Inequalities in vaccination coverage and differences in follow-up procedures for asylum-seeking children arriving in Wales, UK
The European Vaccine Action Plan 2015–2020 highlights the importance of reducing inequities and monitoring performance in underserved groups including migrants. However, there are limited data from European countries and policies for catch-up vary by country. Vaccination coverage in accompanied asylum-seeking children aged 5 to 16 years in two dispersal areas of Wales is presented alongside the coverage in the local population. Coverage data for asylum-seeking children were collated locally using asylum seeker nurse records whilst coverage in the local population was calculated using data from the National Community Child Health Database, a repository of data from all local Child Health Systems in Wales. The processes for following up outstanding vaccinations were also collected using a face-to-face questionnaire distributed to lead asylum seeker nurses in each area. As at the date of assessment, 45.6% (67/147) of children dispersed to area one had received all recommended immunisations compared with 62.2% (150/241) dispersed to area two, OR 0.51 (95% CI 0.33–0.79). At both sites the odds of being vaccinated against key vaccine preventable infections were around three times lower if you were an asylum-seeking child, compared with the local population. Similar procedures were in place for new asylum seekers in both dispersal areas. Area one had less resource to follow up missing immunisations, and children did not receive an initial health assessment unlike area two. Verbal history was accepted in area one but not in area two, despite area two having higher vaccine uptake.
What is Known:
• The European Vaccine Action Plan 2015–2020 highlights the importance of reducing inequities and monitoring performance in underserved groups including migrants.
• Limited data from European countries suggest inequalities in uptake of immunisations in migrants compared with the local population. Policies for catching up immunisations vary by country.
What is New:
• Despite national policy for vaccination of migrants with missing or incomplete vaccination history in Wales, this work suggests vaccination coverage in asylum-seeking children is not equitable with the local population.
• Vaccination coverage in asylum-seeking children dispersed to different areas of Wales also varies, and this may be associated with differences in local catch-up strategies and the ability to follow national policy. Resource and strategies to maintain engagement with health services play an important role in increasing vaccine uptake in underserved groups.
KeywordsChild Health policy Immunisation Migrants Refugees Vaccine preventable diseases
We acknowledge all members of the local asylum seeker teams for participating in the survey and supporting with data collection. We also acknowledge immunisation co-ordinators Catherine Watts and Jane Francis and the staff in the local child health offices as well as Anna Stielke in the Policy, Research and International Development Division at Public Health Wales.
MP and MT drafted the article. MT collected the data with help from the asylum seeker teams, designed and conducted the face-to-face questionnaires. MP completed the analysis on uptake in the general population and the comparative analysis to the asylum seeker population. SC supported the analysis and provided background information on the Child Health System. GR and LF supported MT with the project idea and acted as supervisor during her placement with Public Health Wales. JE, JS and RO assisted with data collection, provided responses to the questionnaires and information on the asylum seeker service in Wales. GR oversaw and co-ordinated the project. All authors provided useful comments on the article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Boyce T, Gudorf A, de Kat C, Muscat M, Butler R, Habersaat KB (2019) Towards equity in immunisation. Eurosurveillance. 24Google Scholar
- 3.Currie J, Davies L, McCarthy J et al (2017) Measles outbreak linked to European B3 outbreaks, Wales, United Kingdom, 2017. Eurosurveillance. 22Google Scholar
- 4.GOV.UK (2017) Vaccination of individuals with uncertain or incomplete immunisation status. Public Health England. [Cited 2019 Jan 10]. Available from: https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status
- 5.GOV.UK (2018) Immunisation against infectious disease. Public Health England. [Cited 2019 Jan 10]. Available from: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book#the-green-book
- 9.National Assembly for Wales (2017) Inquiry into refugees and asylum seekers in Wales | National Assembly for Wales. Welsh Assembly Government [Cited 2019 Jan 10]. Available from: http://senedd.assembly.wales/mgIssueHistoryHome.aspx?IId= 6180
- 10.Ravensbergen SJ, Nellums LB, Hargreaves S, Stienstra Y, Friedland JS (2018) National approaches to the vaccination of recently arrived migrants in Europe: a comparative policy analysis across 32 European countries. Travel Med Infect Dis. https://doi.org/10.1016/j.tmaid.2018.10.011 (forthcoming)CrossRefGoogle Scholar
- 13.Welsh asylum seekers and refugee health advisory group (2013) Dispersal areas provision summaries, recommendations and key findings. Public Health Wales [Cited 2019 Jan 10]. Available from: http://www2.nphs.wales.nhs.uk:8080/vulnerableadultsdocs.nsf/($all)/51cc4d1fafeb290a80257d860030273a/$file/asylum%20seeker%20&%20refugee%20dispersal%20areas%20findings%20and%20recommendations%202014.pdf
- 14.WHO Regional Office for Europe (2014) European Vaccine Action Plan 2015-2020. WHO [Cited 2019 Jan 10]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0007/255679/WHO_EVAP_UK_v30_WEBx.pdf?ua=1