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A new study, published in The Lancet Infectious Diseases, finds that migrant communities may be an under-immunized group in Europe that have been affected by vaccine-preventable disease outbreaks—including measles, clonidine addiction chicken pox and hepatitis A. The results point to a need for improved health and vaccination systems to provide better care for migrant populations and ensure they have meaningful access to appropriate catch-up vaccination services after arrival in Europe, findings which have direct implications for COVID-19 vaccine roll out in the European region.

Funded by the NIHR and led by researchers from the Migrant Health Research Group at St George’s, University of London, the systematic review included 45 studies, detailing 47 distinct outbreaks of vaccine-preventable diseases (measles, chicken pox, hepatitis A, rubella and mumps) involving migrants across 13 countries.

The results show a disproportionate burden of outbreaks among adult and child migrants living in hosting facilities such as camps and detention/reception centers. In these outbreaks, large numbers of migrants were often affected, for example, 351 migrants became infected with chicken pox in a camp in Calais.

The authors point to different vaccination strategies in the countries migrants arrive from as a key reason for the spread of outbreaks, with many coming from countries where healthcare systems have been disrupted due to instability. Migrants may have therefore missed key vaccines as children and subsequent boosters, and/or may not be aligned with the vaccine schedule of the hosting European countries. In addition, the authors write that migrants face considerable barriers to accessing vaccination services on arrival, with limited systems in place to deliver catch-up vaccination.

Since the large influx of migration in 2015, migrant camps have become a new feature in Europe and the numbers of forced migrants residing in overcrowded poor conditions has continued to increase. The paper adds that Greece alone hosted almost 40,000 migrants in temporary reception centers and tented camps in 2020, and these environments are conducive to the spread of vaccine-preventable disease, including COVID-19, in unvaccinated individuals.

With migration on the rise and COVID-19 shining a light on the importance of vaccine delivery in order to prevent outbreaks, the report highlights the need for more research to understand barriers and facilitators to vaccination for migrant populations. The authors add that better data collection is also needed to gain a deeper understanding of vaccine uptake and demand in migrant groups, with a greater focus on co-designing vaccine uptake strategies in collaboration with communities themselves.

Dr. Sally Hargreaves, senior author on the paper from St George’s, University of London, said: “Our research shows that a clear policy shift is needed in vaccines and wider healthcare for migrant populations. There are tens of thousands of migrants across Europe operating outside of health and vaccination systems, and we need systems in place to align them with the host country’s vaccination schedule on arrival and to ensure they are protected from vaccine-preventable diseases, including COVID-19.

“With COVID-19 vaccination we have begun to make better progress in reaching groups on the fringes of society, but now we need to develop this approach further and apply it to other routine vaccine-preventable diseases. Key to this is directly engaging communities and understanding what works to reduce hesitancy and barriers to vaccination in these populations, then designing and delivering innovative tailored and targeted strategies to improve vaccine coverage where needed.”

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