Ensuring equitable access to vaccines for refugees and migrants during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems worldwide. To mitigate the transmission of the virus, governments have implemented many public health measures. However, maintaining immunization services is crucial to ensure protection from vaccine-preventable diseases. If essential health services and immunization programmes are disrupted, the resurgence of such diseases may soon occur in under-immunized population groups, such as refugees and migrants.¹

Already before the pandemic, in the World Health Organization (WHO) European Region, refugees and migrants faced socioeconomic, sociocultural and educational barriers when accessing immunization services in host countries.² Seroprevalence studies have shown suboptimal immunity to various vaccine-preventable diseases, indicating lower vaccination coverage in refugees and migrants compared to the host population average.³ During the pandemic, the vulnerability of these groups might have increased.

To address these issues, national vaccination policies need to adopt innovative measures. Immunization doses missed as a result of COVID-19 pandemic containment measures should be offered as quickly as possible to refugees and migrants. Mobile vaccination clinics, combined health-care services (such as antenatal care and vaccination programmes) and mass vaccination campaigns should be considered to address existing immunity gaps. All efforts must consider delivery of immunization services in hard-to-reach settings and to hard-to-reach population groups.

Decentralized health systems and lack of coordination among local authorities and international stakeholders may have disproportionate negative effects on refugees and migrants.⁴ Many of these groups may have their first and only contact with national health services at arrival or in border areas.⁵ Health professionals may only be able to address imminent health risks, whereas determining the need for vaccination requires assessing a person’s vaccination history and comparing it with the host country’s routine schedule. Follow-ups would also be needed to ensure all necessary doses are received.

Most Member States of the European Region do not have specific immunization directives focusing on refugees and migrants.² Ascertaining whether these groups have completed their vaccinations is impossible without consistent, comprehensive and standardized disaggregated data, shared across borders and along migratory routes for effective health needs and burden-of-disease monitoring.^3,6

Because of the lack of clarity in existing national policies and inconsistent guidelines between countries,⁷ health-care professionals might misunderstand vaccination recommendations for refugees and migrants, particularly when vaccination documentation is not available.^7,8 Migrants might not receive the care they are entitled to, also resulting in missed opportunities for vaccination.⁴ Electronic medical records, interlinking national immunization registers and data sharing along migratory routes can contribute to monitoring and planning of vaccination of refugees and migrants.

Adequate vaccination of refugees and migrants is also influenced by availability of staff, particularly of cultural mediators and interpreters, who are essential in ensuring an effective and inclusive health-care service delivery. To ensure equitable service delivery and use, policy-makers must guarantee a culturally competent health-care service. Medical staff should be trained in cultural competency to avoid discriminatory behaviour that might reinforce stigma and inhibit refugees and migrants from accessing health services. Refugees and migrants should receive culturally and linguistically appropriate immunization messages and practices.

Refugees and migrants’ awareness of their health rights must be prioritized, particularly for irregular migrants and those in transit.

Effective measures to address barriers to immunization for refugees and migrants must include strengthening the capacity of health systems and primary health-care providers; setting up or expanding immunization information systems to monitor vaccination coverage; developing training and awareness of health-care providers; establishing health literacy education programmes; and ensuring national immunization programmes are resilient to humanitarian or health crises.³

As COVID-19 vaccines are expected to become available soon, ensuring equitable distribution among countries will be a key challenge. Governments are already striving to ensure that their populations will have access to a safe and effective COVID-19 vaccine when it becomes available. Strategic considerations in preparing for deployment of COVID-19 vaccine,⁹ outlines how to identify gaps in national vaccination plans. WHO’s Strategic Advisory Group of Experts suggests a tiered system to prioritize who should receive the vaccines, and identifies low-income migrant workers, irregular migrants, those unable to physically distance, including those living in camps and camp-like settings, as priority groups for the allocation of COVID-19 vaccination globally.¹⁰