Experiences and perceptions of COVID-19 infection and vaccination among Palestinian refugees in Jerash camp and Jordanian citizens: a comparative cross-sectional study by face-to-face interviews

Responding to the covid-19 in west bank Palestine refugee camps: lessons and role of community engagement

BACKGROUND

Global unpreparedness was noted, where even high-income countries with their established healthcare systems could not cope with the Covid-19 pandemic. In the Occupied Palestinian Territory (OPT), especially in the Palestinian refugee camps, Covid-19 was an additional burden on multiple levels.

OBJECTIVE

The aim of this study is to understand the notion of Covid-19 responses in the West Bank refugee camps and the health system's ability to meet the needs of the refugees as well as the role of local community actors in the response.

METHODS

Qualitative data were collected through semi-structured interviews. In total, 27 interviews were conducted with popular committees in camps, professionals working at the Palestinian Ministry of Health in addition to local and international health-related non-governmental organizations (NGOs). Participants were contacted via phone calls, Zoom meetings and in-person, for one to one and a half hours maximum. Questions were about the impact of Covid-19 and the way the participants and their organizations responded to this pandemic.

RESULTS

Our findings state that wide-scale multilevel Covid-19 responses were conducted from different committees and institutions in the OPT. For example, the popular committees took part in distributing medicines, food parcels and hygiene kits, and the NGOs provided refugees with educational materials and psychosocial support. However, the overstretched Palestinian health system, the limited resources in addition to the poor coordination between health providers and poor follow up of the imposed restrictions, hindered the fast and effective response. Community engagement was a remarkable element which contributed to the successful deployment of response plans. This was demonstrated by the collaboration of the camps' local bodies in addition to the initiatives of the local community in camps.

CONCLUSION

Covid-19 impacts were particularly pronounced for refugees where response efforts did not fulfil their needs. The study highlights the importance of preparedness, working with community organisations and designing interventions in a human-centred/community-centred way to increase the effectiveness of health interventions and responses.

Vaccination coverage and access among children and adult migrants and refugees in the Middle East and North African region: a systematic review and meta-analysis

Background

The Middle East and North African (MENA) region is a major global hotspot for migration with more than 40 million migrants, who may be an under-vaccinated group because of barriers to vaccination within countries of origin, transit, and destination. We systematically synthesised the evidence on coverage, acceptance, drivers of uptake, and policies pertaining to vaccination for children and adult migrants in the region, in order to explore tailored interventions for these groups.

Methods

We searched six databases (including Medline, Embase) for peer-reviewed literature, and other websites (including WHO, IOM, ministries of health) for grey literature on coverage, acceptance, drivers of uptake and policies for any vaccination in migrants in the MENA region from between 2000 and 27 August 2024 in any language. We included studies reporting primary data on coverage, acceptance, and drivers of uptake, and any relevant articles on policies. We defined migrants as individuals who move away from their place of habitual residence, within or across international borders, temporarily or permanently. Studies without disaggregated migrant data were excluded. Primary outcomes were coverage (% individuals receiving ≥1 doses of any vaccine) and acceptance (% individuals accepting any vaccine). We separately synthesised data on children (<18 years) and adults (≥18). Estimates were pooled using a random-effects meta-analysis where possible or narratively synthesised, and drivers of uptake were synthesised using the WHO Behavioural and Social Drivers model. PROSPERO protocol: CRD42023401694.

Findings

We identified 6088 database and 282 grey literature records and included 55 studies and 1,906,975 migrants across 15 countries (including mostly refugees in the Middle East and expatriates in Gulf Cooperation Council countries). COVID-19 vaccination was reportedly provided free of charge to migrants in all countries whereas childhood vaccinations were reportedly provided to migrant children in seven countries. However, for adolescents and adults, there were wide variations across countries, and we found no policies relating to catch-up vaccination. Coverage for childhood vaccination amongst migrants was reportedly low, with only 36.0% of 589 migrant children fully vaccinated according to national schedules (95% CI 35.0%-43.0%, I 2 = 67%; data from migrants in Lebanon, Morocco, Sudan). Likewise, data on specific routine vaccines in children was generally low: measles containing vaccines (MCV): MCV dose 1 63.9%-66.9%; MCV dose 2 25.4%-85.6%; oral polio vaccine (OPV): OPV dose 3 65.1%-76.4%; diphtheria, tetanus and pertussis (DTP) containing vaccines: DTP dose 1 81.8%-86.7%; DTP dose 3 59.7%-76.6%). Drop-out rates across all routine vaccines for subsequent vaccine doses ranged from 12.4 to 38.5%, suggesting that migrants face a range of barriers to vaccine uptake beyond the first dose, that need to be better considered when designing interventions. For adults, we found eleven studies on coverage (including 9 on COVID-19) showing that COVID-19 vaccination coverage ranged 33.5-84.8% in migrants and 25.0-59.0% in host populations. Drivers of uptake of childhood vaccination in migrants included limited availability of vaccines and vaccination personnel, communication and administrative barriers, financial difficulties, lack of caregiver knowledge about services, and concerns expressed by caregivers around safety and benefits. For adults, drivers were mainly related to the COVID-19 vaccine and included concerns around safety, quality, side effects, and mistrust in vaccines and the systems that deliver them.

Interpretation

Migrants have unique risk factors for under-immunisation in the MENA region and have low vaccination coverage despite some level of entitlement to services. Data on vaccination coverage, drivers of uptake and policies for migrants in the MENA region is limited to small-scale studies among accessible groups, mostly focusing on COVID-19 compared to routine childhood and adult vaccination. There is an urgent need to strengthen data collection to better understand coverage across different migrant groups, ages, and MENA countries, especially on adult and catch-up vaccinations for routine immunisations, and develop innovative co-designed strategies to address specific drivers of vaccine uptake among this group.

Funding

La Caixa, LCF/PR/SP21/52930003.

Development of prediction models of COVID-19 vaccine uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study

Introduction

Vaccines are essential to prevent infection and reduce the morbidity of infectious diseases. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion and discrimination, and low COVID-19 vaccine intention and uptake were observed among refugees globally. This study aimed to develop and internally validate prediction models of COVID-19 vaccine uptake by nationality.

Methods

This is a nested prognostic population-based cross-sectional analysis. Data were collected between June and October 2022 in Sin-El-Fil, a district of Beirut, Lebanon. The study population included a random sample of Lebanese adults and all Syrian adults residing in areas of low socioeconomic status. Data were collected through a telephone survey. The main outcome was the uptake of at least one dose of the COVID-19 vaccine. Predictors of COVID-19 vaccine uptake were assessed using the Least Absolute Shrinkage and Selection Operator regression for Lebanese and Syrian nationalities in separate models.

Results

Of 2028 participants, 79% were Lebanese, 18% Syrians and 3% of other nationalities. COVID-19 vaccination uptake was higher among Lebanese (85% (95% CI 82% to 86%) compared to Syrians (47% (95% CI 43% to 51%)) (p<0.001); adjusted OR 6.2 (95% CI 4.9 to 7.7). Predictors of uptake of one or more COVID-19 vaccine doses for Lebanese were older age, presence of an older adult in the household, higher education, greater asset-based wealth index, private healthcare coverage, feeling susceptible to COVID-19, belief in the safety and efficacy of vaccines and previous receipt of the influenza vaccine. For Syrians, predictors were older age, male sex, completing school or higher education, receipt of cash assistance, presence of chronic illness, belief in the safety and efficacy of vaccines, previous receipt of the influenza vaccine and possession of a legal residency permit in Lebanon.

Conclusions

These findings indicate barriers to vaccine uptake among Syrian refugees and migrants, including legal residency status. These findings call for urgent action to enable equitable access to vaccines by raising awareness about the importance of vaccination and the targeting of migrant and refugee populations through vaccination campaigns.

Influence parental- and child-related factors on the acceptance of SARS-CoV-2 test methods in schools and daycare facilities

Introduction

Rapid testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections was an essential step in reducing the spread of the virus and monitoring pandemic development. Most mandatory standard pandemic testing in Germany has been performed in schools and daycare facilities. We investigated the influence of behavioral and attitudinal characteristics of children and caregivers on their acceptance of (i) antigen-based nasal swab rapid and (ii) oral saliva-based pooled Polymerase Chain Reaction (PCR) tests.

Methods

Conducted through a cross-sectional survey between November and December 2021, with 1962 caregivers and 581 children/adolescents participating, the study evaluated the acceptability of each testing method on a six-point scale. Participants scored one test method conducted on their child at one of six levels with 1 and 6 denoting "excellent" (1) and "inadequate" (6), respectively. We considered demographic variables, vaccination status, child mental health (measured by the SDQ-questionnaire), and facility type (kindergarten, primary school, secondary school) as covariates.

Results

Results reveal a preference for saliva-based PCR tests over nasal swabs by about one grade, particularly among parents of unvaccinated children, especially if their child expressed future vaccination reluctance. Testing acceptance was lower among children with mental health issues, primary school-aged, and those with less-educated parents. Perception of test accuracy and convenience influenced attitudes, favoring saliva-based PCR tests. Moreover, children with mental health issues felt less secure during testing.

Discussion

To our knowledge, this is the first study to investigate the influence of different testing methods on testing acceptance for SARS-CoV-2 in children and caregivers. Our study identifies predictors of lower acceptance of public health surveillance measures and enables the development of educational programs on testing and vaccination tailored to the needs of specific target groups. Moreover, we demonstrate that test acceptance in vulnerable groups can be enhanced by careful choice of an appropriate testing method.

Psychological distress among unemployed migrants settling in southwestern Spain: A cross-sectional study

Migrants living in the informal settlements of Southern Spain tend to have precarious employment and poor living conditions, making then vulnerable to mental health issues. This study aimed to assess psychological distress in a sample of unemployed migrants residing in informal settlements in the province of Huelva (southern Spain), during the fourth wave of the COVID-19 pandemic. A descriptive cross-sectional study was conducted during the months of April to June 2021, through a heteroadministered questionnaire, in informal settlements. The measurement instrument was the General Health Questionnaire (GHQ-12), used to analyze psychological distress, and other sociodemographic and health-related variables. Univariate and bivariate descriptive data analysis were performed, using the nonparametric statistics Mann-Whitney U test, Kruskal-Wallis H test, and Tau β correlation. A categorical regression analysis was performed to study the relationship between psychological distress and the rest of the variables. The sample consisted of 317 subjects, 83.9% of whom were males, and the mean age was 33.4 years (SD = 10.7 years). The mean score obtained in the GHQ-12 questionnaire was 13.69 points (SD = 3.86). Significant differences were found between levels of psychological distress and substance abuse (H = 14.085; P = .049), people who wished to stay in Spain (t = 6987; P = .049), people who experienced isolation due to COVID-19 contact (t = 1379.5; P = .001), people who needed medical assistance due to COVID-19 (t = 7.990; P = .018), and those who reported having chronic illnesses (t = 2686.5, P = .02). The mean score of psychological distress indicates general high levels of psychological distress. Participants who had experienced isolation due to COVID-19 contact, who consumed substances, and who had chronic illnesses reported the highest levels of psychological distress.

Non-vaccination Against COVID-19 Among Venezuelan Refugees and Migrants Adults in Peru: A Cross-sectional Study, 2022

OBJECTIVES

The purpose of this study was to determine factors associated with non-vaccination against coronavirus disease 2019 (COVID-19) among the Venezuelan immigrant population residing in Peru.

METHODS

A cross-sectional study was conducted using data obtained from the Second Survey of the Venezuelan Population Residing in Peru in 2022. The dependent variable was vaccination status against COVID-19. The independent variables included socio-demographic, economic, and migratory characteristics of the included population. Crude and adjusted generalized linear Poisson-family models were used to calculate prevalence ratios with 95% confidence intervals (CIs).

RESULTS

A total of 7739 Venezuelan migrants aged 18 years or older were included. The proportion of non-vaccination against COVID-19 was 5.7%. Regarding associated factors, unemployment (adjusted prevalence ratio [aPR], 1.31; 95% CI, 1.04 to 1.65) was linked to an increased likelihood of not being vaccinated against COVID-19. In contrast, women (aPR, 0.76; 95% CI, 0.61 to 0.95), possessing a migration permit (aPR, 0.41; 95% CI, 0.31 to 0.54), and having health insurance (aPR, 0.47; 95% CI, 0.27 to 0.81) were associated with a decreased likelihood of being unvaccinated.

CONCLUSIONS

The primary governmental and non-governmental institutions responsible for supporting and protecting the Venezuelan migrant and refugee population should improve vaccination access by issuing migration permits and providing health insurance.

Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world

Despite widespread availability of vaccines against SARS-CoV-2 virus, the cause of Coronavirus Disease 2019 (COVID-19), its uptake in many Arab countries is relatively low. This literature review aimed to scope evidence on COVID-19 vaccine hesitancy (VH) in the Arab world. A total of 134 articles reporting prevalence of COVID-19 VH and associated factors, conducted in any of the 22 Arab League countries, were reviewed. COVID-19 VH prevalence ranged from 5.4% to 83.0%. Female gender, young age, low education level and lack of previous influenza vaccine uptake were most commonly reported to be associated with COVID-19 VH. The most-reported personal concerns contributing toward VH were related to the rapid development, safety and side effects of vaccine, as well as an overall lack of trust in government policies toward pandemic control and widespread conspiracy theories. Tailored interventions to enable the distribution of trusted information and enhance public acceptance of immunization are warranted.

COVID-19 Vaccine Acceptance and Hesitancy among Migrants, Refugees, and Foreign Workers: A Systematic Review and Meta-Analysis

Despite the effectiveness of current vaccines in reducing the spread and severity of SARS-CoV-2 infections, many people, including migrants, refugees, and foreign workers, are hesitant to be vaccinated. This systematic review and meta-analysis (SRMA) was conducted to determine the pooled prevalence estimate of the acceptance and hesitancy rates of the COVID-19 vaccine among these populations. A comprehensive search of the peer-reviewed literature indexed in PubMed, Scopus, Science Direct, and Web of Science databases was conducted. Initially, 797 potential records were identified, of which 19 articles met the inclusion criteria. A meta-analysis of proportions using data from 14 studies revealed that the overall acceptance rate of COVID vaccination among 29,152 subjects was 56.7% (95% CI: 44.9-68.5%), while the prevalence of vaccine hesitancy among 26,154 migrants reported in 12 studies was estimated to be 31.7% (95% CI: 44.9-68.5%). The acceptance rate for the COVID-19 vaccination first declined from 77.3% in 2020 to 52.9% in 2021 and then slightly increased to 56.1% in 2022. The most frequent factors influencing vaccine hesitancy were worries about vaccine efficacy and safety. Intensive vaccination campaigns should be implemented to raise vaccination awareness among migrants, which will increase the acceptance rate for the COVID-19 vaccine and result in herd immunity.

Combined Impact of Omicron Vaccination and Environmental Risk Exposure: A Thailand Case Study

This research aimed to determine the levels of COVID-19 booster dose vaccinations in Thai populations in areas with environmental risk exposure during the Omicron outbreak. Five of twenty provinces in Thailand were selected by assessing environmental risk exposure for study settings. A total of 1038 people were interviewed by a structured questionnaire. The predicting factors of COVID-19 booster dose vaccinations were analyzed by univariate and multivariate analysis. The results showed that 69.4% (95% CI 66.5-72.1) of the population was vaccinated with COVID-19 booster doses. Multiple logistics regression revealed that the female gender (AOR 1.49, 95% CI 1.11-2.00), all age groups from 38 to 60 years old, all education levels of at least secondary school, high income (AOR 1.16, 95% CI 1.15-2.24), populations having experience with COVID-19 infection (AOR 2.27, 95% CI 2.05-3.76), knowledge of vaccine (AOR 1.78, 95% CI 1.11-2.83), and trusting attitude (AOR 1.76, 95% CI 1.32-2.36) were factors among those more likely to take COVID-19 booster dose vaccinations in high-environmental-risk-exposure areas. Therefore, an effective booster dose campaign with education programs to increase attitudes toward booster vaccinations should be implemented for the resilience of COVID-19 prevention and control.