Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers—including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals—for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.
Bibliographical noteFunding Information: This study was funded by the National Institute for Health Research (NIHR300072). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. AFC, LPG, and SH are funded by the NIHR (NIHR300072); AFC and SH are funded by the Academy of Medical Sciences (SBF005\1111). SH acknowledges funding from the Novo Nordisk Foundation (Mobility – Global Medicine and Health Research) and WHO. AD and SEH are funded by the Medical Research Council (MRC/N013638/1). JC is funded by an NIHR in-practice clinical fellowship (NIHR300290). KR is funded by the Rosetrees Trust (M775). AM is supported by the NIHR Applied Research Collaboration NW London. The funders did not have any direct role in the writing or decision to submit this manuscript for publication. The views expressed are those of the author(s) and not necessarily those of the National Health Service, Department of Health and Social Care, or the NIHR. We thank the members of our NIHR Patient and Public Involvement Project Advisory Board, including Larysa Agbaso, Monika Hartmann, Saliha Majeed, and Yusuf Ciftci. We also thank the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM).
HB is a member of the National Institute for Health and Care Excellence committee developing guidance on vaccine uptake in the general population. SH is a freelance senior editor for The Lancet Infectious Diseases and other Lancet journals. FW is a member of the Vulnerable Migrants Wellbeing Project Advisory Board, led by the University of Birmingham and Doctors of the World and funded by the Nuffield Foundation. All other authors declare no competing interests.
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Publisher Copyright: © 2022 Elsevier Ltd. All rights reserved.
Citation: Alison F Crawshaw, Yasmin Farah, Anna Deal, Kieran Rustage, Sally E Hayward, Jessica Carter, Felicity Knights, Lucy P Goldsmith, Ines Campos-Matos, Fatima Wurie, Azeem Majeed, Helen Bedford, Alice S Forster, Sally Hargreaves,
Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review, The Lancet Infectious Diseases, Volume 22, Issue 9, 2022,
Pages e254-e266, ISSN 1473-3099, https://doi.org/10.1016/S1473-3099(22)00066-4.