What is the uptake of, and attitude to the COVID-19 vaccination among asylum seekers and refugees in Bristol?

Problem

COVID-19 disproportionately affected asylum-seeking and refugee (ASR) populations in infection prevalence and disease severity, compounded by complex individual and societal factors. These include language and cultural barriers, lower health literacy, poly-traumas and mental health needs poorly understood by practitioners, and increased exposure due to mobile status and adverse living conditions contributed to by delays in the asylum process. Despite the increased risk, and significant measures to increase uptake however, vaccine hesitancy and low vaccination rates were reported in ASR populations.

Approach

A scoping literature review was conducted to develop a topic guide. Semi-structured interviews based on a diverse, purposive sample of 12 consenting service-users of three refugee projects in Bristol were conducted, transcribed verbatim and analysed thematically using NVivo software to identify emergent themes.

Liaising with Bristol City Council and CCG, quantitative data surrounding vaccine uptake specific to ASR populations was shared and analysed. Qualitative and quantitative data were triangulated, and conclusions drawn from this mixed-methods approach.

Findings

Citywide vaccination data uptake over a time-span of over 1 year was analysed alongside interview transcripts from 12 individuals ranging in age from 23-48, from across the Middle East, Africa and Asian nations. Four were seeking asylum, and eight had refugee status with an even split between those part of a resettlement scheme and those travelling the UK independently.

Findings indicate delayed rather than lower vaccine uptake, and reasoning for this summarised by 3 key qualitative themes. Firstly, ‘systemic asylum issues’, with sub-themes of regular relocation, housing and accommodation, delayed processing of applications and dependency on the charity sector impact individuals’ capacity to prioritise vaccination. Secondly, “the role of fear” contributed to by social isolation, misinformation, bereavement and previous traumas generating barriers to taking the perceived additional risk of vaccination. Finally, the importance of trust regarding perceived and practical access care, the role of GPs and reliable, accessible information. We present findings with reference to Maslow’s hierarchy of needs, discussing a holistic approach to interventions such as vaccination campaigns in this vulnerable and isolated population.

Consequences

In collaboration with Bristol city council, we examined identified specific ways to tailor effective interventions to this vulnerable group. These are based on an understanding of their specific barriers to vaccination and healthcare, and health needs. These include the role of communicating electronically, methods of conveying information successfully, the role of GPs and the benefits of resettlement schemes. Findings can be extrapolated to inform primary care provision for ASRs as they navigate a complex healthcare system from within an overloaded asylum system, from the perspective of managing needs, risks and benefits.