A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region

Right to Health – Immunization

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A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region
WHO Health Evidence Network Synthesis Reports 53.
Editors – De Vito E, Parente P, de Waure C, Poscia A, Ricciardi W.
Source – Copenhagen: WHO Regional Office for Europe; 2017.
PDF: https://www.ncbi.nlm.nih.gov/books/n/whohen53/pdf/
Excerpt
This review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services. Evidence was obtained by a scoping review of academic and grey literature in English and a further 11 languages and included official documents available from the websites of ministries of health and national health institutes of the WHO European Region Member States. The review highlights that vaccination policies tailored to migrants and refugees are very heterogeneous among WHO European Region Member States. By comparison, common barriers for the implementation and utilization of immunization services can be identified across countries. Outlined policy options are intended to strengthen information about immunization for migrants and refugees, support future evidence-informed policy-making, enable the achievement of national vaccination coverage goals and improve the eligibility of migrants and refugees to access culturally competent immunization services.

SUMMARY
The issue
Providing equitable access to safe and cost-effective vaccines is vital to protect vulnerable groups in any country and to reduce morbidity and mortality from vaccine-preventable diseases (VPDs), particularly among children. Migrants and refugees in the WHO European Region may be particularly vulnerable to VPDs. Children, who constitute approximately 25% of the total migrant population, are considered at greatest risk of VPDs because they may not have yet been vaccinated or may not have completed the schedule for all vaccines. In November 2015, WHO, the United Nations High Commissioner for Refugees and the United Nations Childrens Fund made a joint recommendation that migrants and refugees in the WHO European Region should be vaccinated without unnecessary delay according to the immunization schedule of the host countries. The WHO European Region’s Strategy action plan and resolution on refugee and migrant health, adopted in September 2016, addresses the issue of immunization among migrants and refugees…

Results
Immunization policies, vaccine delivery practices and barriers to access and utilization of immunization services by migrants and refugees vary widely in WHO European Region:
:: national immunization programmes seldom include specific recommendations for immunization for migrants and refugees;
:: fewer than one third of the countries have specific directives on immunization focusing on migrants and refugees, including children and pregnant women;
:: undocumented migrants receive immunization services in very few countries because of inbuilt administrative barriers in the host countries related to their entitlement to free health services, including immunization;
:: in most of the countries of the Region, the delivery of immunization services is primarily carried out by the public health care systems, but international organizations and nongovernmental organizations are also involved in a few;
:: lack of financial and human resources, in particular cultural mediators and/or interpreters, is seen as a barrier to the effective implementation of national immunization policies and to the systematic collection and evaluation of data for corrective actions;
:: socioeconomic, sociocultural and educational issues remain important obstacles for migrants and refugees in accessing the available immunization services in the host countries; and
:: targeted interventions have been shown to be successful in improving the uptake of immunization programmes among migrants and refugees, for example door-to-door vaccination initiatives, media campaigns, thematic lectures, peer-to-peer interactions and health promotion days.