD cases due to serogroups X and W have been reported and are an emerging health threat for persons arriving from Africa to refugee camps in Italy. There have been sporadic case reports of IMD due to serogroup B in Turkey; however, there has not yet been increased disease activity in this population and no outbreaks have been observed. Outbreaks of IMD in refugee camps have been and could be successfully controlled through the implementation of timely and high-coverage vaccination campaigns, and individual cases of IMD can be treated with antibiotics. Research is needed to determine the prevalence of meningococcal carriage and serogroup distribution among refugees and migrants to inform vaccine recommendations. There is no official recommendation for meningococcal vaccination of refugees. Further strategies for prevention and treatment of human immunodeficiency virus, tuberculosis and antibiotic resistance among refugees are directly related to potential prevention methods for IMD. Meningococcal vaccines have been administered only to risk groups in most host countries Thus, further strategies for the definition of new/emerging risk factors for IMD would be helpful to guide vaccine implementation for refugees and immigrants.

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National approaches to the vaccination of recently arrived migrants in Europe: A comparative policy analysis across 32 European countries

Cited by 29 publications

References 19 publications

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

Attitudes on vaccination among Portuguese travelers and Brazilian migrans: A pilot study in Portugal

Meningococcal infections among refugees and immigrants: silent threats of past, present and future

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