Migrant's access to immunization in Mediterranean Countries

doi:10.1016/j.healthpol.2012.02.004

Health Policy

Volume 105, Issue 1, April 2012, Pages 17-24

https://doi.org/10.1016/j.healthpol.2012.02.004 Get rights and content

Abstract

Countries bordering the Mediterranean are part of a major migration system. The aim of this study is to assess the main access barriers to immunization of mobile populations in the region and propose an action based framework to decrease health access inequalities.

A survey on formal and informal barriers to immunization among mobile communities was conducted among public health officials formally appointed as focal points of the EpiSouth Network by 26 Mediterranean countries. Twenty-two completed the questionnaire.

Thirteen countries reported at least one vaccine preventable disease (VPD) outbreak occurring among mobile populations since 2006 even though their legal entitlement to immunization is mostly equivalent to the general population's. Informal barriers, particularly lack of information and lack of trust in authorities, and disaggregation of data collection are the major issues still to be addressed.

Mediterranean countries need to fill the gap in immunization coverage among pockets of susceptible individuals in order to prevent VPD outbreaks. Having for the most part ensured free entitlement, introducing more migrant friendly approaches, increasing information availability among mobile communities, building trust in public health services and disaggregating data collection to monitor and evaluate service performance among mobile groups are key aspects to address in the region.

Introduction

The current resurgence of measles in Europe [1], South-East Europe [2] and the Eastern Mediterranean [3], [4], [5], has put Vaccine Preventable Disease (VPD) control in the spotlight. WHO EURO's shift of its regional goal for measles and rubella elimination from 2010 to 2015 [6], is emblematic of the failure to meet expected results. Experts point to a vaccination coverage below the recommended 95% and the accumulation of large pockets of susceptible population in many countries [7] as the main causes of the subsequent outbreaks that have occurred since 2005. Although in most cases unimmunized individuals in the general population were affected, measles outbreaks occurring among specific migrant groups have also been described. Vulnerable groups involved in such outbreaks include Roma and Sinti communities in Italy [8], Roma and immigrant families in Greece [9] and Roma communities in Bulgaria [10].

The need to address inequalities in access to health care and the social determinants of health in order to prevent disease has recently challenged public health research. Contextually this stimulated a new awareness of public health needs in diverse and generally vulnerable migrant population groups. Notwithstanding this interest, there is still a dearth of information on access to immunization services and on immunization coverage among mobile populations [11]. This challenges monitoring and evaluation of existing programmes and calls for further research to identify barriers for vaccination uptake [12], [13]. Given the ever changing dynamics of the Mediterranean migration system and the growing number of people moving across its international borders, a Mediterranean as opposed to an EU-centred approach to assessing access to immunization among mobile populations is warranted.

This study investigates formal (entitlement to service, user fees) and informal (linguistic, cultural, psychological) access barriers to immunization of mobile communities in the Mediterranean region in order to identify strengths and weaknesses for public health planning.

Section snippets

Materials and methods

A cross-sectional survey to assess access barriers to immunization services of mobile populations in the Mediterranean region was performed among focal points (FP) of the EpiSouth network [14] appointed by the governments of 26 countries (9 EU) bordering the Mediterranean basin. All the EpiSouth FP are experts in communicable diseases directly involved in the elaboration of surveillance and control policies in the Ministries of Health or Public Health Institutions of their countries. Most also

Results

Twenty-two countries completed the questionnaires: Albania, Algeria, Bosnia & Herzegovina, Bulgaria, Croatia, Cyprus, France, Greece, Israel, Italy, Jordan, Kosovo, Lebanon, Morocco, Malta, Palestine, Romania, Serbia, Slovenia, Spain, Tunisia and Turkey. Eight were from South-East Europe, five from South-Europe, six from the Middle-East and three from Northern Africa. As in the study period the EpiSouth network comprised 26 countries, the response rate was 85%.

Twenty countries reported the

Discussion

As yet most Mediterranean countries are not in the position to monitor the vaccination coverage of mobile populations both due to the lack of demographic information and of disaggregated immunization data. This dearth of information is probably the reason why almost all countries officially report eligibility to immunization services between the general population and migrant groups to be equal (90% of countries) while stating that Roma-Sinti communities (41% of countries), irregular migrants

Conclusions

Health policies have been identified as an important determinant of access to healthcare for migrant populations acting on two levels: the legislative level whereby the rights of migrants are established, and the health systems’ specific response to this legislation [24]. The way immunization services are provided in Mediterranean countries mostly reflects an assimilation model rather than a multicultural or multiethnic one. Mobile communities are mostly expected to use the country's

Conflict of interest

Authors declare no financial, personal, political, intellectual, or religious interests in relation to the paper presented.

Source of funding

The EpiSouth Project was co-funded by EC DG SANCO (Grant number 2005206) and the Italian Ministry of Health (Grant number 2007/7M25). The financial support of EC EuropeAid and DG Enlargement through the TAIEX facility is also acknowledged.

Acknowledgements

We thank all members of the EpiSouth WP7 Steering Team and the EpiSouth Focal Points who compiled the questionnaires. Special thanks are addressed to EC DG SANCO, the Italian Ministry of Health and to all participating national Ministries of Health and Institutes of Public Health for their technical support to the EpiSouth Network.

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Migrant's access to immunization in Mediterranean Countries

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Conflict of interest

Source of funding

Acknowledgements

Journal of Clinical Virology

Journal of Infection

Health Policy

An update on an ongoing measles outbreak in Bulgaria April–November 2009

Euro Surveillance

Measles epidemics in Turkey and developing countries: review of the literature

Middle East Journal of Family Medicine

Measles still spreads in Europe: who is responsible for the failure to vaccinate?

Euro Surveillance

Cluster of measles cases in the Roma/Sinti population, Italy, June–September 2006

Euro Surveillance

Spotlight on measles 2010: ongoing measles outbreak in Greece, January–July 2010

Euro Surveillance

Migration and health in EU health systems

Euro Observer

EpiSouth: network for communicable disease control in Southern Europe and Mediterranean Countries