Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study
Background The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study a...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e087629.full |
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| author | Biraj Man Karmacharya Karl Blanchet Jai K Das Laetitia Nyirazinyoye Maria Midea M Kabamalan Nguyen Toan Tran Zahra A Padhani Anjali Joshi Seyed-Moeen Hosseinalipour Enrique Teran Pierina Benavente Vinay N Kampalath Moussa Lonkila Zan Elżbieta Anna Czapka Cheryl Martens Vicente B Jurlano |
| author_facet | Biraj Man Karmacharya Karl Blanchet Jai K Das Laetitia Nyirazinyoye Maria Midea M Kabamalan Nguyen Toan Tran Zahra A Padhani Anjali Joshi Seyed-Moeen Hosseinalipour Enrique Teran Pierina Benavente Vinay N Kampalath Moussa Lonkila Zan Elżbieta Anna Czapka Cheryl Martens Vicente B Jurlano |
| author_sort | Biraj Man Karmacharya |
| collection | DOAJ |
| description | Background The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study aimed to identify barriers and facilitators and estimate vaccination coverage among refugees and migrants in low- and middle-income countries, emphasising inclusive policies for effective rollout.Methods A mixed-method study was conducted in two phases in Ecuador, Nepal, Pakistan, the Philippines and Rwanda. Phase 1 (March–May 2022) included policy analysis, in-depth interviews and focus-group discussions with 52 key informants analysed with thematic and grounded theory approaches using hybrid coding. Phase 2 (June–August 2022) included a cross-sectional study among refugees and migrants in regular (MIRS) and irregular situations (MIIS) and used descriptive analysis and a COVID-19 Vaccine Equity Index (CVEI).Results A total of 1378 individuals responded to the survey (43.8% MIRS, 31.2% MIIS and 25% refugees). 87% reported receiving at least one dose of the COVID-19 vaccine. The CVEI at the global level (0.824) suggested differences in complete vaccination between migrants and other residents in most of the study countries (refugees reported more access to vaccines than MIRS and MIIS). However, the qualitative phase reported delays and inequities in the early stage of the vaccination process in all countries. Overall, 64.2% of respondents perceived that government’ campaigns were successful. Both the qualitative and quantitative phases identified several barriers and facilitators. The main barriers included a lack of trust in authorities, extended waiting times and distance to vaccination centres, discrimination and xenophobia, lack of identity documentation, and adverse reaction concerns. On the other hand, the primary facilitators were the widespread distribution of vaccination centres, sources and provision of information, specific campaigns for refugees and migrants, free vaccination and the motivation to protect others’ health.Conclusions Despite the high coverage of COVID-19 vaccines among refugees and migrants in the study countries, the process had significant barriers. Simple vaccination registration procedures, targeted campaigns, mobile vaccination teams for hard-to-reach and vulnerable groups, and building trust in the host country authorities are pivotal for future and inclusive vaccine deployments. |
| format | Article |
| id | doaj-art-2d6fa06ea5054cbd899ca18cd04c4fed |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-2d6fa06ea5054cbd899ca18cd04c4fed2025-02-03T03:40:12ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115110.1136/bmjopen-2024-087629Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry studyBiraj Man Karmacharya0Karl Blanchet1Jai K Das2Laetitia Nyirazinyoye3Maria Midea M Kabamalan4Nguyen Toan Tran5Zahra A Padhani6Anjali Joshi7Seyed-Moeen Hosseinalipour8Enrique Teran9Pierina Benavente10Vinay N Kampalath11Moussa Lonkila Zan12Elżbieta Anna Czapka13Cheryl Martens14Vicente B Jurlano15Kathmandu University, Dhulikhel, NepalGeneva Cenre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneve, SwitzerlandDivision of Women and Child Health, Aga Khan University, Karachi, PakistanSchool of Public Health, Department of Community Health, University of Rwanda College of Medicine and Health Sciences, Kigali, RwandaCollege of Social Sciences and Philosophy, University of the Philippines Diliman, Quezon City, Metro Manila, PhilippinesUniversity of Geneva Faculty of Medicine, Geneve, SwitzerlandInstitute for Global Health and Development, Aga Khan University, Karachi, PakistanDepartment of Public Health, Kathmandu University School of Medical Sciences, Kathmandu, NepalGeneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, SwitzerlandUniversidad San Francisco de Quito, Quito, EcuadorDepartment of Global Public Health and Primary Care, Faculty of Medicine, Pandemic Centre, Bergen, NorwayDepartment of Paediatrics, Children’s Hospital of Philadelphia, Division of Emergency Medicine, Philadelphia, Pennsylvania, USAInstitut Supérieur des Sciences de la Population, Ouagadougou, Centre, Burkina FasoSociology Institute, University of Gdańsk Faculty of Social Sciences, Gdansk, Pomorskie, PolandInstituto de Estudios Avanzados en Desigualdades, Universidad San Francisco de Quito, Quito, Pichincha, EcuadorThe Demographic Research and Development Foundation, Inc, Quezon City, PhilippinesBackground The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study aimed to identify barriers and facilitators and estimate vaccination coverage among refugees and migrants in low- and middle-income countries, emphasising inclusive policies for effective rollout.Methods A mixed-method study was conducted in two phases in Ecuador, Nepal, Pakistan, the Philippines and Rwanda. Phase 1 (March–May 2022) included policy analysis, in-depth interviews and focus-group discussions with 52 key informants analysed with thematic and grounded theory approaches using hybrid coding. Phase 2 (June–August 2022) included a cross-sectional study among refugees and migrants in regular (MIRS) and irregular situations (MIIS) and used descriptive analysis and a COVID-19 Vaccine Equity Index (CVEI).Results A total of 1378 individuals responded to the survey (43.8% MIRS, 31.2% MIIS and 25% refugees). 87% reported receiving at least one dose of the COVID-19 vaccine. The CVEI at the global level (0.824) suggested differences in complete vaccination between migrants and other residents in most of the study countries (refugees reported more access to vaccines than MIRS and MIIS). However, the qualitative phase reported delays and inequities in the early stage of the vaccination process in all countries. Overall, 64.2% of respondents perceived that government’ campaigns were successful. Both the qualitative and quantitative phases identified several barriers and facilitators. The main barriers included a lack of trust in authorities, extended waiting times and distance to vaccination centres, discrimination and xenophobia, lack of identity documentation, and adverse reaction concerns. On the other hand, the primary facilitators were the widespread distribution of vaccination centres, sources and provision of information, specific campaigns for refugees and migrants, free vaccination and the motivation to protect others’ health.Conclusions Despite the high coverage of COVID-19 vaccines among refugees and migrants in the study countries, the process had significant barriers. Simple vaccination registration procedures, targeted campaigns, mobile vaccination teams for hard-to-reach and vulnerable groups, and building trust in the host country authorities are pivotal for future and inclusive vaccine deployments.https://bmjopen.bmj.com/content/15/1/e087629.full |
| spellingShingle | Biraj Man Karmacharya Karl Blanchet Jai K Das Laetitia Nyirazinyoye Maria Midea M Kabamalan Nguyen Toan Tran Zahra A Padhani Anjali Joshi Seyed-Moeen Hosseinalipour Enrique Teran Pierina Benavente Vinay N Kampalath Moussa Lonkila Zan Elżbieta Anna Czapka Cheryl Martens Vicente B Jurlano Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study BMJ Open |
| title | Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study |
| title_full | Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study |
| title_fullStr | Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study |
| title_full_unstemmed | Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study |
| title_short | Deployment and uptake of COVID-19 vaccines for refugees and migrants in regular and irregular situations: a mixed-method multicountry study |
| title_sort | deployment and uptake of covid 19 vaccines for refugees and migrants in regular and irregular situations a mixed method multicountry study |
| url | https://bmjopen.bmj.com/content/15/1/e087629.full |
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