Table 2.
Factors contributing to low acceptability of vaccination, and proposed solutions
| Vaccine | Population | Factors contributing to low acceptability | Solutions, strategies, best practices proposed | |
|---|---|---|---|---|
| Andrade, UAE | COVID-19 | Migrants generally | Alienation from society, perceived ethnic discrimination, education levels | Educational campaigns, vaccine mandates, increased social integration |
| Aragones, USA | HPV | Latino immigrants | Lack of provider recommendation, fear of side effects | Need for tailored information, preferably from HCWs |
| Artiga, USA | COVID-19 | Migrants generally | Fear of side effects; language barriers to information; fear of links to immigration services | Tailored outreach and education; culturally appropriate information in range of languages; pop-up services to counter lack of trust |
| Berardi, multiple countries | COVID-19 | Migrants generally | Lack of details and language diversity in translated campaigns, requirement for undocumented migrants to register, exclusion from healthcare/welfare systems, stigmatization | effective community engagement for bidirectional communication and dialogue |
| Campeau, USA | Measles | Somali parents | Migration history and structural marginalization (which make it hard to trust medical providers) during resettlement, concerns about non-inclusive clinical research, beliefs in immunity as flexible and personalized (developed through encounters with germs, not through vaccination) influence vaccination decisions | Collective social and institutional change and resource redistribution |
| Crawshaw, UK | COVID-19 | Migrants generally | Doctor–patient relationships; language barriers; religious and cultural beliefs; structural inequities; susceptibility to misinformation; conflicting recommendations from country of origin; lack of inclusiveness in vaccination programmes | Participatory approaches, engagement and co-design of vaccination programmes/interventions; provide platforms for concerns to be shared without judgement; build trust through transparency |
| Dailey, USA | HPV | Somali parents | Fears of side effects, cultural beliefs, complacency about need for vaccine, lack of information on efficacy | Tailored, culturally appropriate communication needed with stress on health benefits of vaccination, oral information given by a GP/HCW important |
| Deal, UK | COVID-19 | Refugees, asylum seekers, undocumented migrants | Fears of side effects, misinformation circulating, lack of trust in authorities, fears over immigration checks, preference for ‘natural’ solutions, structural inequity, religious beliefs | Campaigns to increase trust in primary care and educate HCWs about migrant health needs; walk-in/pop-up vaccination centres in trusted places; tailored information in range of languages; avoid stigmatization; collaboration with community/religious groups or non-governmental organizations |
| El Salibi, Lebanon | COVID-19 | Syrian refugees | Fears of side effects or low vaccine safety, newness of vaccine, COVID-19 vaccine not essential, newness of vaccine, lack of confidence in vaccine efficacy, preference for ‘natural’ prevention methods (e.g. social distancing), lack of trust in the system | Information campaigns to counter misinformation, collaboration with community leaders, organizations and other key influencers to re-establish trust |
| Ganczak, Poland | Childhood | Ukrainian | Difficulty finding trusted information on vaccines, low trust in the system and vaccines in home country, misinformation circulating, fears around vaccine safety | Information on vaccination importance and safety to be given by HCWs, training needed to allow HCWs to do this accurately, translated information/material required |
| Gehlbach, USA | COVID-19 | Latinx farm workers | Distrust in the system and medicine, misinformation circulating, financial and social insecurity and inequality, lack of access to internet or other information sources, language barriers | Education in digital literacy; normalization of vaccination; engage community in decision making around service delivery and outreach; tailored information campaigns |
| Riccardo, EU | Childhood/all | Migrants generally | Lack of trust in authorities, cultural acceptability and fear of immunization | Advocate for decreasing inequalities in healthcare, involve and empower community health leaders; use cultural mediators; guidelines training and tools should be created for migrant sensitive advocacy and communication |
| Godoy-Ramirez, Sweden | Childhood | Undocumented migrants | Low trust in system; fear of side effects; instability meaning vaccination becomes a lower priority; previous bad experiences of host healthcare system | Education for HCWs on migrant health needs, efforts to restore trust in health system; greater focus on tailoring appropriate strategies to specific groups; interventions should be multi-component and dialogue based |
| Gonzalez, USA | COVID-19 | Immigrant families | Fears of side effects, unsure about vaccine efficacy or feel vaccination is not needed | Immigrants more likely than non-immigrants to trust local public health officials; use elected officials and religious leaders for vaccine information; culturally appropriate, tailored information of vaccine safety, efficacy and access points needed |
| Gorman, UK | Influenza | Polish migrants | Fear of side effects, influence of diaspora/home media; complacency around rare disease; distrust in new vaccines | Promote vaccination on social media through community-specific influencers; recruit HCWs from specific community |
| Gorman, UK | HPV | Polish migrants | Influence of distrust in home healthcare system; difficulty understanding UK health and vaccination system; communication and language barriers | Educate parents and HCWs, tailor information and ensure it is accessible and understandable; collaboration with community members |
| Jalloh, Bangladesh | Childhood | Rohingya refugees | Fear of side effects, preference for traditional treatments; religious beliefs; past experiences of vaccination in the camp; fears that ‘white’ humanitarian workers had ulterior motives behind vaccination | Information campaigns in religious or community meetings; collaboration with community and religious leaders; increased awareness and accommodation of religious or cultural barriers among HCWs |
| Kim, USA | HPV | Korean migrants | Worries about vaccine safety, peer opinions on vaccination | Recommendation by HCW or other authority (e.g. school) important, school-based education recommended or education in any other existing, familiar environment (e.g. church) |
| Kobetz, USA | HPV | Haitian migrants | Scepticism about vaccine efficacy; fear of side effects and safety; ambivalence; fears about newness of vaccine | Recommendation by doctor important; information and education about side effects and efficacy delivered through trusted sources e.g. community HCW |
| Lin, Canada | COVID-19 | Migrants generally | Fear of side effects, vaccine safety and mistrust in vaccination generally | Pro-active health communication, pop-up COVID-19 vaccine clinics via community- and faith-based organizations |
| Louka, Greece, Netherlands | Childhood/all | Asylum seekers | Vaccination not always considered important, particularly in country of resettlement (i.e. Netherlands) compared with transit countries (i.e. Greece) | Point of entry to Europe considered best timing for vaccination by asylum seekers; public healthcare system preferred as access point over NGOs; promotional work on vaccination important |
| Netfa, Global | HPV | Immigrant parents | Side effect and vaccine safety concerns; religious and cultural norms; feeling vaccination is not important or needed; distrust in medical provider/pharmaceutical companies | Negative attitudes often changed when information given; information in multiple languages; personal counselling in clinics; educational programmes |
| Page, multiple countries | COVID-19 | Undocumented migrants | Use of social media or community networks as vaccination information source | Community engagement and messaging in multiple languages |
| Perry, UK | Childhood | Asylum-seeking children | Lack of trust; language barriers with HCWs | None given |
| Ricco, Italy | Tetanus | Immigrant construction? Workers | Foreign-born more likely to see recommendation by local public health services as a reason to get vaccinated; more likely to state religious/personal belief as a reason to not | Foreign-born workers mostly received doses through occupational health teams |
| Sim, UK | Influenza | Polish pregnant women | Complacency about seriousness of vaccine-preventable diseases; fears around vaccine safety; concerns about being used as ‘guinea pigs’ | Provide translated, accessible information for range of literacy skills, assistance accessing face-to-face advice |
| Thomas, USA | COVID-19 | Migrants generally | Lack of investment in community partnerships | Integrate community groups and individuals into vaccination processes; including at leadership and decision-making levels |
| Tomlinson, UK | Childhood | Somali women | Risk perception: disease vs vaccine safety, fears of side effects, misinformation, peer opinions, religious concerns especially worry around gelatine content | Oral information from a Somali speaker; develop closer relationships between health providers and community; work with religious leaders |
| Truman, USA | Childhood/all | Karen refugees | Longer time spent in USA associated with more reluctance to vaccinate | Culturally fit interventions and education programmes recommended |
| Walker, Africa | COVID-19 | Migrants generally | Fears around hidden agendas of ‘the west’, misinformation, different policies about vaccination across countries (e.g. Tanzania, Madagascar) | Inclusion of community groups, religious leaders etc; sharing information online in migrant languages |
| Wang, Canada | COVID-19 | Asian migrants | Misinformation on social media; language and literacy barriers; mistrust in healthcare services; hesitancy among HCWs; systematic racism and mistrust | Incorporate cultural competency in healthcare; tailored information for preferred languages; directly address specific concerns; HCWs from migrant communities can aid communication |
| Jama, Sweden | MMR | Somali mothers | Fear of side effects (autism); bad previous experiences with HCWs; misinformation from word-of-mouth; stigmatization and feeling their views are not listened to by HCWs; peer opinions on vaccination | Interventions that focus on communication mechanisms; particularly through nurses |
| Jenness, Norway | Measles | Somali immigrants | More time in host country and urban location associated with lower uptake | Tailored strategies for community; social network analysis needed to identify influencers in communities to collaborate with; improved communication |
| Khodadadi, USA | HPV | Latina mothers | Low perceived risk of HPV associated with reluctance to vaccinate | Education and improvement of health literacy to increase risk awareness |
| Pratt, USA | HPV | Somali adolescents | Scepticism or fear about vaccines in general; religious and cultural norms; feelings of stigmatization | |
| Lockyer, UK | COVID-19 | Mix | Fear of side effects and vaccine safety; structural inequality and precarity, confusion and distrust in authorities and traditional media; conflicting or negative information from home country or social media, existing distrust in institutions | Systematic monitoring of misinformation on social media and responding sensitively; inform HCWs about circulating misinformation; harnessing connections with trusted community network; providing information in multiple languages |
| Grandahl, Sweden | HPV | Immigrant women | Communication barriers; cultural health norms, fears of side effects of low efficacy | Ensure availability of interpreter; more information required; translated invitation letters |
| Mupandawana, UK | HPV | African parents | Cultural and religious norms, complacency about VPD risk; risk perception, preferring natural prevention methods (abstinence); side effects, misinformation; distrust of ‘the West’ | Tailored information that addresses cultural and religious concerns; create smaller subgroups for targeted communication; video/story-based educational material, collaboration with religious or other leaders |
| Rubens- Augustson, Canada | HPV | HCWs | Language barriers; lack of appropriate information resources; cultural and religious factors; limited HCW time | Targeted health promotion e.g. in schools, ensuring access to appropriate personnel, culturally sensitive risk communication |
| Tankwanchi, Global | All | Migrants generally | Fears and misinformation about safety; limited knowledge of VPDs and vaccines; distrust of host health systems; language barriers; religious beliefs | Tailored, community-based immunization service delivery with migrant-friendly health systems and policies that affirm and protect human rights and dignity |
| Harmsen, Netherlands | All | Immigrant parents | Lack of time/information given to patients by HCWs; fear of side effects; language barriers; newness of vaccines | Information in own language; more oral information from HCWs or in specific educative meetings |
| Bell, UK | All | Polish and Romanian migrants | Expectations largely built on knowledge and experience from Poland and Romania; greater refusal of influenza vaccine due to perceptions around lack of efficacy | HCWs to explain how the health system works and clarify expectations; outreach to those facing barriers to healthcare; translated information; use pictograms or pictures; improve access to interpreting and translation services; use views and expectations of service users to shape services |
| Bell, UK | Measles | Romanian women and key providers | Concerns around vaccine safety; distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK | Tackle cultural and linguistic barriers; strengthen provider–service user relationships; establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve |
| Hellenic Red Cross | COVID-19 | Refugees and migrants in deprived areas | Do not think vaccines are effective in ending the pandemic; did not consider themselves at risk; side effects; not adequately informed about the vaccine; did not believe COVID-19 existed | Creation of information material with Q&A type information in all spoken languages; because respondents sourced information from the internet, provide robust sources of internet information; use a combination of information approaches—printed material, posters, community meetings; establish a COVID-19 handbook for all involved in vaccine delivery |
HCW = healthcare worker; GP = general practitioner.