Webinar: Initiatives to increase access to and uptake of COVID-19 vaccination in socially vulnerable populations
Socially vulnerable populations have borne a disproportionate burden from the restrictive non-pharmaceutical interventions (NPIs) aimed at preventing the spread of COVID-19. In addition, data from several countries highlight inequalities in the rate of COVID-19 vaccination in migrant and ethnic minority populations and socioeconomic status. In many other countries, disaggregated data are still largely lacking on the uptake of COVID-19 vaccination in socially vulnerable populations. To date, there have been limited opportunities for sharing lessons learned and innovations developed to increase COVID-19 vaccination uptake in these populations.
In order to promote an exchange of emerging good practices and lessons learned regarding equitable uptake of COVID-19 vaccination in EU/EEA countries, ECDC held a webinar on 23 June 2021 to bring together stakeholders from national public health authorities and from civil society. Participants shared experiences and evidence about efforts to increase access to and uptake of COVID-19 vaccination among socially vulnerable populations.
The webinar agenda is available below.
Through this webinar, ECDC aimed to contribute towards optimising uptake of COVID-19 vaccination for socially vulnerable populations in the EU/EEA, whereby equity in access to vaccination is assured for all on the principle that “Nobody is safe until everybody is safe”.
Participants in the webinar included experts from EU/EEA countries and the United Kingdom, representatives from EU institutions, WHO, UNICEF, and a wide range of civil society and academic organisations. John Ryan, Director Public Health, DG SANTE, European Commission delivered a keynote speech highlighting the importance of the webinar in the context of the on-going COVID-19 vaccination campaign in Europe, and reaffirming EU’s vision for Equity in health, as an objective for a fair and equal Europe. He also highlighted the EU’s efforts to ensure that all EU citizens had access to COVID-19 vaccines at the same price and at the same time. Further, the following EU policy documents were mentioned which already set down the political support for focusing on vulnerable groups and ensuring equal access to vaccination:
- Conclusions on Common values and principles in the European Union Health Systems (2006)
- The international framework of the Sustainable Development Goals and in particular SDG 3
- European Consensus on development: “Our world, Our dignity, Our future“
- The European Council Recommendation on strengthened cooperation against vaccine-preventable diseases (2018)
Many good practice examples and experiences were presented by experts from the European Union Agency for Fundamental Rights, Italian National Institute of Health (ISS), Belgian Institute for Health (Sciensano) and Flanders Region, Platform for International Cooperation on Undocumented Migrants (PICUM), Swedish Public Health Agency, Robert Koch Institute and the European Federation of National Organisations Working with the Homeless (FEANTSA). Their presentations are available to view below.
A panel session concluded the webinar, with representatives from Health Promotion and Disease Prevention Directorate of Malta, Swedish Public Health Agency, the European Disability Forum and the European Commission. Panellists exchanged views on intervention challenges and considerations when targeting socially vulnerable populations.
Seven suggested good practices to address inequitable access to COVID-19 vaccines in the EU/EEA emerged during the webinar. Note that most of these are already being implemented in some EU/EEA Member States; they are presented here as options for consideration by national authorities and civil society stakeholders.
1. How to address the causes of inequalities in vaccination coverage
- COVID-19 has highlighted underlying vulnerabilities, which are multi-factorial but fundamentally socially determined
- Solutions require a good understanding and assessment of the problem (e.g. access, hesitancy, lack of knowledge, distrust of government/systems, misinformation)
- Addressing the causes in a sustainable way will provide protection against future pandemics while also facilitating health equity more broadly
- BEWARE – one size does not fit all, interventions need to be tailored
2. How to strengthen partnerships between public health and community organisations
- Collaboration between some public health agencies and community organisations was, in many areas, not optimal at the start of the pandemic, but there have been marked improvements since then
- NGOs and community-based organisations are now more actively involved with governments in defining different strategies
- Establishing longer term relationships where they do not exist can facilitate community engagement
3. How to strengthen community engagement
- Direct engagement of public health authorities with target communities, where it does not exist, can enhance trust in vaccination services, and may therefore encourage uptake
- Community engagement also facilitates culturally competent risk communication strategies, tailored for different groups
- Engagement can be facilitated through channels that are already established, e.g. through NGOs
4. The following good practices, facilitating access to vaccinations, have been identified
- Dissemination of information about the vaccines and where to access them in all relevant languages, also ensuring that it is disability-inclusive
- Ensuring straightforward registration procedures, including guaranteeing access e.g. for people without social security numbers
- Providing commitment that personal data will not be shared with immigration or other non-public health authorities
- Providing transport services to enable access to vaccination centres
- Developing drop-in vaccination centres (without appointment) and outreach mobile health teams (e.g. for people experiencing homelessness)
- If possible within a national context, considering use of single dose COVID-19 vaccines for groups where follow-up for a second dose may be challenging
5. How to work towards closing the data gap
- Vaccine coverage data are rarely stratified by migrant/homeless/disability status
- Vaccination rates among socially vulnerable populations can therefore become invisible
- There are also limitations in the available data about how COVID-19 has impacted, for example, persons with disabilities
- Strategies for data collection about refugee and migrant populations have been outlined in Collection and integration of data on refugee and migrant health in the WHO European Region (2020) – Technical guidance. Similar approaches could be considered for other socially vulnerable populations.
6. The following good practices have been identified on conducting evaluations of interventions aimed at improving vaccine uptake
- Including collection and analysis of both quantitative and qualitative data in evaluations, as well as experiences of both providers and recipients of services.
- Where possible, including both process and impact in any evaluation
- Wide sharing of findings from evaluations, so everyone can learn
7. Seize the moment
- Interest in implementing lessons learned may quickly decrease once the acute pandemic phase is over
- It may be important to consider how to institutionalise the lessons learned so that new innovations can be integrated into public health systems before the momentum is lost
SESSION 1: SETTING THE STAGE
Chair: John Kinsman
|13:00-13:05||Welcoming remarks Piotr Kramarz, Deputy Head of Unit Disease Programmes/ Deputy Chief Scientist/ Head of Section Air-Borne, Blood-Borne and STI, ECDC|
Equity in health, an objective for a fair and equal Europe
John Ryan, Director Public Health, DG SANTE, European Commission
COVID-19 vaccination deployment and rollout in the EU: fundamental rights considerations
Stella Reznyik, European Union Agency for Fundamental Rights
SESSION 2: SHARING GOOD PRACTICES ON INCREASING COVID- 19 VACCINATION UPTAKE IN VULNERABLE POPULATIONS
Chairs: Kate Olsson and John Kinsman
Vaccine uptake in the migrant populations and people experiencing social fragility: actions in connection with the Italian Society of Migration Medicine and a civil society Network for Immigration and Health
Silvia Declich, Italian National Institute of Health (ISS)
Initiatives in Belgium to reach vulnerable populations during the COVID-19 vaccination campaign
Chloé Wyndham-Thomas, Belgian Institute for Health (Sciensano) and Jeroen Van Den Brandt
Access to the COVID-19 vaccines for undocumented people in the EU – trends and emerging promising practices
Alyna Smith, Platform for International Cooperation on Undocumented Migrants (PICUM)
Guide for tailored interventions to support regions in promoting vaccination acceptance and uptake in vulnerable populations, Sweden
Karina Godoy, Public Health Agency, Sweden
The importance of targeted health information for and with people experiencing homelessness during the COVID-19 pandemic
Navina Sarma, Department for Infectious Disease Epidemiology Robert Koch-Institute, Germany
COVID vaccine delivery for people experiencing homelessness
Dalma Fabian, European Federation of National Organisations Working with the Homeless (FEANTSA)
SESSION 3: PANEL DISCUSSION
Chairs: Anastasia Pharris and Charlotte Deogan
|15:30-16:00||Panellists: Tanya Melillo (Health Promotion and Disease Prevention Directorate, Malta) Anders Tegnell (Public Health Agency, Sweden) Catherine Naughton (European Disability Forum) Isabel de la Mata (European Commission)|
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