During the coronavirus disease 2019 (Covid-19) pandemic, refugees and migrant groups are known to have been at increased risk of infection and adverse outcomes compared with the general population. This has reinforced the importance of equitable access and distribution of vaccines, as well as addressing vaccine hesitancy in marginalised populations.
In its Immunisation Agenda for 2030, the World Health Organisation (WHO) has called for greater attention to be placed on vulnerable groups, including migrants, to ensure more equitable access to vaccinations. However, a study published by Deal and colleagues last month in the Lancet Public Health has found that vaccine coverage in UK-bound refugees is sub-optimal.
Refugees undergo an International Organisation for Migration (IOM) Health assessment as part of the UK resettlement scheme. Other countries, including the US, Canada, Australia and New Zealand, have similar programmes. An important part of the assessment involves documenting immunisation history and administering key vaccines to protect refugees from vaccine-preventable diseases and sustain herd immunity in host countries.
The UK Refugee Technical instructions state that people with uncertain immunisation status should be treated as unvaccinated. In this case, vaccination efforts should be prioritised to protect against measles, mumps, rubella, tetanus, diphtheria, polio and meningitis. It has, however, historically been difficult to target catch-up vaccinations for those who need them the most, as the National Health Service (NHS) does not routinely collect data on migrant status.
Deal and colleagues conducted an epidemiological analysis to explore factors associated with varying immunisation coverage in 12,526 UK-bound refugees of 36 nationalities between January 2018 and October 2019. The study found that only 32.2% and 50.9% of children were in line with the UK’s immunisation schedules for polio and measles, respectively. This is in stark contrast to the UK’s childhood vaccination rates in the general population.
According to GlobalData epidemiologists, the UK is expected to have vaccinated 87.4% of children aged younger than six years with at least two doses of the measles, mumps and rubella (MMR) vaccine, and to have vaccinated 83.3% of children of the same age group with four doses of the diphtheria, tetanus and pertussis (DTP) vaccine, by the end of this year. However, actual vaccination rates may fall slightly below forecast estimates due to the impact of the Covid-19 pandemic.
The study’s findings have highlighted the importance of strengthening refugee pre-entry health assessments and domestic initiatives in order to improve vaccination coverage among refugee groups. In addition to aligning with the WHO’s Immunisation Agenda for 2030 (IA2030), this would ensure that vaccination coverage in the host country remains at a sufficient level to achieve herd immunity.