Strategies to increase catch-up vaccination among migrants: a qualitative study and rapid review

Abstract Background WHO’s Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules. Methods We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an in-depth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis. Results 63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving under-immunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations. Conclusions Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catch-up vaccination among marginalised migrant groups. Key messages • Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks. • Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.


Background:
WHO's Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules.

Methods:
We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an indepth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis.

Results
: 63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving underimmunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations.

Conclusions:
Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catchup vaccination among marginalised migrant groups.

Key messages:
Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks. Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.

Background:
Providing equal access to health care is a major goal of health systems and a criterion for health system performance assessment (HSPA). The first systematic HSPA for Germany has been piloted in 2021. Access is one dimension of the conceptual framework (others are, e.g., population health, quality, and efficiency), which will be analysed in the following.

Methods:
Nine indicators to measure access were selected based on a systematic search of established instruments in (inter)national HSPA initiatives. Included indicators are availability and accessibility of services (e.g., waiting times) and financial risk protection, among others. Other criteria for the inclusion of indicators were data availability and international comparability. Indicators were evaluated in terms of their trend over time , in international comparison (e.g., Austria, Denmark, France), and according to various equity categories (e.g., age, gender, region).

Results:
The indicator access to palliative care could not be evaluated due to lack of data. Overall, access is good in Germany. Internationally, Germany performs better than average on most of the indicators, and its performance has improved over time. Physician density in the inpatient and outpatient sectors has increased since 2000 and is above the average of comparator countries. For some specialties, physician density in rural areas is lower than in urban areas, but the gap has decreased in recent years and does not apply to primary care. Furthermore, only 0.3% of the total population report having foregone care, although they had considered it necessary.