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

Abstract

Background Some refugee and migrant populations have been disproportionately impacted by the COVID-19 pandemic, yet evidence suggests lower uptake of COVID-19 vaccines. They are also an under-immunised group for many routine vaccines. We did a rapid review to explore drivers of under-immunisation and vaccine hesitancy among refugee and migrant populations globally to define strategies to strengthen both COVID-19 and routine vaccination uptake. Methods We collected global literature (01/01/2010 - 05/05/2022) pertaining to drivers of under-immunisation and vaccine hesitancy in refugees and migrants, incorporating all vaccines. We searched MEDLINE, Embase, Global Health PsycINFO and the WHO Global Research on COVID-19 database and grey literature. Qualitative data were analysed thematically to identify drivers of under-immunisation and vaccine hesitancy, then categorised using the Increasing Vaccination Model. Results 63 papers were included in this review, reporting data on diverse population groups, including refugees, asylum seekers, labour and undocumented migrants from 22 countries, with six papers reporting on a regional or global scale. Drivers of under-immunisation and vaccine hesitancy pertaining to a wide range of vaccines were covered, including COVID-19 (n=27), HPV (13), measles or MMR (3), influenza (3), tetanus (1), and vaccination in general. We found a range of factors driving under-immunisation and hesitancy in refugee and migrant groups, including unique awareness and access factors that need to be better considered in policy and service delivery. Acceptability of vaccination was often deeply rooted in social and historical context and influenced by personal risk perception. Conclusions These findings hold direct relevance to current efforts to ensure high levels of global immunisation coverage, key to which is to ensure marginalised refugees and migrant populations are included in national vaccination plans of low- middle- and high-income countries. We found a stark lack of research from low- and middle-income and humanitarian contexts on vaccination in mobile groups, a situation that needs to be urgently rectified to ensure high coverage for COVID-19 and routine vaccinations.

Driving uptake of missed routine vaccines in adolescent and adult migrants: a prospective observational mixed-methods pilot study of catch-up vaccination in UK general practice

“…The reasons why some migrants are at risk of under-immunisation for routine vaccinations are well documented (11)(12)(13)(14)(15), and include a range of cultural, socio-structural, political, economic, and behavioural factors, including language barriers and a lack of specific procedures to engage older age groups in catch-up vaccination. Migrants' countries of origin often have differing immunisation schedules, reduced availability of vaccines, poor health system infrastructure or fragmented delivery systems so these populations in Europe and the UK may have missed vaccines, doses, and boosters and not have been offered newer vaccines such as HPV that were not available in their host countries.…”