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Benoni R, Sartorello A, Moretti F, Marchiori F, Accordini L, Postiglione C, Coffele V, Tardivo S. Disparities in access to COVID-19 vaccine in Verona, Italy: a cohort study using local health immunization data. Front Public Health 2023; 11:1167414. [PMID: 37397767 PMCID: PMC10310303 DOI: 10.3389/fpubh.2023.1167414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Migrant populations worldwide were disproportionately impacted by the COVID-19 pandemic. Although substantial resources have been invested in scaling COVID-19 vaccination campaigns, globally vaccine rate and uptake remained low among migrants from across many countries. This study aimed to explore the country of birth as a factor influencing access to the COVID-19 vaccine. Methods This retrospective cohort study included adults vaccinated against SARS-CoV-2 receiving at least one dose in the Verona province between 27 December 2020 and 31 December 2021. Time-to-vaccination was estimated as the difference between the actual date of each person's first dose of COVID-19 vaccination and the date in which the local health authorities opened vaccination reservations for the corresponding age group. The birth country was classified based on both the World Health Organization regions and the World Bank country-level economic classification. Results were reported as the average marginal effect (AME) with corresponding 0.95 confidence intervals (CI). Results During the study period, 7,54,004 first doses were administered and 5,06,734 (F = 2,46,399, 48.6%) were included after applying the exclusion criteria, with a mean age of 51.2 years (SD 19.4). Migrants were 85,989 (17.0%, F = 40,277, 46.8%), with a mean age of 42.4 years (SD 13.3). The mean time-to-vaccination for the whole sample was 46.9 days (SD 45.9), 41.8 days (SD 43.5) in the Italian population, and 71.6 days (SD 49.1) in the migrant one (p < 0.001). The AME of the time-to-vaccination compared to the Italian population was higher by 27.6 [0.95 CI 25.4-29.8], 24.5 [0.95 CI 24.0-24.9], 30.5 [0.95 CI 30.1-31.0] and 7.3 [0.95 CI 6.2-8.3] days for migrants from low-, low-middle-, upper-middle- and high-income countries, respectively. Considering the WHO region, the AME of the time-to-vaccination compared to the Italian group was higher by 31.5 [0.95 CI 30.6-32.5], 31.1 [0.95 CI 30.6-31.5], and 29.2 [0.95 CI 28.5-29.9] days for migrants from African, European, and East-Mediterranean regions, respectively. Overall, time-to-vaccination decreased with increasing age (p < 0.001). Although both migrants and Italians mainly used hub centers (>90%), migrants also used pharmacies and local health units as alternative sites (2.9% and 1.5%, respectively), while Italians (3.3%) and migrants from the European region (4.2%) relied more on family doctors. Conclusion The birth country of migrants influenced access to COVID-19 vaccine both in terms of time-to-vaccination and vaccination points used, especially for the LIC migrant group. Public health authorities should take socio-cultural and economic factors into consideration for tailored communication to people from migrant communities and for planning a mass vaccination campaign.
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Affiliation(s)
- Roberto Benoni
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anna Sartorello
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesco Marchiori
- Department of Prevention, Unità Locale Socio-Sanitaria (ULSS) 9, Verona, Italy
| | - Luciana Accordini
- Department of Prevention, Unità Locale Socio-Sanitaria (ULSS) 9, Verona, Italy
| | - Chiara Postiglione
- Department of Prevention, Unità Locale Socio-Sanitaria (ULSS) 9, Verona, Italy
| | - Viviana Coffele
- Department of Prevention, Unità Locale Socio-Sanitaria (ULSS) 9, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Svallfors S, Larsson EC, Puranen B, Ekström AM. COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden. Eur J Public Health 2023:7179915. [PMID: 37229599 PMCID: PMC10395762 DOI: 10.1093/eurpub/ckad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. METHODS Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. RESULTS One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. CONCLUSIONS The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.
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Affiliation(s)
- Signe Svallfors
- Department of Sociology, Stanford University, Stanford, CA, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bi Puranen
- World Values Survey Association, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Venhälsan, Stockholm, Sweden
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Uansri S, Kunpeuk W, Julchoo S, Sinam P, Phaiyarom M, Suphanchaimat R. Perceived Barriers of Accessing Healthcare among Migrant Workers in Thailand during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105781. [PMID: 37239510 DOI: 10.3390/ijerph20105781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
The outbreak of Coronavirus Disease 2019 (COVID-19) has threatened health and well-being in all populations. This impact is also deepening structural inequalities for migrant workers in Thailand. Due to their vulnerability and limited opportunity to access health services, they have greater risks in many health aspects compared to other populations. This qualitative study sought to examine the key health concerns and barriers during the COVID-19 pandemic on healthcare access among migrant workers in Thailand through the lens of policymakers, healthcare professionals, experts on migrant health, and migrant workers. We conducted 17 semi-structured in-depth interviews of stakeholders from health and non-health sectors in Thailand from July to October 2021. The interviews were transcribed and analyzed using both deductive and inductive thematic approaches. Thematic coding was applied. The results showed that financial constraints were a major barrier for healthcare access among migrant workers. These included affordability of healthcare and difficulty accessing funds (migrant health insurance). Structural barriers included some health facilities opening for emergency cases only. Insufficient healthcare resources were profound during the peak of positive cases. Cognitive barriers included negative attitudes and diverse understanding of healthcare rights. Language and communication barriers, and a lack of information also played an important role. Conclusion, our study highlights healthcare access barriers to migrant workers in Thailand during the COVID-19 pandemic. Recommendations for future resolution of these barriers were also proposed.
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Affiliation(s)
- Sonvanee Uansri
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Watinee Kunpeuk
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Sataporn Julchoo
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Pigunkaew Sinam
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Mathudara Phaiyarom
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
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Bastola K, Nohynek H, Lilja E, Castaneda AE, Austero S, Kuusio H, Skogberg N. Incidence of SARS-CoV-2 Infection and Factors Associated With Complete COVID-19 Vaccine Uptake Among Migrant Origin Persons in Finland. Int J Public Health 2023; 68:1605547. [PMID: 37206095 PMCID: PMC10189547 DOI: 10.3389/ijph.2023.1605547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
Objective: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n = 13,223) and MigCOVID (n = 3,668) survey data using unique personal identifier. Logistic regression was the main method of analyses. Results: Among FinMonik sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union, Estonia, and rest of Africa and higher among persons of Southeast Asia, rest of Asia, and the Middle East/North Africa than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among FinMonik sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.
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Affiliation(s)
- Kalpana Bastola
- National Institute for Health and Welfare, Helsinki, Finland
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Kühlbrandt C, McGowan CR, Stuart R, Grenfell P, Miles S, Renedo A, Marston C. COVID-19 vaccination decisions among Gypsy, Roma, and Traveller communities: A qualitative study moving beyond "vaccine hesitancy". Vaccine 2023:S0264-410X(23)00515-7. [PMID: 37202271 DOI: 10.1016/j.vaccine.2023.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. METHODS We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. FINDINGS Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of "vaccine hesitancy". Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others' health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. INTERPRETATION A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. FUNDING This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.
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Affiliation(s)
- Charlotte Kühlbrandt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Catherine R McGowan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Rachel Stuart
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; College of Business, Arts and Social Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, United Kingdom
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Barts & The London School of Medicine and Dentistry, Queen Mary University of London E1 2AD, United Kingdom
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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Holdbrook LE, Hassan N, Clarke SK, Coakley A, Norrie E, Yemane M, Youssef MR, Sahilie A, Antonio M, Cerino ER, Pendharkar SR, Lake D, Spitzer DL, Pottie K, Edwards ST, Fabreau GE. Vaccines for all: A formative evaluation of a multistakeholder community-engaged COVID-19 vaccine outreach clinic for migrant communities. J Migr Health 2023; 7:100188. [PMID: 37007284 PMCID: PMC10040088 DOI: 10.1016/j.jmh.2023.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/15/2023] [Accepted: 03/25/2023] [Indexed: 03/28/2023] Open
Abstract
Background Racialized, low-income, and migrant populations experience persistent barriers to vaccines against COVID-19. These communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. Diverse multi-stakeholder coalitions and community partnerships can improve vaccine outreach strategies, but how stakeholders perceive these models is unknown. Methods We conducted a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5-6, 2021. We delivered an online post-clinic survey to clinic stakeholders, to assess whether the clinic achieved its collectively derived pre-specified goals (effective, efficient, patient-centered, and safe), to asses whether the clinic model was scalable, and to solicit improvement recommendations. Survey responses were analyzed using descriptive statistics and thematic analysis. Results Overall, 166/195 (85%) stakeholders responded. The majority were from non-healthcare positions (59%), between 30 and 49 years of age (87/136; 64%), and self-identified as racialized individuals (96/136; 71%). Respondents felt the clinic was effective (99.2%), efficient (96.9%), patient-centered (92.3%), and safe (90.8%), and that the outreach model was scalable 94.6% (123/130). There were no differences across stakeholder categories. The open-ended survey responses supported the scale responses. Improvement suggestions describe increased time for clinic planning and promotion, more multilingual staff, and further efforts to reduce accessibility barriers, such as priority check-in for people with disabilities. Conclusion Diverse stakeholders almost universally felt that this community-engaged COVID-19 vaccine outreach clinic achieved its goals and was scalable. These findings support the value of community-engaged outreach to improve vaccine equity among other marginalized newcomer communities.
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Affiliation(s)
- Linda E. Holdbrook
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Nour Hassan
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | | | - Annalee Coakley
- Mosaic Refugee Health Clinic, Canada
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Eric Norrie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Mussie Yemane
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Michael R. Youssef
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Adanech Sahilie
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Minnella Antonio
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Edna Ramirez Cerino
- Department of Medicine, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Canada
| | - Sachin R. Pendharkar
- Department of Medicine and Community Health Sciences, CSM, University of Calgary, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association (AIMGA), Canada
| | | | - Kevin Pottie
- Departments of Family Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
- Institute du Saviour Montfort, Ottawa, ON, Canada
| | - Samuel T. Edwards
- Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Medicine, Oregon Health & Science University
| | - Gabriel E. Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, AB, Canada
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Skogberg N, Prinkey T, Lilja E, Koponen P, Castaneda AE. Association of sociodemographic characteristics with self-perceived access to COVID-19 information and adherence to preventive measures among migrant origin and general populations in Finland: a cross-sectional study. BMJ Open 2023; 13:e069192. [PMID: 36914190 PMCID: PMC10015668 DOI: 10.1136/bmjopen-2022-069192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES This study examines how access to COVID-19 information and adherence to preventive measures varies by sociodemographic characteristics, and whether the associations differ among the migrant origin and the general Finnish population. Additionally, the association of perceived access to information with adherence to preventive measures is examined. DESIGN Cross-sectional, population-based random sample. BACKGROUND Equity in access to information is crucial for securing individual well-being and successful management of a crisis at population level. SETTING Persons who have a residence permit in Finland. PARTICIPANTS Migrant origin population constituted of persons aged 21-66 years born abroad, who took part in the Impact of the Coronavirus on the Wellbeing of the Foreign Born Population (MigCOVID) Survey conducted from October 2020 to February 2021 (n=3611). Participants in the FinHealth 2017 Follow-up Survey conducted within the same time frame, representing the general Finnish population, constituted the reference group (n=3490). OUTCOME MEASURES Self-perceived access to COVID-19 information, adherence to preventive measures. RESULTS Self-perceived access to information and adherence to preventive measures was overall high both among the migrant origin and the general population. Perceived adequate access to information was associated with living in Finland for 12 years or longer (OR 1.94, 95% CI 1.05-3.57) and excellent Finnish/Swedish language skills (OR 2.71, 95% CI 1.62-4.53) among the migrant origin population and with higher education (OR 3.56, 95% CI 1.49-8.55 for tertiary and OR 2.87, 95% CI 1.25-6.59 for secondary) among the general population. The association between examined sociodemographic characteristics with adherence to preventive measures varied by study group. CONCLUSIONS Findings on the association of perceived access to information with language proficiency in official languages highlight the need for rapid multilingual and simple language crisis communications. Findings also suggest that crisis communications and measures designed to influence health behaviours at population level may not be directly transferable if the aim is to influence health behaviours also among ethnically and culturally diverse populations.
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Affiliation(s)
- Natalia Skogberg
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tyler Prinkey
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eero Lilja
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivikki Koponen
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu E Castaneda
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Al-Kassab-Córdova A, Silva-Perez C, Mendez-Guerra C, Herrera-Añazco P, Benites-Zapata VA. Factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru: A population-based cross-sectional study. Travel Med Infect Dis 2023; 53:102563. [PMID: 36898490 PMCID: PMC9995296 DOI: 10.1016/j.tmaid.2023.102563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Ensuring broad COVID-19 vaccination coverage among migrants is a global public health concern. Thus, our study aimed to assess the factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru. METHODS This was a cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. Our population included Venezuelan migrants and refugees over 18 years old living in Peru with complete information for the variables of interest. Two outcome variables were assessed: not receiving the primary series and not receiving the booster dose of the COVID-19 vaccine. Crude and adjusted prevalences were calculated with 95% confidence intervals. RESULTS A total of 7,727 Venezuelan adults were included in our study, of whom 6,511 completed the primary series. The overall COVID-19 vaccination coverage of the primary series was 84.17%, whilst the coverage of the booster dose was 28.06%. Being younger, uninsured, illegally-staying, and having a low educational level were associated with both outcomes. CONCLUSION Several sociodemographic and migration-related variables were associated with both outcomes. Governmental policies prioritizing vaccination among Venezuelan migrants are needed to ensure broad coverage in this vulnerable group.
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Affiliation(s)
- Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Claudia Silva-Perez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Peru; Red Peruana de Salud Colectiva, Lima, Peru
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Fujita M, Kanda M, Kiyohara H, Ikeda S, Iwamoto A, Sudo K, Teshima Y, Nii M, Murata Y, Kato J, Komatsu A, Yumino A, Sawada T, Sato H, Nakasa T. Migrants' access to COVID-19 vaccination in Japan: Progress and challenges. J Migr Health 2023; 7:100169. [PMID: 36814897 PMCID: PMC9932756 DOI: 10.1016/j.jmh.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/17/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Objectives This study aimed to review the progress and challenges of COVID-19 vaccine roll-out for migrants in Japan and discuss the approaches to address the challenges and better prepare for future waves of COVID-19 and other pandemics. Methods We conducted a literature review using an assessment framework which we developed building upon existing frameworks and tools on access to health services and COVID-19 vaccination among migrants. Results COVID-19 vaccination coverage among foreigners might be lower than that of nationals although the data on foreigners were not widely available. A gap appeared to exist between the government's efforts to disseminate vaccine-related information through multi-lingual websites and migrant communities as recipients. A series of barriers for migrants were identified at different stages of the vaccination process. While efforts were made by different units of local governments, NGOs, migrant communities, and international exchange associations, linkages across sectors and scaling-up appeared to be an issue. No foreigners were explicitly excluded from the entitlements of COVID-19 vaccination. The national level guidance, however, allowed sub-national levels to make a decision on whether or not undocumented foreigners should be reported to the immigration office or law enforcement when providing the services. In consequence, units in charge of public health and vaccination of some municipalities did not offer vaccination to those in need. Conclusion Migrants, especially those unregistered face various barriers in accessing COVID-19 vaccination. It is critical to assess and address challenges concerning channels of information dissemination, pathways to access services, obstacles for vulnerable migrants, and data for evidence-based actions.
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Affiliation(s)
- Masami Fujita
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan
| | - Miwa Kanda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,Corresponding author.
| | - Hiroyuki Kiyohara
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan
| | - Saki Ikeda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan
| | - Kyoko Sudo
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan,Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan
| | - Yuko Teshima
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,University of Tokyo, Japan
| | - Midori Nii
- Citizen's Network for Global Activities (CINGA), Japan
| | - Yoji Murata
- Bureau of Citizens and Cultural Affairs, Tokyo Metropolitan Government, Japan
| | | | - Aiko Komatsu
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,Nagasaki University, Japan
| | - Aya Yumino
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,University of Tokyo, Japan
| | - Takashi Sawada
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,Minatomachi Medical Center, Japan,SHARE, Japan
| | - Hiroshi Sato
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,Institute of Developing Economies, Japan
| | - Tamotsu Nakasa
- Migrants’ Neighbor Network & Action (MINNA), Tokyo, Japan,SHARE, Japan
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Crawshaw AF, Hickey C, Lutumba LM, Kitoko LM, Nkembi S, Knights F, Ciftci Y, Goldsmith LP, Vandrevala T, Forster AS, Hargreaves S. Codesigning an intervention to strengthen COVID-19 vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory qualitative study protocol. BMJ Open 2023; 13:e063462. [PMID: 36639215 PMCID: PMC9842599 DOI: 10.1136/bmjopen-2022-063462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Migrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration. METHODS AND ANALYSIS LISOLO MALAMU ('Good Talk') is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community-academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022. ETHICS AND DISSEMINATION Ethics approval was granted by the St George's University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Caroline Hickey
- Hackney Refugee and Migrant Forum, Hackney Council for Voluntary Service, London, UK
| | | | | | - Sarah Nkembi
- Hackney Congolese Women Support Group, London, UK
| | - Felicity Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | | | - Lucy Pollyanna Goldsmith
- Institute for Infection and Immunity and Population Health Research Institute, St George's, University of London, London, UK
| | - Tushna Vandrevala
- Faculty of Health, Science, Social Care and Education, Centre for Applied Health and Social Care Research, Kingston University, Kingston, UK
| | | | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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Ottone M, Bartolini L, Bonvicini L, Giorgi Rossi P. The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations. Front Public Health 2023; 11:969143. [PMID: 36969620 PMCID: PMC10031649 DOI: 10.3389/fpubh.2023.969143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC populations. A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality. Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC group were 0.84 (95% CI 0.82-0.87) and 0.67 (95% CI 0.46-0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC population than in the HDC population (HRs for infection: 1.37 95% CI 1.22-1.53 vs. 1.20 95% CI 1.14-1.25; HRs for mortality: 3.96 95% CI 1.82-8.60 vs. 1.71 95% CI 1.50-1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95% CI 4.48-79.87 vs. 3.91 95% CI 2.69-5.69) were larger in HMPC than in the HDC population, but differences could be due to chance. Among the population with diabetes, the HMPC group showed similar incidence (IRR: 0.99 95% CI: 0.88-1.12) and mortality (MRR: 0.89 95% CI: 0.49-1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC populations (HRs: 1.73 95% CI 1.41-2.11 among HDC vs. 1.41 95% CI 0.63-3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on COVID-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.
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Ganczak M, Kalinowski P, Pasek O, Duda-Duma Ł, Sobieraj E, Goławski J, Biesiada D, Jansen D, Vervoort JPM, Edelstein M, Kowalska M. Health System Barriers to Child Mandatory and Optional Vaccination among Ukrainian Migrants in Poland in the Context of MMR and HPV Vaccines-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:712. [PMID: 36613034 PMCID: PMC9819946 DOI: 10.3390/ijerph20010712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Background Migrants' access to healthcare services is limited. This study aimed to identify health system barriers to vaccination, specifically HPV/MMR vaccination among children in Ukrainian economic migrants (UMs). Methods Between December 2021-March 2022, a qualitative study of UMs living in Poland was conducted. Six focus groups were held with 53 UMs aged 15-45; in-depth interviews with 12 healthcare workers (HCWs) were also performed. A thematic analysis was conducted based on the six WHO health system building blocks. Results HCWs described gaps in integrating migrant status in accessible healthcare data which impeded active management of vaccination procedures. UMs reported that the digitization of healthcare services, intensified during the COVID-19 pandemic, reduced their access to primary care. Inadequate health information systems caused problems with the provision of credible vaccine information in translated forms, and language difficulties, experienced by both UMs and HCWs; this was enhanced by a lack of professional interpreting services. Although most UMs reported vaccinating children according to the Polish schedule, the variations in schedules across countries caused concern among UMs and increased HCWs' uncertainty about how to interpret vaccination cards, particularly in the context of possible false certificates. UMs were affected by discrimination through HCWs. HPV was deprioritized by UMs due to misconceptions about non-mandatory vaccinations; the cost was also a barrier. Conclusions The study findings have implications for migrant vaccination delivery targeting children in Poland, and other UMs receiving countries. A concerted effort is required to improve UM's awareness of the significance of vaccinations. Barriers to healthcare access must be recognized by policymakers. Importantly, removing the cost barrier may increase the uptake of the HPV vaccine among Ukrainian migrant adolescents.
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Affiliation(s)
- Maria Ganczak
- Department of Infectious Diseases, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Paweł Kalinowski
- Department of Hygiene and Epidemiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Oskar Pasek
- Student Research Group, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Łukasz Duda-Duma
- Student Research Group, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Ewa Sobieraj
- Student Research Group, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Jakub Goławski
- Student Research Group, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | | | - Danielle Jansen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Johanna P. M. Vervoort
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Michael Edelstein
- Ziv Medical Center, Safed 7404703, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Marta Kowalska
- Department of Hygiene and Epidemiology, Medical University of Lublin, 20-059 Lublin, Poland
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Nichol AA, Parcharidi Z, Al-Delaimy WK, Kondilis E. Rapid Review of COVID-19 Vaccination Access and Acceptance for Global Refugee, Asylum Seeker and Undocumented Migrant Populations. Int J Public Health 2022; 67:1605508. [PMID: 36618432 PMCID: PMC9812946 DOI: 10.3389/ijph.2022.1605508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Refugees, asylum seekers, and undocumented migrants globally have been disproportionally impacted by COVID-19. Vaccination has been a major tool to reduce disease impact, yet concerns exist regarding equitable allocation and uptake. Methods: A rapid literature review was conducted based on PRISMA guidelines to determine COVID-19 vaccination acceptance rates and level of access for these population groups globally. Results: Relatively high COVID-19 vaccine acceptance levels were commonly reported in these populations, although, trust in host governments was a frequently expressed concern, especially for undocumented migrants. Outreach efforts and access to comprehensive information from a trusted source and in appropriate language were found to be major determinants of COVID-19 vaccine acceptance. COVID-19 vaccination access and policies varied considerably across host countries despite urgings by international organizations to include migrants and refugees. While most governments endorsed inclusive policies, evidence of successful program implementation was frequently lacking, creating difficulty to better tailor and implement COVID-19 outreach programs. Conclusion: This review identifies impactful improvements to be implemented to ensure equitable COVID-19 vaccinations and to reduce disease burden on refugees, asylum seekers, and undocumented migrants.
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Affiliation(s)
- Ariadne A. Nichol
- School of Medicine, University of California, San Diego, La Jolla, CA, United States,Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, CA, United States,*Correspondence: Ariadne A. Nichol,
| | - Zoi Parcharidi
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Wael K. Al-Delaimy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Elias Kondilis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Daniels D, Imdad A, Buscemi-Kimmins T, Vitale D, Rani U, Darabaner E, Shaw A, Shaw J. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2131168. [PMID: 36332155 PMCID: PMC9746503 DOI: 10.1080/21645515.2022.2131168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.
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Affiliation(s)
- Danielle Daniels
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA,CONTACT Danielle Daniels 750 East Adams St. Room 5400, Syracuse, NY13210, USA
| | - Aamer Imdad
- Department of Pediatrics, Karjoo Family Center for Pediatric Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Danielle Vitale
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Uzma Rani
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ellen Darabaner
- Hunter-Rice Health Sciences Library, Samaritan Medical Center, Watertown, NY, USA
| | - Andrea Shaw
- Department of Pediatrics, Department of Internal Medicine, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jana Shaw
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
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Hnuploy K, Sornlorm K, Soe TK, Khammaneechan P, Rakchart N, Jongjit W, Supaviboolas S, Chutipattana N. COVID-19 Vaccine Acceptance and Its Determinants among Myanmar Migrant Workers in Southern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13420. [PMID: 36294001 PMCID: PMC9602811 DOI: 10.3390/ijerph192013420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Success in eradicating COVID-19 will rely on the rate of vaccination adoption worldwide. Vaccine acceptance among vulnerable groups is critical for preventing the spread of COVID-19 and decreasing unnecessary deaths. The purpose of this study was to report on the willingness to obtain COVID-19 immunization and the factors related to its acceptance among Myanmar migrant workers in southern Thailand. This cross-sectional study consisted of 301 samples collected between October and November 2021 and analyzed using multiple logistic regression. Thirty-nine percent of workers intended to receive the COVID-19 vaccine within a year. The following factors were associated with obtaining the COVID-19 vaccine: a high level of perception of COVID-19 (AOR = 5.43), income less than or equal to 10,000 baht/month (AOR = 6.98), financial status at a sufficient level (AOR = 7.79), wearing a face mask in the previous month almost all the time (AOR =4.26), maintaining 1-2 m of distance from anyone in the last month (AOR =2.51), and measuring temperature in the previous month (AOR = 5.24). High reluctance to accept the COVID-19 vaccine among Myanmar migrant workers can influence efforts to eliminate COVID-19. Collaboration with all stakeholders is critical to helping Myanmar workers understand COVID-19, social measures, and preventive beliefs to increase vaccine uptake.
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Affiliation(s)
- Kanit Hnuploy
- Faculty of Science and Technology, Suratthani Rajabhat University, Suratthani 84100, Thailand
| | - Kittipong Sornlorm
- Faculty of Public Health, Khon Kaen University, Khon Kean 40002, Thailand
| | | | - Patthanasak Khammaneechan
- Excellent Centre for Dengue and Community Public Health (E.C. for DACH), School of Public Health, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | - Navarat Rakchart
- School of Nursing, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | - Wajinee Jongjit
- Department of Public Health Strategy Development, Nakhon Si Thammarat Provincial Public Health Office, Nakhon Si Thammarat 80000, Thailand
| | - Suttakarn Supaviboolas
- Southern Border Regional Center for Primary Health Care Development, Nakhon Si Thammarat 80000, Thailand
| | - Nirachon Chutipattana
- Excellent Centre for Dengue and Community Public Health (E.C. for DACH), School of Public Health, Walailak University, Nakhon Si Thammarat 80161, Thailand
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Tiley KS, White JM, Andrews N, Tessier E, Edelstein M. Equity of the Meningitis B vaccination programme in England, 2016-2018. Vaccine 2022; 40:6125-6132. [PMID: 36117004 DOI: 10.1016/j.vaccine.2022.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Abstract
In England, the Meningitis B (MenB) vaccine is scheduled at eight and 16 weeks with a booster dose at one year of age and protects children against invasive bacterial meningococcal disease caused by Neisseria meningitidis serogroup B. Coverage of the second dose of MenB vaccine at 12 months was >92% in 2017/18, but this may mask inequalities in coverage in particular population groups. MenB vaccination records for children aged six, 12 and 18 months of age from December 2016 to May 2018 were routinely extracted from GP patient management systems every month in England via a web-based platform for national monitoring of vaccine coverage. We determined the association between ethnicity, deprivation and area of residence, vaccine coverage and drop-out rates (between dose one and dose two), using binomial regression. After adjusting for other factors, ethnic groups with lowest dose one coverage (Black or Black British-Caribbean, White-Any other White background, White-Irish) also had lowest dose two coverage, but in addition, these ethnic groups also had the largest drop-out rates between dose one and dose two. The drop-out rate for Black or Black British-Caribbean children was 5.7 percentage points higher than for White-British children. Vaccine coverage decreased with increasing deprivation quintile, and this was most marked for the booster coverage (6.2 percentage points lower in the most deprived compared to least deprived quintile, p < 0.001). To achieve high coverage for completed courses across all ethnic groups and deprivation quintiles both high initiation rates and a reduction in drop-out rates for ethnic groups with lowest coverage is necessary. A qualitative approach to better understand reasons behind lower coverage and higher drop-out rates in the most underserved ethnic groups is required to develop tailored approaches addressing these inequalities.
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Affiliation(s)
- Karen S Tiley
- Public Health England (now UK Health Security Agency), 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Joanne M White
- Public Health England (now UK Health Security Agency), 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Nick Andrews
- Public Health England (now UK Health Security Agency), 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Elise Tessier
- Public Health England (now UK Health Security Agency), 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Michael Edelstein
- Public Health England (now UK Health Security Agency), 61 Colindale Avenue, London NW9 5EQ, UK.
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Declich S, De Ponte G, Marchetti G, Dente MG, Tosti ME, Tavoschi L, Lopalco PL, Russo ML, Marceca M. Life-course vaccinations for migrants and refugees: Drawing lessons from the COVID-19 vaccination campaigns. J Glob Health 2022; 12:03064. [PMID: 36181721 PMCID: PMC9526476 DOI: 10.7189/jogh.12.03064] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giulia Marchetti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Grazia Dente
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | | | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Davies D, McDougall A, Prophete A, Sivashanmugarajan V, Yoong W. COVID-19 vaccination: patient uptake and attitudes in a multi-ethnic North London maternity unit. Postgrad Med J 2022; 98:750-755. [PMID: 37062992 DOI: 10.1136/pmj-2022-141829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE COVID-19 vaccine uptake among pregnant women has been low, particularly in younger and ethnic minority mothers. We performed a 'snapshot' survey to explore vaccine uptake and factors which influence this, as well as underlying beliefs regarding COVID-19 vaccination among pregnant women in a North London hospital. STUDY DESIGN Pregnant women were invited to complete an anonymised survey, where data were collected on demographics, personal and household vaccination status, and beliefs about the vaccine. Free-text comments were analysed thematically. RESULTS Two hundred and two women completed the survey, of whom 56.9% (n=115) were unvaccinated and 43.1% (n=87) had received at least one dose of COVID-19 vaccine, with 35.6% (n=72) having received two doses. Factors associated with acceptance of vaccination included: (a) age over 25 years (57.6% vaccinated vs 17.2% under 25 years); (b) Asian ethnicity (69.4% vaccinated vs 41.2% white ethnicity, 27.5% black/Caribbean/African/black-British ethnicity and 12.5% mixed ethnicity) and (c) living in a vaccinated household (63.7% vaccinated vs 9.7% living in an unvaccinated household) (all p<0.001). Vaccine uptake was higher in women who had relied on formal medical advice as their main source of information compared with other sources (59.0% vs 37.5% friends and family, 30.4% news and 21.4% social media). Qualitative data revealed concerns about a lack of information regarding the safety of COVID-19 vaccination in pregnancy. CONCLUSION Age, ethnicity, household vaccination status and information source influenced vaccination status in our pregnant population. These findings highlight the urgent need to tackle vaccine mistrust and disseminate pregnancy-specific vaccine safety data to pregnant women. TRIAL REGISTRATION NUMBER 5467.
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Affiliation(s)
- Dorothy Davies
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - Anna McDougall
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - Amelia Prophete
- St George's International School of Medicine, St George's, Grenada
| | | | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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A Framework for Inspiring COVID-19 Vaccine Confidence in African American and Latino Communities. Vaccines (Basel) 2022; 10:vaccines10081319. [PMID: 36016207 PMCID: PMC9416715 DOI: 10.3390/vaccines10081319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted racial and ethnic minority communities, particularly African American and Latino communities. The impacts of social determinants of health, structural racism, misinformation, and mistrust have contributed to a decreased COVID-19 vaccine uptake. Effective methods of addressing and combatting these barriers are essential. Accurate and targeted messaging delivered by trusted voices from community-based organizations, government health systems and organizations, and healthcare and academic systems is imperative. Outreach and communication should be culturally sensitive, provided in the preferred language of the community, flexible, and tailored for in-person and virtual outlets. This communication must also increase trust, combat misinformation, and inspire COVID-19 vaccine confidence. In this manuscript, we outline a framework for inspiring COVID-19 vaccine confidence in African American and Latino communities. These methods of targeted outreach should be considered and implemented for urgent and nonurgent community public health efforts beyond the COVID-19 pandemic (e.g., monkeypox) and as a framework to inspire vaccine confidence in those living in racial and ethnic minority communities globally.
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Matlin SA, Smith AC, Merone J, LeVoy M, Shah J, Vanbiervliet F, Vandentorren S, Vearey J, Saso L. The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9973. [PMID: 36011606 PMCID: PMC9408401 DOI: 10.3390/ijerph19169973] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 05/02/2023]
Abstract
Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as "essential workers", including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.
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Affiliation(s)
- Stephen A. Matlin
- Institute of Global Health Innovation, Imperial College London, South Kensington, London SW7 2AZ, UK
| | - Alyna C. Smith
- Rue du Congrès/Congresstraat 37-41, P.O. Box 5, 1000 Brussels, Belgium
| | - Jessica Merone
- Human Rights Center, University of Padova, Via 8 Febbraio, 2, 35122 Padova, Italy
| | - Michele LeVoy
- Rue du Congrès/Congresstraat 37-41, P.O. Box 5, 1000 Brussels, Belgium
| | - Jalpa Shah
- Santé Publique France, 12 rue du Val d’Osne, CEDEX, 94415 Saint-Maurice, France
| | | | - Stéphanie Vandentorren
- Santé Publique France, 12 rue du Val d’Osne, CEDEX, 94415 Saint-Maurice, France
- INSERM UMR 1219-Bordeaux Population Health, University of Bordeaux, 33000 Bordeaux, France
| | - Joanna Vearey
- African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Luciano Saso
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
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Agaku IT, Adeoye C, Long TG. Geographic, Occupational, and Sociodemographic Variations in Uptake of COVID-19 Booster Doses Among Fully Vaccinated US Adults, December 1, 2021, to January 10, 2022. JAMA Netw Open 2022; 5:e2227680. [PMID: 35984657 PMCID: PMC9391956 DOI: 10.1001/jamanetworkopen.2022.27680] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE COVID-19 booster vaccine can strengthen waning immunity and widen the range of immunity against new variants. OBJECTIVE To describe geographic, occupational, and sociodemographic variations in uptake of COVID-19 booster doses among fully vaccinated US adults. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used data from the Household Pulse Survey conducted from December 1, 2021, to January 10, 2022. Household Pulse Survey is an online, probability-based survey conducted by the US Census Bureau and is designed to yield estimates nationally, by state, and across selected metropolitan areas. MAIN OUTCOMES AND MEASURES Receipt of a booster dose was defined as taking 2 or more doses of COVID-19 vaccines with the first one being the Johnson and Johnson (Janssen) vaccine, or taking 3 or more doses of any of the other COVID-19 vaccines. Weighted prevalence estimates (percentages) were computed overall and among subgroups. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to explore correlates of receiving a booster dose among those fully vaccinated. RESULTS A total of 135 821 adults completed the survey. Overall, 51.0% were female and 41.5% were aged 18 to 44 years (mean [SD] age, 48.07 [17.18] years). Of fully vaccinated adults, the percentage who reported being boosted was 48.5% (state-specific range, from 39.1% in Mississippi to 66.5% in Vermont). Nationally, the proportion of boosted adults was highest among non-Hispanic Asian individuals (54.1%); those aged 65 years or older (71.4%); those with a doctoral, professional, or master's degree (68.1%); those who were married with no children in the household (61.2%); those with annual household income of $200 000 or higher (69.3%); those enrolled in Medicare (70.9%); and those working in hospitals (60.5%) or in deathcare facilities (eg, funeral homes; 60.5%). Conversely, only one-third of those who ever received a diagnosis of COVID-19, were enrolled in Medicaid, working in pharmacies, with less than a high school education, and aged 18 to 24 years old were boosted. Multivariable analysis of pooled national data revealed that compared with those who did not work outside their home, the likelihood of being boosted was higher among adults working in hospitals (APR, 1.23; 95% CI, 1.17-1.30), ambulatory health care centers (APR, 1.16; 95% CI, 1.09-1.24), and social service settings (APR, 1.08; 95% CI, 1.01-1.15), whereas lower likelihood was seen among those working in food or beverage stores (APR, 0.85; 95% CI, 0.74-0.96) and the agriculture, forestry, fishing, or hunting industries (APR, 0.83; 95% CI, 0.72-0.97). CONCLUSIONS AND RELEVANCE These findings suggest continuing disparities in receipt of booster vaccine doses among US adults. Targeted efforts at populations with low uptake may be needed to improve booster vaccine coverage in the US.
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Affiliation(s)
- Israel T. Agaku
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
| | - Caleb Adeoye
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
| | - Theodore G. Long
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
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Martínez-Donate AP, Correa-Salazar C, Bakely L, González-Fagoaga JE, Asadi-Gonzalez A, Lazo M, Parrado E, Zhang X, Rangel Gomez MG. COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border. Front Public Health 2022; 10:928385. [PMID: 35968453 PMCID: PMC9372570 DOI: 10.3389/fpubh.2022.928385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.
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Affiliation(s)
- Ana P. Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- *Correspondence: Ana P. Martínez-Donate
| | - Catalina Correa-Salazar
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Leah Bakely
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Ahmed Asadi-Gonzalez
- School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Mexico
| | - Mariana Lazo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Emilio Parrado
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States
| | - Xiao Zhang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Maria Gudelia Rangel Gomez
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte, Tijuana, Mexico
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Bianchi FP, Stefanizzi P, Di Gioia MC, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1443-1454. [PMID: 35818804 DOI: 10.1080/14760584.2022.2100766] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group. AREAS COVERED The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI= 43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. EXPERT OPINION Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education.
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Affiliation(s)
| | | | | | - Nazario Brescia
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Sabrina Lattanzio
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
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Abba-Aji M, Stuckler D, Galea S, McKee M. Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators. J Migr Health 2022; 5:100086. [PMID: 35194589 PMCID: PMC8855618 DOI: 10.1016/j.jmh.2022.100086] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background There are widespread concerns that ethnic minorities and migrants may have inadequate access to COVID-19 vaccines. . Improving vaccine uptake among these vulnerable groups is important towards controlling the spread of COVID-19 and reducing unnecessary mortality. Here we perform a systematic review of ethnic minorities’ and migrants’ access to and acceptance of COVID-19 vaccines. Methods We searched PubMed and Web of Science databases for papers published between 1 January 2020 and 7 October 2021. Studies were included if they were peer-reviewed articles; written in English, included data or estimates of ethnic minorities’ or migrants’ access to vaccines; and employed either qualitative or quantitative methods. Of a total of 248 studies screened, 33 met these criteria and included in the final sample. Risk of bias in the included studies was assessed using Newcastle Ottawa Scale and Critical Appraisal Skills Program tools. We conducted a Synthesis Without Meta-analysis for quantitative studies and a Framework synthesis for qualitative studies. Results 31 of the included studies were conducted in high-income countries, including in the US (n = 17 studies), UK (n = 10), Qatar (n = 2), Israel (n = 1) and France (n = 1). One study was in an upper middle-income country -China (n = 1) and another covered multiple countries (n = 1). 26 studies reported outcomes for ethnic minorities while 9 studies reported on migrants. Most of the studies were quantitative -cross sectional studies (n = 24) and ecological (n = 4). The remaining were qualitative (n = 4) and mixed methods (n = 1). There was consistent evidence of elevated levels of COVID-19 vaccine hesitancy among Black/Afro-Caribbean groups in the US and UK, while studies of Hispanic/Latino populations in the US and Asian populations in the UK provided mixed pictures, with levels higher, lower, or the same as their White counterparts. Asians in the US had the highest COVID-19 vaccine acceptance compared to other ethnic groups. There was higher vaccine acceptance among migrant groups in Qatar and China than in the general population. However, migrants to the UK experienced barriers to vaccine access, mainly attributed to language and communication issues. Lack of confidence, mainly due to mistrust of government and health systems coupled with poor communication were the main barriers to uptake among Black ethnic minorities and migrants. Conclusions Our study found that low confidence in COVID-19 vaccines among Black ethnic minorities driven by mistrust and safety concerns led to high vaccine hesitancy in this group. Such vaccine hesitancy rates constitute a major barrier to COVID-19 vaccine uptake among this ethnic minority. For migrants, convenience factors such as language barriers, fear of deportation and reduced physical access reduced access to COVID-19 vaccines. Building trust, reducing physical barriers and improving communication and transparency about vaccine development through healthcare workers, religious and community leaders can improve access and facilitate uptake of COVID-19 vaccines among ethnic minority and migrant communities.
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