Sarah Bennett
The COVID-19 pandemic has had a significant impact on immunization activities, with 67 million children worldwide missing out on routine vaccinations between 2019 and 2021. Immigrant and migrant children are the most at risk of severe health consequences due to under-immunization or no immunization. This is often due to a lack of awareness about the importance of vaccinations and the risk of infection, as well as limited access to certain vaccines. In the United States, for example, foreign-born individuals have lower vaccination coverage than US-born individuals, with non-US citizens and recent immigrants being the least likely to be vaccinated. Similarly, in Italy, immigrant mother-child pairs have lower vaccination coverage than Italian mother-child pairs, with language barriers and differences in healthcare access playing a role. These disparities highlight the need for education and equitable access to vaccinations for all children, regardless of their migration status.
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What You'll Learn
- Foreign-born mothers from Ukraine, Russia, Somalia, and Mexico are more likely to be averse to the MMR vaccine
- Language barriers can hinder access to vaccinations
- The COVID-19 pandemic has negatively impacted immunization activities
- Lack of awareness about the importance of vaccination leads to low awareness of the risk of infection
- Socioeconomic factors and income levels play a role in vaccination rates
Foreign-born mothers from Ukraine, Russia, Somalia, and Mexico are more likely to be averse to the MMR vaccine
A study by Bahta and Ashkir highlighted the erroneous perception of a link between MMR and autism in the Somali community. This fear of autism was also the most commonly cited reason for MMR hesitancy among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. Similarly, in Washington State and Hennepin County, Minnesota, even highly educated Somalis expressed their resistance to the MMR vaccine, citing the disproportionately high cases of Autism Spectrum Disorder among Somalis.
Language barriers and limited access to healthcare services can also play a role in vaccine hesitancy among foreign-born mothers. For example, Ukrainian migrants in Poland reported that the digitization of healthcare services during the COVID-19 pandemic reduced their access to primary care and made it difficult to obtain credible vaccine information in translated forms. Inadequate health information systems and discrimination from healthcare workers created further obstacles to vaccination.
Additionally, vaccination coverage and immunization schedules vary by country and region, which can cause confusion and concern among immigrants and refugees. For instance, adult vaccination schedules in Mexico differ from those in the United States, and variations in schedules can make it challenging for healthcare workers to interpret vaccination cards, especially when dealing with possible false certificates.
The consequences of not receiving routine vaccinations can be severe. UNICEF and the World Health Organization (WHO) have warned of an alarming decline in childhood vaccinations due to COVID-19 lockdowns and disruptions, leaving children vulnerable to preventable diseases such as hepatitis, tuberculosis, whooping cough, and diphtheria. Incomplete vaccination contributes to a decrease in life expectancy, while complete vaccination among toddlers can lead to an increase in life expectancy.
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Language barriers can hinder access to vaccinations
The COVID-19 pandemic has had a significant impact on immunization activities worldwide, with millions of children missing out on routine vaccinations. Among them, foreign-born and migrant children are particularly vulnerable to being unvaccinated or under-immunized. While access to vaccinations is generally better for children than adults, foreign-born children often face additional barriers to vaccination, including language barriers.
Language barriers can pose significant challenges to foreign-born individuals and their families seeking vaccinations. Limited English proficiency or a preference for a different language can hinder access to critical information, making it difficult for individuals to navigate the vaccination process, understand the risks and benefits, and make informed decisions. This was particularly evident during the COVID-19 vaccine rollout, where non-English speakers faced difficulties accessing online portals, registering for appointments, and understanding essential pandemic information.
In the United States, for example, several national surveys and studies have highlighted disparities in vaccination coverage between foreign-born children and US-born children. These disparities are often more pronounced among non-US citizens, recent immigrants, and those interviewed in a language other than English. Additionally, in specific states like Alabama, New Jersey, and South Dakota, language translation services on vaccine-finder websites were found to be inadequate or non-existent, further exacerbating the issue.
Language barriers not only affect access to vaccination services but also impact the understanding of vaccine-related information. Without clear and accessible communication, individuals may struggle to comprehend the importance of vaccinations, the risks associated with vaccine-preventable diseases, and the specific recommendations for different vaccines. This lack of awareness can lead to lower vaccination rates among foreign-born populations, placing them at a higher risk of infectious diseases.
To address these challenges, it is crucial to prioritize language accessibility in public health campaigns and vaccination programs. This includes providing translations of websites, registration portals, and informational materials in multiple languages commonly spoken by the target population. Additionally, offering language interpretation services at vaccination sites can help ensure that individuals can ask questions, address concerns, and make informed decisions about their health. By removing language barriers, public health officials can improve vaccination uptake among foreign-born children and their families, contributing to better health outcomes and equity worldwide.
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The COVID-19 pandemic has negatively impacted immunization activities
In the early stages of the pandemic, guidance to halt mass vaccination campaigns, particularly in lower-income countries, put millions of infants at risk of vaccine-preventable diseases. While subsequent guidance from the WHO and other agencies advised restarting immunization activities, the impact of these disruptions may be long-lasting.
Data from 2020 indicates that 23 million children missed routine immunizations, with even higher numbers missing out on specific vaccines such as DTP3 and MCV1. This represents a significant increase compared to 2019. The pandemic has also disrupted healthcare services, with healthcare worker shortages and reduced access to routine medical services, further impacting immunization activities.
The consequences of these disruptions are particularly concerning for vulnerable populations, including migrants and refugees. The UNICEF report highlights that children who miss routine vaccinations are often those most at risk, including the poorest, the most marginalized, and those affected by conflict or forced migration. Immigrant and migrant children are at increased risk of severe health consequences due to under-immunization or lack of immunization.
Additionally, the pandemic experience has reduced trust in public health authorities and vaccine hesitancy in some populations. Surveys conducted in 2023 reported lower intentions to receive COVID-19 booster vaccines and routine vaccinations, with participants expressing decreased trust in vaccine information sources. These findings underscore the ongoing challenges faced by public health practitioners in addressing vaccine hesitancy and rebuilding trust.
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Lack of awareness about the importance of vaccination leads to low awareness of the risk of infection
The COVID-19 pandemic has had a significant impact on immunization activities worldwide. The World Health Organization (WHO) and UNICEF warned in July 2020 of a concerning decline in the number of children receiving life-saving vaccines due to COVID-19 lockdowns and disruptions to essential health services. This has affected all children, but migrant and immigrant children are particularly vulnerable.
A study on immunization uptake among migrants in Italy found that a lack of awareness about the importance of vaccination can lead to low awareness of the risk of infection among immigrant communities. This lack of awareness can result in a lack of prevention and an increased risk of infectious diseases. While immigrants were willing to get vaccinated, they often lacked access to vaccines like the HPV vaccine. Additionally, language barriers, healthcare access during pregnancy, and the transient nature of migrants can further hinder vaccination rates.
In the United States, unadjusted vaccination coverage among US-born individuals was significantly higher than that of foreign-born individuals for various vaccines, including influenza, PPV, tetanus, Tdap, hepatitis B, shingles, and HPV. Foreign-born individuals, particularly non-US citizens, recent immigrants, and those with language barriers, tend to have lower vaccination coverage.
The consequences of not vaccinating children can be severe. UNICEF Indonesia highlights that children who do not receive complete immunization are more susceptible to vaccine-preventable diseases such as hepatitis, tuberculosis, whooping cough, and diphtheria. They are also at risk of developing severe complications from measles, such as diarrhoea, pneumonia, blindness, and malnutrition. Incomplete vaccination contributes to a decrease in life expectancy, while full vaccination among toddlers increases it.
To address these disparities, organizations like the WHO and UNICEF are working to raise awareness about immunization and support global immunization initiatives. Efforts to educate migrants and newcomers about immunization are critical to achieving health equity worldwide. By increasing awareness, addressing access barriers, and promoting vaccination uptake, we can help protect vulnerable populations from vaccine-preventable diseases.
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Socioeconomic factors and income levels play a role in vaccination rates
Socioeconomic factors and income levels play a significant role in vaccination rates. Disparities in income levels among countries have influenced the supply and vaccination rates, with low- and lower-middle-income countries facing challenges in accessing vaccines and achieving high vaccination coverage.
During the COVID-19 pandemic, the economic status of a country impacted its ability to secure vaccines for its population. High-income countries had higher vaccination rates, while low- and lower-middle-income countries struggled to obtain sufficient vaccines. The stringency of COVID-19 mitigation strategies and vaccination policies also influenced vaccination rates, with high-income countries demonstrating a stronger association.
At the individual level, socioeconomic status (SES) significantly affects vaccine uptake. Disadvantaged groups with lower incomes, lower education levels, and higher deprivation tend to have lower vaccination rates. This trend is not limited to a specific country or region, as evidenced by global studies. Income, poverty, deprivation, race/ethnicity, education, and health insurance are all factors that contribute to vaccine uptake within a population.
In the context of immigrant and migrant populations, socioeconomic factors also influence vaccination rates. Language barriers, access to healthcare, and varying immunization policies across countries can impact the vaccination status of foreign-born individuals and their children. In some cases, foreign-born children may face challenges in accessing the same vaccines as native-born children, contributing to disparities in vaccination coverage.
To address these disparities, it is crucial to prioritize the health information needs of migrants and refugees, ensuring they have equal access to vaccinations and understand the importance of immunization for themselves and their children.
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Frequently asked questions
UNICEF and the World Health Organization (WHO) have warned of a decline in the number of children receiving vaccinations due to the COVID-19 pandemic. The most vulnerable children are those who are the poorest, most marginalized, and those affected by conflict or forced migration. Foreign-born children are more likely to be unvaccinated compared to native-born children.
There are several reasons for lower vaccination rates among foreign-born children. These include language barriers, lack of awareness about the importance of vaccinations, and differences in healthcare systems between their country of origin and their new country. Other factors include the level of healthcare available during pregnancy and the ability to contact migrants, who may frequently change their domicile.
Not vaccinating children can lead to several health problems and complications such as measles, diarrhoea, pneumonia, blindness, malnutrition, hepatitis, tuberculosis, whooping cough, and diphtheria. Incomplete vaccination can also contribute to a decrease in life expectancy and make children more susceptible to various diseases.
