Migration and outbreaks of vaccine-preventable disease in the UK and Europe

The substantial recent rise in migration to and within Europe has been linked to the resurgence and spread of re-emerging infectious diseases in European countries, including vaccine-preventable diseases (VPDs) such as measles and rubella. The European Vaccine Action Plan, approved in 2015, calls on all Member States in the region to pay particular attention to migrants, international travellers and marginalised communities, to ensure their access to effective and culturally appropriate catch-up vaccination services on arrival to host countries, in order to reach Herd Immunity Threshold (HIT) targets with the aim of eliminating diseases such as measles from the Region. However, there remain major data gaps in relation to the links between migration, immunisation coverage and vaccination intent and uptake in these populations as well as VPD incidence and outbreaks. These data are now critical to acquire if we are going to strengthen vaccination catch-up strategies for at-risk migrant groups, develop innovative new tools and approaches, and thereby reduce the risk of VPD outbreaks and incidence of disease.

This project uses a mixed methods approach to address the below aims:

1. To synthesise existing evidence on the role of migration in the UK and Europe in outbreaks of VPDs
I will carry out a systematic review following PRISMA guidelines, searching three major bibliographic databases for for published literature relating to vaccine-preventable disease outbreaks involving migrants in all EU countries. Data on scale of outbreaks, involvement and demographics of migrant populations and any other relevant information will be extracted and narratively synthesised.

2. To assess immunisation coverage and vaccination uptake in migrant populations in the UK and Europe
I will do retrospective quantitative analyses on two large datasets on immunisation coverage among migrants. The first database, available as part of an IOM-PHE collaboration, describes pre-entry health assessments and immunisation coverages of 12,xxx UK-bound refugees, and will allow me to explore levels of immunisation in this population as well as factors associated with varying coverage. The second dataset, which consists of Danish registry data, will allow me to compare immunisation coverage and uptake in host and migrant populations in Denmark, data which is not available in the UK.

3. To explore the effect of COVID-19 on access to healthcare for precarious migrants in the UK, including confidence in and access to COVID-19 vaccines
In the context of the COVID-19 pandemic, many migrant groups in the UK have been disproportianetely affected by the pandemic, both directly in terms of morbidity and mortality, but also in reduced access to healthcare and in social or economic terms. I will carry out a qualitative study with precarious migrants in the UK (undocumented, asylum seekers, refugees) to explore effects of the pandemic on livelihoods and access to healthcare as well as views on the vaccine roll-out.

4. To investigate views on routine vaccines and and identify opportunities for improving service delivery post-COVID-19 pandemic
Based on findings around key at-risk migrant groups in the UK and Europe from the quantitative analyses (Aims and 2), I will identify specific communities who we will seek to work with to understand views on routine vaccination in the UK and potential opportunities for improving service delivery. This will be done through a large qualitative study to understand barriers and facilitators to healthcare, views and concerns about the NHS and vaccination access in the UK and history of accessing medical care or catch-up vaccination since leaving their home country.