Reducing COVID 19 transmission and strengthening vaccine uptake among migrant populations in the EU/EEA

Technical report
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European Centre for Disease Prevention and Control. Reducing COVID-19 transmission and strengthening vaccine uptake among migrant populations in the EU/EEA – 3 June 2021. ECDC: Stockholm; 2021.

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This report presents evidence on the impact of COVID-19 on migrant populations in EU/EEA countries; risk factors for increased COVID-19 exposure in migrant populations; and considerations for ensuring equitable access to the COVID-19 vaccine for migrant populations.

Executive summary

Some migrant groups in the European Union (EU), European Economic Area (EEA) and the United Kingdom (UK) have been disproportionately impacted by the coronavirus disease (COVID-19) pandemic, experiencing a range of health and social impacts. In addition, certain migrant groups have a known range of risk factors for low vaccine uptake and may face barriers to accessing health and vaccination systems.

This report presents:

  1. evidence around the clinical, health, and social impact that COVID-19 has had on migrant populations in EU/EEA countries and the UK;
  2. risk factors and vulnerabilities in migrant populations to COVID-19; and
  3. considerations for ensuring equitable access to the COVID-19 vaccine rollout through identifying successes, lessons learned, and good practices to date.

While migrant populations across the EU/EEA are extremely heterogeneous, there is evidence that some migrant communities may be at high risk of exposure to, and infection with, SARS-CoV-2, and are disproportionately represented in cases, hospitalisations, and deaths. For example, Denmark, Norway and Sweden have all seen higher than expected proportions of migrants amongst COVID-19 cases given their numbers in the population: 42% of all cases (to April 27 2020) in Norway, 26% in Denmark (to Sept 7 2020), and 32% in Sweden (to May 7 2020). In Italy and Spain, studies have suggested migrants may be more likely than nationals to be hospitalised. The UK, Netherlands, France, and Sweden have reported significantly higher all-cause mortality in migrants from specific countries/regions in 2020 compared with the host population, and when compared to previous years. Multiple outbreaks of COVID-19 have been reported in several camps and closed settings (including detention and reception centres) housing migrants across Europe. Some migrant populations have also been impacted disproportionately by the restrictions and measures implemented to fight the pandemic. Some migrants have experienced a range of direct and indirect health and social impacts including increased discrimination, more protracted lockdowns and severe restrictions on movement, and travel restrictions and border closures impacting family reunifications and the asylum process. Migrants in precarious work environments may have been at increased risk of losing jobs and sources of income. Certain migrant groups have a range of risk factors and vulnerabilities to COVID-19 that put them at higher risk of exposure, including occupational risk, overcrowded accommodation (including residing in camps, detention facilities, and homeless shelters), and/or lower levels of accessibility to public health services and messaging.

There is emerging evidence of low COVID-19 vaccination rates in some migrant and ethnic minority groups in the EU/EEA. Strategies to reduce transmission and ensure equitable vaccine uptake in migrant populations in the EU/EEA should include targeted public health messaging that is co-produced with affected communities, with information and messaging translated into key migrant languages and effectively disseminated. Strengthening engagement and outreach to a diverse range of at-risk migrant communities is an essential next step. Furthermore, greater emphasis should be placed on innovative policy options that can support at-risk migrant groups to minimise transmission and gain better access to health services and vaccination. How to ensure equitable access for migrants to the COVID-19 vaccine and ensure equitable uptake, particularly in migrants who are excluded from health systems, requires consideration, with an urgent need to share models of good practice and lessons learned from across the EU/EEA. This will involve addressing both individual and structural barriers to vaccination. Building trust with migrant communities around the vaccine, countering misinformation with robust and accurate information, and identifying innovative access points for the vaccine for migrants not registered with mainstream health systems are vital next steps.

These findings have immediate implications for national public health responses to reduce transmission and support COVID-19 vaccine rollout, with implications beyond the pandemic to promote health equity, human rights, and universal health coverage in marginalised migrant populations.

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