Migration, Vaccination and COVID-19 Flashcards
(32 cards)
How can migration be an issue for our generation?
Migration is a defining issue of our generation
How the world addresses human mobility will determine public health and social cohesion for decades ahead
What % of children globally are vaccinated for measles?
Around 80% of children have been vaccinated against measles (1st dose of measles) 70% of children have recieved their second dose of measles vaccine (MMR)
Along with other vaccinations (like rubella, polio, pneumococcal disease etc), these equate to around 23 million children last year (2021) not getting basic vaccinations. Around 60% of this figure live in 10 countries.
To acheicve and maintain elimination, WHO recommends 95% uptake with two doses of the MMR vaccine by 5 years of age
We need to acheive herd immunity threshold (HIT) targets in a given population to present disease from persisting
How does herd immunity work?
- If only some get vaccinated, then the virus spreads easily
- If most get vaccinated, then the virus is contained
What is happening with Uk vaccination coverage?
- UK vaccination coverage is declining for all routine vaccinations
- Considerable regional variations: London has a low measles coverage (83%)
- PHE data show there are inequities in vaccine uptake by ethnic and deprivation scores, but no data on migrants despite increases in migration to the UK in recent years
- Under immunisation has resulted in a large sustained outbreak of measles in recent months, involving 17+ countries
- 55% cases in adolescents/adults 15+ years; including adult labour migrants from Eastern Europe alongside other underimmunised groups
- UK lost its WHO elimination status for measles in 2019
- We need to know what extent migrants are an under-immunised group so that we can better target catch-up vaccination campaigns
Are migrants an underimmunised group?
- Migrants are an under-immunised groups involved in multiple outbreaks of vaccine-preventable diseases in Europe
- 19 (40%) of outbreaks were reported in temporary refugee camps or shelters
- Outbreaks often associated with adult migrants
- ‘a better understanding of vaccine access and intent in migrant groups is needed…with direct implications for COVID-19 vaccine delivery
To what extent are migrants an underimmunised group?
2126 recently arrived asylum-seeking children and adolescents:
- 33% not immunised according to Danish national schedule
- 22% not immunised for MMR
- Afghan children and Eritrean least likely to be vaccinated
- 48% of those aged 12-17 years were vaccinated/status unknown
Describe a systematic review of serology studies that pertain to migrant vaccination?
There was a systematic review conducted to observe the serology studies over the last decade
Measurement of antibodies in vaccine-preventable diseases
80 000 migrants (large study)
Study included 56 studies from 14 european countries
Metaanalysis included 37 studies (80 185 migrants) reporting on: measles, mumps, rubella, diptheria, tetanus, and polio
What is the measles coverge in the meta-analysis ?
Aiming for approx. 92-95% coverage of measles immunity in migrant populations
Under hit target= 85.5%
What is the mumps coverage in the metaanalysis?
- Below the HIT target
- Mumps coverage= 68.5%
- HIT target= 75-86%
What is the diptheria coverage in the metaanalysis?
Below the HIT target
Diptheria coverage: 55%
HIT target= 83-86%
What is the Rubella coverage in the metaanalysis?
Just below the HIT target however, it is very close
Rubella coverage: 82.8%
HIT target is 83-86%
In 2019, over 95% of rubella cases in pregnancy in the UK were in migrant women
What is the polio coverage in the metaanalysis?
Polio coverage is higher than HIT targets (80-86%).
Type 1= 94.5%
Type 2= 96.4
Type 3: 87.3%
How do people perform an analysis of UK bound refugee datasets?
= Study in the international organisation for migration: analysis of UK bound refugee datasets
They look at vaccine history, update vaccines, health updates, health check, TB screening before they come into the UK
What did a study of UK immunisation say about migrants?
Under-immunisation of UK bound refugees
- Resettled refugees are arriving in the UK under-immunised
- More than one in 10 arrive in the UK with no doses of polio-containing vaccine and almost one in five with no doses of measles-containing vaccine
- Large majority had no recorded doses of diptheria, tetanus and pertussis (DTP) vaccine
What are the barriers to vaccination?
Use a case study to highlight your point
Nigeria
- Poor functioning vaccine and health systems, lack of vaccines: measles coverage is currently 41.8%
- 1996 ‘Trovan trial’:Pfizer’s illegal trial of an unregistered drug that resulted in child deaths and an extreme lack of trust in western organisations and vaccine initiatives, and led to a polio vaccine boycott
- Vaccine hesitancy/ anti vaccination in Muslim communities in Northern Nigeria
What are the barriers facing migrants on arrival in the UK, in terms of vaccination?
- Limited data on the perspectives of migrants: one recent study in Polish and Romanians
- Overall acceptance of vaccination/not vaccine hesitant, but several barriers to getting vaccinated
- Difficulties navigating and trusting the NHS
- Language barriers and challenges in accessing credible/translated vaccine information
- Problems communicating their previous vaccine histories
What are the differnces between access barriers and acceptance barriers with regards to vaccination?
Access
- Language, literacy and communication
- Practical, legal and service barriers
Acceptance
- Eastern European and Muslin migrants
- HPV, measles and influenza vaccines
- Being African or E European was associated with being under-immunised
- No apparent or strong association with gender or age
What is vaccine hesitancy?
- Vaccine hesitancy: the delay in acceptance or refusal of vaccination services despite the availability of vaccination services
- It is complex and context specific varying across time place and vaccines
Describe the increasing vaccination model
Like the COVID-19 VACCINE
- Practical coverage of COVID vaccine-> failure of global health
- If someone is working a lot-> may not access vaccine on time
What are the health system barriers to catch migrants up on their vaccines?
- Focus is very much on migrant children for catch-up vaccinations on arrival to align them with the national schedule: assumption made by clinicians that they are vaccinated as children
- Less than half of all reporting countries in Europe offered DTP (16 of 31 countries), polio (12 of 32), MMR (12 of 32) to adults
- UK primary care: no systems in place
- 10 out of 32 countries charge adult migrants for routine vaccines
- Cheap routine vaccines that have been made inaccessible
What are the social factors that may influence the vaccination of migrants?
Lack of trust:
- Both trust in vacicne itself, but also health system and wider governance system if host country
- Lack of trust in government messaging
Personal confidence
- Concerns around vaccine safety and side-effects, concerns about low efficacy
- Feas that the COVID-19 vaccine not well enough tested on minority groups
Low awareness and access to information
- Plenty of evidence showing lack of accessible robust information as a key driver of under-immunisation
Risk-perception
- Low percieved need
- preference for ‘natural options’
- Other life/health issues are a priority
What are some of the social processes that may negatively influence motivation to vaccinate in migrants?
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Cultural or religious expectations
- Religious norms or expectations are key social processes that may influence migrants motivations to vaccinate
- Concern over vaccines being anti-islamic
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Influence of home country.dispora media
- Lack of trust in vaccines and/or lack of percieved need to have one due to influence from factors in home country and dispora media
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Historical and structural racism in host country
- Distrust in healthcare providers based on past experiences of discrimination or fears of being charged fees
- In Africa, fears that there are ‘hidden agendas in the West’ for vaccination campaigns
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Lack of resources or awareness among Healthcare workers (HCWs)
- Low knowledge of migrant needs among healthcare workers
- Low proactivity in healthcare system to reach marginalised groups
- Resource constraints: lack of access to interpreters and advocates, lack of information
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Circulating misinformation
- Social media based communication negatively influencing motivation to vaccinate
- Multiple conflicting information sources and migrants are not clear which ones to trust
Vaccines and social media
- Social media is a communication platform
- Shares high levels of misinformation about vaccines
- Evidence suggests some ethnic minorities/migrant groups are potentially more at risk of recieving misinformation on social media
- Study on approx 400 Syrian refugee mothers in jordan found that the main sources of public health info were via Facebook (Approx 90%) and WhatsApp (Approx 70%)
- Greater considertiokn must be given to influence of social media-based communciation as a major source of vaccine misinformation
- You cannot control private messages, therefore you must mobilise community response
What are the current policies in Europe for vaccinating migrants
- Identify who has been missed out in the past & reach them with the vaccines they need
- All groups have equitable access to vaccination services and that these are convenient
- UK recommends MMR, Td/IPV (Tetanus, diptheria and polio), MenACWY (aged 10-25) to be readministered to all adult migrants with uncertain vaccination status
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