As countries across Europe speed up their COVID-19 vaccination programmes, there are growing concerns about low vaccination uptake among the continent's largest ethnic minority—the Roma.
An estimated 12 million Roma live in Europe and they are among the most discriminated and disadvantaged groups in the continent. In many countries, particularly in central and eastern Europe, large numbers live in segregated settlements characterised by poor living conditions, extreme poverty, and higher burdens of infectious and non-communicable diseases.
These factors have made Roma particularly vulnerable to COVID-19, and across Europe they have been disproportionately affected by the disease, both directly (in terms of increased rates of infections, hospitalisations, and deaths, although official data for the latter are unavailable) and indirectly (eg, in terms of increased inequality and stigmatisation).
Zeljko Jovanovic, director of the Open Society Foundation (OSF) Roma Initiatives Office (Berlin, Germany), told The Lancet Microbe, “It is fair to assume that the risk is far greater for Roma than any other population. Physical distancing is almost impossible in overcrowded homes and settlements that [also] lack access to water, sewerage systems, and electricity.” Reports from people working with Roma communities suggest Jovanovic is correct.
In Hungary, where an estimated 700 000 Roma live, local activists have told media that people in settlements have been “dropping like flies” from COVID-19. In Slovakia, where Roma make up almost 10% of the population, health expert Andrej Belak has been monitoring pandemic developments in Roma settlements for the Health Ministry. He told The Lancet Microbe that serological testing showed anti-SARS-CoV-2 IgG antibody positivity rates of up to 60% in some communities. Furthermore, 45% of individuals living in settlements hospitalised with COVID-19 and 22% of those who died with the disease were younger than 50 years. According to Health Ministry data, in the general population 98% of deaths were among people older than 65 years.
“All these numbers indicate a much harsher pandemic impact in lower age groups in segregated settlements, compared to national (and international) averages”, said Belak. He added that the situation was likely to be similar in Roma communities in other parts of Europe.
However, there appears to be a deep hesitancy towards COVID-19 vaccinations among Roma. Although no exact data on vaccine uptake among Roma in Europe are available as health authorities in this region do not collect such data on the basis of ethnicity, some studies in the USA have shown vaccination rates among ethnic minority groups are generally lower, and experts expect it to be the same with Roma.
Daniel La Parra Casado (University of Alicante, Spain) told The Lancet Microbe: “There are reasons to think there are inequities in vaccination affecting the Roma population, with important variations between countries.” The OSF said it had information that vaccine uptake was low among Roma, especially in central and eastern European countries and the Balkan region. It said, for example, only 9% of Roma in Hungary and 11·5% in North Macedonia were willing to get vaccinated. In Slovakia, the figure is even lower at as little as 1% in some segregated settlements, according to Belak.
This low uptake has been attributed to a combination of factors. Historical vaccine hesitancy among Roma is documented, but there is also widespread misinformation about vaccines in many communities, a perception that COVID-19 is a low-risk disease, and a mistaken belief that previous infection confers permanent immunity, groups working with Roma told The Lancet Microbe.
Mistrust of national health-care systems and authorities is also a problem and can be partly linked to specific episodes of violation of health ethics principles, such as decades of coerced or involuntary sterilisation of Roma women, primarily in former Czechoslovakia.
Furthermore, vaccines can also be difficult to access. In some European countries, large numbers of Roma are undocumented or do not have health-care coverage and thus cannot access COVID-19 vaccination programmes. Others cannot afford travel to often far vaccination centres, or are put off by what they perceive as widespread discrimination against them in the health-care system.
International organisations and local Roma groups have launched initiatives in many countries to encourage Roma to get vaccinated, or have called on governments to do so. They have also urged Roma to be prioritised in national vaccination plans. Among EU member states, only Slovakia's vaccination programme specifically mentions prioritising Roma; however, Belak said, this has not been adhered to in practice.
Meanwhile, there are concerns that if COVID-19 vaccine uptake is low among Roma—who in some countries represent a large proportion of the population—the success of overall national vaccination programmes will be jeopardised. “A failed vaccination drive among Roma will not only worsen their already desperate situation but will enable the virus to spread, and likely lead to new variants developing. That could pose a risk to everyone”, said Jovanovic.
© 2021 Erwin Jacob V. Miciano/Flickr