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

Abstract

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.

The use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review

“…For some migrants and ethnic minority groups, consistent use of social media platforms for sharing and receiving COVID-19-related health information was reported in several included studies 29 34-36 40-42 44 43 . Social media was reported to be the preferred source of information about COVID-19 for international migrants in China (WeChat was used by 94.5% of respondents for COVID-19 information).…”

“…An additional eight studies were conducted in the US, 32-39 and one each in China, 40 Jordan, 41 Qatar, 42 and Turkey. 43 Eight studies reported on migrants, 27 29 32 40-44 including migrants in the host countries of China 40 , Jordan 41 , Quatar, 42 Turkey 43 , and the US 32 and UK 27 29 , and one study involved predominantly migrants from Venezuela residing in other countries. 44 Nine studies reported about a specific ethnic minority or group (Latino individuals, 32 34 36 37 Black American citizens, 35 39 , Jain community members 28 and Syrian migrants 41 43 ).…”

“…In Qatar, migrants reported they preferred to find out about COVID-19 using their own personal research or searching for information, including using social media as a source 42 . A study of precarious migrants (asylum seekers, undocumented migrants) in the UK found many relied on social media (WhatsApp groups, Facebook) for information on the pandemic and the ongoing vaccination programme 29 .…”

“…Several studies highlight concerns that some migrant and ethnic minority groups were unable to find official information in their host country in their native language about various aspects of COVID-19, hence their reliance on social media 24 27 29 40 43 . For example, a UK study of precarious migrants (asylum seekers, undocumented migrants) reported that those feeling most abandoned or scared due to a lack of understandable, clear official information in the early stages of the pandemic were more likely to rely on word-of-mouth or social media (WhatsApp groups, Facebook) for information, including around the vaccination programme 29 . One study of international migrants in China (94.5% of whom preferred social media for news about COVID-19) had lower rates of correct knowledge about COVID-19 compared to rates reported for Chinese residents 40 .…”

Attitudes Towards Coronavirus (COVID-19) Vaccine and Sources of Information Across Diverse Ethnic Groups in the UK: a Qualitative Study

“…[32] Easy access will be important to facilitate vaccination uptake for those with risk due to occupation or comorbidity[24]. Our study and others certainly indicated that many would prefer a local, low risk community healthcare setting with convenience of booking appointments[29, 41, 42]. However, a key difference to note is that at the time of data collection, access to vaccines was not a tangible issue as they had not yet been approved.…”