Why some migrants in Europe have lower vaccination uptake

Environment and sustainability 17. jan 2023 2 min PhD Fellow Alison Crawshaw Written by Kristian Sjøgren

In a major review, researchers investigated why so many migrants in Europe are undervaccinated against diseases, including measles and COVID-19. A researcher says that targeted initiatives are required to ensure that undervaccinated migrants in Europe are aligned with the European vaccination programmes and are thereby protected against deadly diseases.

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Because of differences in health systems worldwide and in barriers to vaccination uptake, many migrants arrive in Europe without having received all the vaccinations recommended in the various European countries. This increases their risk of becoming seriously ill.

In addition, many migrants remain undervaccinated because the various European health systems are not designed to facilitate follow-up vaccination of migrants across all age groups.

A new study shows why migrants do not get vaccinated and which groups of migrants should be targeted with specific interventions to increase their vaccination uptake.

The results can help to identify how and where to start to increase vaccination uptake among migrants and thus close the global immunisation gap.

“Our research is immediately relevant in strengthening vaccination programmes in high-income countries and decision-making processes and planning related to immunising migrants. For example, this could involve offering follow-up vaccination of migrants arriving in a new host country or follow-up vaccination at the first doctor’s visit. There is also a gap in healthcare professionals’ knowledge about follow-up vaccination of migrants, and experts have wanted guidelines in this area for many years,” explains the lead researcher behind the study, Alison Crawshaw, PhD Fellow, St. George’s, University of London.

The research has been published in Lancet Infectious Diseases.

Barriers to vaccination

The researchers systematically reviewed 67 previously published studies from 16 countries in Europe representing 366,529 migrants.

The study identified which factors may contribute to migrants not getting the recommended vaccinations, such as childhood vaccination programmes or vaccination against COVID-19.

Overall, the study shows that various factors are barriers to participating in vaccination programmes, including language, literacy and communication barriers, practical and legal barriers, concerns about safety and side-effects and stigma regarding various vaccines.

The study also shows that barriers related to vaccination acceptance were most frequently reported among eastern European and Muslim migrants.

The researchers also identified 23 factors that may be decisive for undervaccination of migrants, such as the migrants being of African, Asian or eastern European origin, having migrated recently or being refugees or asylum seekers.

The researchers found no strong overall association between vaccination uptake and sex or age.

“But the literature and data on migrant populations are limited. The data may therefore be biased, and other prominent factors relevant to the uptake of vaccination programmes may be insufficiently researched and were therefore not included in this study,” says Alison Crawshaw.

Solutions are possible

Alison Crawshaw says that the fact that some migrant groups are undervaccinated is well known, but this does not apply to all groups, and classifying all migrants as undervaccinated therefore does not make sense.

More tailored and evidence-informed strategies should be adopted to solve the problems.

“Identifying which groups of migrants are undervaccinated, and the reasons why, is important so that we can develop strategies and interventions that have a greater chance of being effective. This should be facilitated to close the global immunisation gap and ensure the health of migrant populations, which comprise about 5% of the European population and up to 14% of the population of the United Kingdom and Germany,” explains Alison Crawshaw.:

The researchers highlight six important points from the study.

  • Access to vaccination and acceptance of vaccination are key factors influencing vaccination uptake in migrant populations in Europe.
  • Vaccination offers and services should be designed to better meet the social, cultural and language needs of migrants, including providing interpreters, training healthcare professionals in migrant health and cultural competence and implementing tailored interventions to facilitate vaccination for migrants.
  • Strategies are needed to ensure that all migrants, including adults, are included in catch-up vaccination initiatives and supported in accessing health and social care when they arrive in host countries.
  • Tailored and evidence-informed strategies codesigned with migrant populations are needed to address specific barriers and perceptions towards vaccines and vaccination in context.
  • Ensuring that public health messages reach migrant populations clearly and distinctly through the specific communication channels, formats and languages they use is important. The purpose is to build trust and combat the spread of misinformation.

The measures mentioned should be implemented today rather than tomorrow.

“Our findings have immediate implications for strengthening national and regional immunisation programmes and public health responses to both routine vaccination and the COVID-19 pandemic,” concludes Alison Crawshaw.

Alison is a public health specialist and member of the Migrant Health Research Group at St George’s, University of London, where her PhD research focu...

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