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

Abstract

Background: 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 the determinants of under-vaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

“…(35,52) In the absence of translated or accessible information, many migrants reported that they turned to alternative and unregulated sources, such as Google, social media, friends, and family. (22,33,53,56,57) ii. Practical and legal barriers to accessing healthcare and services Practical and legal barriers to accessing healthcare (whether perceived or real) and vaccination delivery models, meant that many migrants experienced exclusion and challenges accessing vaccination services.…”

“…(31,36,65) Fears of being charged for care or asked about immigration status, distrust of HCPs and authorities based on rumours or past experiences of discrimination, difficulties registering with a GP, or being refused care, were also highlighted. (7,31,36,(55)(56)(57)65) These fears were a major barrier to COVID-19 vaccination access in two UK studies of asylum seekers, refugees, and migrants with precarious immigration status, who expressed concern that they would be de-prioritised or excluded from the COVID-19 vaccine roll-out because of their status. (7,56) Migrants (n=10) interviewed after government announcements to widen COVID-19 vaccine access to undocumented migrants also remained unaware that they could be accessed free of charge and without immigration checks.…”

“…Poor HCP knowledge of migrants' entitlements to healthcare and vaccination guidelines (e.g., vaccination of individuals with incomplete/uncertain immunisation status) was highlighted, with instances of patients being wrongly refused access to primary care or not offered recommended catch-up vaccinations. (31,45,57,62) A French study of GPs found wide variation in vaccination practices for newly-arrived migrants with no vaccination record, with some GPs reluctant to revaccinate those with uncertain immunisation status due to concerns about reactogenicity. (58) There were also missed opportunities to vaccinate;…”

“…( 55) Five studies highlighted how this lack of information could lead to exposure to misinformation from unofficial sources, presenting further barriers to uptake. (7,33,53,56,57) Some migrants explained their reluctance to vaccinate against COVID-19 was because they felt it was not needed, and they preferred to rely on natural remedies, their immune system or self-isolation to prevent infection. (7,56) iv.…”

“…Knowledge-related barriers in migrants included low health literacy or knowledge of the need for vaccination or boosters (25,27,32,36,39,40,42,48,51,61), lacking knowledge about the disease, or its relationship to the vaccine (particularly in the case of cervical cancer and HPV vaccine) (7,25,34,48,52,56,57), unfamiliarity with the immunisation schedule or need for boosters, or where to access them (43,48,51,55,63), and lacking knowledge or evidence of one's own vaccination history. (38,42,62,63) Many migrants commented that they struggled to find credible and trustworthy information about vaccination in their own language.…”