Vaccination concerns, beliefs and practices among Ukrainian migrants in Poland: A qualitative study

Abstract

Objectives Ukrainians numbering approximately 1.2 million are the largest migrant group in Poland. Data on vaccination coverage among migrants are not collected in EU, including Poland. Therefore, this qualitative study aimed to identify vaccination practices in this migrant group, to explore facilitators and barriers to vaccination and related access to Polish healthcare services. Methods In September 2019, a qualitative study of Ukrainian migrants (UMs) living in Szczecin, Poland, and recruited through a snowball sampling method, was conducted. Using a semi-structured topic guide, four focus groups were held with 22 UMs aged 18-45. Participants were asked about their attitudes towards vaccination in general with comparison between services in Poland and Ukraine. Following transcription and translation, a thematic analysis was conducted. Results Respondents were distrustful of Ukrainian vaccination policy, medical personnel and individual vaccines, however, they often returned to Ukraine for dental and gynaecological appoint-ments. While critical with regards to registering with Polish GPs practices, UMs were confident in health professionals, as well as vaccine delivery. Vaccines were perceived as safer and of better quality than in Ukraine. Difficulties in translating vaccination records were rarely reported, verbal communi-cation was not problematic due to language similarities. All UM parents reported vaccinating their children according to the Polish schedule. However, a significant number of adult UMs have not completed mandatory vaccinations, although they may have obtained false immunization certificates; according to UMs those can be obtained by bribing. Participants reported lower acceptance of the influenza vaccine, mainly due to perceptions around its importance; none had been vaccinated against influenza. None of UMs had heard of the HPV vaccine. UMs experienced challenges in accessing credible online vaccination information in Ukrainian, no official local health authority vaccination material existed either, except for information about measles. Conclusions This study pinpointed positive UM attitudes and practices regarding child vaccination in the Polish healthcare system and identified issues for improvement, such as adult vaccination. Health communication should be more tailored within UMs information delivery systems to enable migrants to make informed choices about vaccination. Further research is needed to better assess factors affecting vaccine uptake identified in this study.

Defining drivers of under-immunisation and vaccine hesitancy in refugee and migrant populations globally to support strategies to strengthen vaccine uptake for COVID-19: a rapid review

“…After title, abstract and full-text screening, 63 papers were identified and included in this review, see for vaccine refusal (45). Risk perception has been shown to be important among migrant communities when making vaccination decisions (46), with the perceived dangers of vaccination weighed against complacency around either the need for vaccination (47) or perceptions of danger relating to the specific vaccine-preventable disease (48). In some communities, preferences exist for 'more natural' options such as herbal remedies, avoiding human contact, reliance on our immune system (40,44).…”

“…Several papers suggest that economic barriers and affordability of vaccines are also important in decision making for some refugees and migrants (40,47,52,53,57,62,64,67,94). This can include direct costs; for example, Louka et al found that asylum seekers in Greece and the Netherlands became less likely to accept vaccination as the cost increased (57).…”

“…Refugees are defined in the Convention and Protocol Relating to the Status of Refugees as "persons outside their countries of origin who are in need of international protection because of feared persecution, or a serious threat to their life, physical integrity or freedom in their country of origin as a result of for vaccine refusal (45). Risk perception has been shown to be important among migrant communities when making vaccination decisions (46), with the perceived dangers of vaccination weighed against complacency around either the need for vaccination (47) or perceptions of danger relating to the specific vaccine-preventable disease (48). In some communities, preferences exist for 'more natural' options such as herbal remedies, avoiding human contact, reliance on our immune system (40,44).…”

“…For example, a systematic review on attitudes towards HPV vaccination in migrants found that attitudes often changed for the better once information was given (59), and low awareness about a vaccine or vaccine-preventable disease has been shown to be a key barrier to vaccination (60). Some refugee and migrant populations face specific barriers to information access, such as digital literacy or lack of technology (40,61), language barriers (11,32,39,40,47,51,(61)(62)(63)(64), poor doctor-patient communication (41,60,64,65), or a lack of information in an accessible and acceptable format (44,47,60,61,64), leading to low awareness. The evidence suggests that prior to a vaccination campaign, research should be done on what information is felt to be important among different groups (41,42,47,61,63,66).…”

“…Some refugee and migrant populations face specific barriers to information access, such as digital literacy or lack of technology (40,61), language barriers (11,32,39,40,47,51,(61)(62)(63)(64), poor doctor-patient communication (41,60,64,65), or a lack of information in an accessible and acceptable format (44,47,60,61,64), leading to low awareness. The evidence suggests that prior to a vaccination campaign, research should be done on what information is felt to be important among different groups (41,42,47,61,63,66). For example, many groups consider safety and efficacy data essential (40,67).…”