A new report of the World Health Organization finds that existing policies on the inclusion of refugees and migrants in vaccine national plans and their implementation vary greatly across countries and regions globally, with disparities in access based on the legal status, age, and the context in which these populations live. The report notes that most countries do not specify a clear policy on refugee and migrant entitlement to vaccination and that where more inclusive policies exist, there are often gaps in their implementation.
Ensuring the integration of refugees and migrants into immunization policies, planning and service delivery globally – the third report of the WHO Global Evidence Review on Health and Migration (GEHM) series – identifies specific and unique barriers that refugees and migrants may face in accessing vaccines. These include administrative and policy barriers; individual-level barriers, including trust, cultural, religious, social norms and beliefs; logistic barriers such as availability and accessibility of vaccinations; information and communication barriers; and financial barriers.
Vaccination is an absolute requirement to achieve universal health coverage, and one of the world’s most cost-effective public health interventions. Yet, under immunization is still common among refugee and migrant populations, as migration and displacement may have adverse effects on the ability and motivation to be vaccinated.
WHO’s new Immunization Agenda 2030 sets out a clear vision of “a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being”. This vitally important global health protection measure must be available to all, including refugees and migrants; therefore, equitable vaccination of refugees and migrants is a priority for WHO.
“Access to health-care services, including immunization services, is a human right for refugees and migrants. They are critical to the prevention and control of infectious-disease outbreaks, such as COVID-19, and therefore ensure health security for all,” stressed Santino Severoni, Director of the WHO Health and Migration Programme. “All countries should ensure the eligibility and non-discriminatory and equitable access to vaccines for all, including refugees and migrants, along with the host population, free from any administrative, cultural, financial, linguistic and other barriers.”
Full inclusion of refugees and migrants in global and national immunization plans and vaccinations is essential to making progress towards universal health coverage. To support countries fully integrating refugees and migrants into national immunization plans, and increase access to routine vaccines, the report provides three key areas for policy consideration:
- Ensure universal and equitable access to vaccines for all refugees and migrants regardless of migrant status, age and gender through inclusive immunization policies; communication, engagement strategies, and community participation to address barriers to access; communication strategies to counter disinformation and misinformation; cost-free delivery of vaccines; integration between immunization and other health programmes to strengthen primary health care.
- Strengthen health systems to provide catch-up vaccination in mobile populations across the life course to close existing immunization gaps, and ensure adequate resources for these activities through increased national vaccine capacity; improved accessibility and outreach capacity of immunization services and primary care providers to promote vaccine uptake; provision of cross-border service delivery and vaccination records; education about barriers to immunization services for these populations.
- Strengthen data collection to monitor immunization coverage and service delivery gaps in refugee and migrant populations through financial support for national data collection and analysis; immunization information systems to capture vaccination coverage data; robust, large-scale studies to identify the drivers of under immunization and vaccine hesitancy.
“The Immunization Agenda 2030 is designed to motivate strategic, impact-directed action at the local, national, regional, and global levels The COVID-19 pandemic is a powerful demonstration that health is not a luxury, but a human right; not a cost, but an investment; not simply an outcome of development, but the foundation of social, economic and political stability and security. Vaccines give everyone the opportunity to reach their full potential and pursue a life well-lived but can only deliver if they reach everyone who needs to be vaccinated, are distributed equitably including to refugees and migrants,” said Kate O’Brien, Director of the WHO’s Department of Immunization, Vaccines, and Biologicals (IVB).