How Can We Advance Vaccination Equity in Europe?

A4: Here are a few ideas…

  • Vaccination offers and services should be designed to better meet the social, cultural and language needs of migrants, including providing interpreters, training healthcare professionals in migrant health and cultural competence and implementing tailored interventions to facilitate vaccination for migrants.
  • Strategies are needed to ensure that all migrants, including adults, are included in catch-up vaccination initiatives and supported in accessing health and social care when they arrive in host countries.
  • Tailored and evidence-informed strategies codesigned with migrant populations are needed to address specific barriers and perceptions towards vaccines and vaccination in context.
  • Ensuring that public health messages reach migrant populations through the specific communication channels, formats and languages they use is important to build trust and combat the spread of misinformation.
  • Community ‘experts by experience’ must be involved in finding solutions and adequately recognised and compensated for their valuable contributions and insights.
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Re data, we experience lots of challenges accessing local data on subpopulations, due both to poor data quality (patient data is often not coded by index of multiple deprivation decile or by ethnicity), and the right data not being collected, e.g. country of birth.

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While work to understand and improve health and vaccination equity has been ongoing for decades, the COVID-19 pandemic has made this issue a political priority in many countries. Solving for inequity begins with an overarching commitment to an immunization system that serves everyone. Action requires a detailed understanding of who is unvaccinated and why, along with commitments to vaccination policies, education, and sustainable investments in resilient immunization systems.

Understand the issue :

  • Invest in robust immunization data systems to measure and respond to inequity
  • Create systems for community input to ensure that policies and programs are adapted to local needs.

Enact Equity focused Policy and Legislation

  • Enact pro-vaccination policies to enhance accessibility, strengthen services, overcome supply or trade barriers and incentivize research that prioritizes equity.
  • Evaluate a ‘health in all policies’ approach to social interventions to enhance vaccination equity.

Strengthen immunization systems

  • Prioritize and tailor programs to build confidence in vaccination among populations underserved by healthcare.
  • Strengthen national capabilities and resources around immunization
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We find the need to guarantee access to health care for the most vulnerable through the following civic reccomendations:

  • The promotion of a Proximity Public Health approach which, in a network work between public and private social sectors, provides for both social and health services and activities operating on the social margin, and some health activities to be directed directly to places where people live and meet marginalised groups.
  • Guarantee basic health care to all people regardless of their legal, social and housing status, releasing them from the requirement of registered residence permits, with the assignment of the general practitioner in favour of all homeless people present in the area.
  • The free assignment of the paediatrician and the general practitioner for all minors present on the national territory regardless of the condition of residence (migrants) and the administrative regularity of the parents and for all unaccompanied foreign minors.
  • Guarantee of the universality of the right to health for people confined to prison, on a par with free citizens, through the full and effective implementation of the reform of prison medicine.
  • The full and uniform implementation, in all Regions, of the current legislation on access to treatment by foreigners who are not registered in the National Health System;
  • The promotion and development of early childhood and full human potential, across four areas of action: responsive care, early learning, an integrated approach to care and nutrition, and support for maternal psychological well-being.
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EU Global Health strategy puts out Strengthening healthsystems, and advancing Universal Health Coverage. That is key!

But also realising that offering vaccine, and even a health system is not enough - so building systems to follow and address misinformation, and to build trust EQUALLY important

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A3. After asking all my colleagues from different regions (states) in Spain, I have not found really relevant initiatives. Vaccination coverage is very good but not too many actions. There is one exception, the COVID vaccination, during the COVID vaccination, vaccinations have been done in refugee camps, horticultural workers have been vaccinated, vaccination has been taken to homeless people, vaccination points have been opened on weekends so that everyone could go to get vaccinated, active recruitment has been done in all sectors.

In addition to this, there are NGOs working with prostitutes and immigrants, etc.
Some Autonomous Communities (Murcia) have made evaluations of vaccination coverage and recruitment of the unvaccinated population according to the place of origin of the parents (especially).

From the Spanish Association of Vaccinology we have created a working group to ensure that all NGOs working with vulnerable populations address vaccination as one of the fundamental points of their work.

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A3: Strong leadership engagement with communities and all those in the value chain. Consistent communication, simplified language and messaging and heightened education but emphasising the benefits as oppose to the dangers land better.

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There also need to be incentives for healthcare professionals to offer catch-up vaccination to migrants (particularly adults/adolescents) in primary care. And we need better recording of migrant-specific data (e.g. country of birth, length of residence) in our health information systems and sharing of data across countries and regions to facilitate surveillance and health protection efforts

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In 2018, UNICEF released their Urban Immunization Toolkit, which provides tips and suggestions for how to tailor vaccination efforts to an urban disadvantaged context.

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In Feb 2020, Equity Reference Group For Immunization asserted that the urban poor population among others is one of the communities where immunization inequities are most acute.

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Nothing to add, just want to ‘second’ this list!

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Huge thank you everyone, that was really fantastic. We will prepare a summary and share it with you all. And we will keep in touch as we evolve our work on immunisation and poverty.
Very best wishes
Alice

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  1. Why are those living in poverty, or with severe material deprivation or socially excluded groups, less likely to be vaccinated?
    Due to digital divide and influences from anti vaccines

  2. What are the main barriers to vaccination for people living in poverty - are there any urban-rural variations to this?
    Communication and education.

  3. What examples are you aware of that have successfully reached those living in poverty or social exclusion with vaccinations?
    Using their elected representatives to spread right information or institutions and civil society organisations to go on the ground to look for them. Local Community does help a lot in advocating. This is when vaccine is free for all. The government have to subsidies it for their all to get the vaccine. Company should also make sure all their workers are protected from any disease. It is a hassle if one is infected, and cost disruption on company’s operation.

On the last question, Alice, I think the first thing is for the ECDC and the WHO European Region to start asking member states for stratified vaccination coverage, coverage in immigrant populations, coverage according to income quintiles, etc. To solve a problem you have to be aware that it exists and this is not a regular topic of discussion because it is not evaluated.

Furthermore, it should be incorporated into the work fields of public administrations, NGOs working with these populations, etc.

Of course, actions related to health education with appropriate cultural approaches are essential (for example, the Ibero-American immigrant population who are accustomed to and appreciate vaccination are not the same as the Eastern European population where the opposite is the case).

Finally, actions related to greater accessibility, both in terms of time and place, are essential (pharmacies, vaccination points without appointment, etc.). Besides, in the most marginalized population, mobile vaccination teams to the place of residence is important. In addition, it would also be useful to promote school vaccination, vaccination in residences, in day centers where the elderly population goes, and any other point that allows bringing vaccination closer to the population.

It is particularly important for us (EMZ/EMC Inc.) to point out that we prefer programs for migrants that address the target groups in cooperation with NGOs, governments and private organizations from the health industry. Our experience is that such concerted cooperation makes it easier to create trust, sustainability and effectiveness. Easier than when everyone wants to reach the goal alone. We do this, for example, in MiMi vaccination programs that we carry out in cooperation with the National Ministry of Health in Germany. We run another MiMi program on health and vaccination together with the Bavarian government and MDS in Bavaria. For example, we carried out vaccination activities in refugee
shelters with the health department in Munich. Our transcultural health mediators accompanied vaccination teams from the public health department, coached those involved on site, interpreted or provided information if necessary. In this way, trust, reliable information and the vaccination rate could be increased. On both sides. We also cooperate with the German Bundeswehr on health measures, because a large proportion of the soldiers in the Bundeswehr have a migration biography and in the context of NATO operations, the topic is once again of particular importance.

Another aspect is multilingualism, which must be more respected than before. Language should not be a barrier to accessing health services. Unfortunately, this barrier is still very high in Europe.

The third important conceptual approach is that programs for professionals in health services are also needed. Because among the professionals there is a surprising amount of helplessness when dealing with and working with migrant groups. Information and education are therefore needed not only for migrants but also for healthcare providers and their professionals.

Here it becomes clear that in order to achieve these goals, increased activities in the field of research, networking of knowledge clusters and the direct participation of migrant stakeholder clusters are necessary. We consider the latter to be fundamental, because working with migrants contributes to empowerment, health literacy, trust and action bridges between the different levels. Networked action makes sense at local and international levels, in practice and in theory.

It is also important that the many “vaccination task forces” also take into account the topic of “vaccination of migrants/refugees” and the corresponding representatives of the migrants.

In order to ensure the participation of migrants to increase health literacy or vaccination readiness, not only in Germany but also in many other European Union states programs have proven themselves that specifically and directly address these target groups and programs that work on the basis of concepts with transcultural health mediators. It is precisely these two approaches that also contribute to developing health competence and empowerment. We describe it as “With migrants for migrants!”

Summing it all up, the main goal to increase immunization readiness and my main suggestion is to focus all Recommendations around the topic of ‘breaking down barriers’. All information and services must be accessible to everyone via analogue and digital channels, considering language, culture, education, religion, gender and age. If it is possible for this guideline to come alive anywhere in the world, then Europe (EU) is the place where this is most likely to happen.

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