Vaccine Equity: Bridging the Gap for Newly Arrived Migrants in Europe
"A systematic review reveals strategies to improve vaccination uptake and cost-effectiveness among newly arrived migrants in the EU/EEA, ensuring healthier communities for all."
In an increasingly interconnected world, migration has become a defining feature of modern societies. With over 258 million people migrating across international borders and an additional 763 million migrating internally, ensuring the health and well-being of migrant populations is a critical public health priority. In the European Union/European Economic Area (EU/EEA), the influx of refugees and migrants between 2014 and 2016, coupled with internal migration, has created unprecedented challenges for healthcare systems.
Vaccine-preventable diseases (VPDs) pose a significant threat, particularly among newly arrived migrants who may be under-immunized or lack documentation of previous vaccinations. Measles and polio outbreaks in the EU/EEA have been linked to under-immunized migrant populations, highlighting the urgent need for effective vaccination strategies. However, seroprevalence studies have revealed sub-optimal immunity to VPDs among both adult and child migrants, underscoring the complexity of the issue.
Recognizing the critical need for targeted interventions, a systematic review was conducted to explore strategies for improving vaccination uptake and cost-effectiveness among newly arrived migrants in the EU/EEA. This review, conforming to PRISMA guidelines, sought to identify interventions that increase vaccine uptake and assess the cost-effectiveness of vaccination strategies in this vulnerable population.
Measuring the Immunization Gap
The WHO Immunization Data portal provides global, regional, and country summaries of vaccine-preventable disease cases, vaccination coverage, immunization-program indicators, vaccine introductions, and vaccination schedules. A 2022 systematic review describes migrants as vulnerable to communicable diseases and reports multiple barriers to immunization programs. The review also examines vaccination coverage among migrants in comparison with non-migrants, while noting that the gap had not previously been quantified. Research on vaccination capability further identifies public health, community and migrant health centers, and data systems such as electronic health records and vaccine databases as relevant areas for assessment.
From Guidance to Catch-Up Care
WHO guidance on COVID-19 immunization in refugees and migrants emphasizes global equity in vaccine distribution, national equity, equal respect, community engagement, and communication to build trust and counter misinformation. Related guidance recommends that public health agencies understand communities’ vaccine beliefs and practices and intentionally partner with them to reduce vaccination barriers. CDC domestic guidance advises clinicians at the first health visit to review available records, perform appropriate testing, and update or revaccinate when necessary. However, a March 2026 review reports that vaccination strategies for adolescent and adult arriving migrants remain poorly described despite life-course policies and global guidelines supporting catch-up vaccination.
Effective Strategies to Boost Vaccination Rates Among Migrants
The systematic review identified three primary intervention studies conducted in the EU/EEA or high-income countries. These studies shed light on promising strategies for improving vaccination uptake among migrant populations. While the impact observed was generally small, the findings offer valuable insights for designing effective interventions.
- Social Mobilization/Community Outreach: Engaging communities through outreach programs to raise awareness and promote vaccination.
- Planned Vaccination Programs: Implementing structured vaccination programs tailored to the specific needs of migrant populations.
- Education Campaigns: Providing accessible and culturally sensitive information about the importance of vaccination.
Mapping Equity-Focused Evidence
Recent research includes a scoping review of fairness-based techniques for optimizing vaccine allocation among migrants during pandemics. That review identifies a need for more research on national policies and delivery models that assess migrants and refugees case by case, while maintaining neutrality toward immigration status rather than using exclusion. Another scoping review examined vaccine access among asylum seekers, refugees, and undocumented migrants across the European Union, European Economic Area, Switzerland, and the United Kingdom, covering literature from 2000 through 2024. Community-engaged research has also described a three-phase program involving scholar recruitment and training, early community engagement, and community outreach vaccinations.
Limits of the Evidence
A systematic review of interventions intended to improve vaccination uptake and cost-effectiveness among newly arrived migrants in the EU and EEA identifies important evidence limitations. The review reports a lack of comparator data, making it difficult to assess interventions against appropriate alternatives. It also states that the only reported outcome was vaccine uptake, which limits conclusions about broader effects such as health outcomes or wider program performance.
Moving Forward: Prioritizing Vaccination for Migrants in the EU/EEA
While data remains scarce, the review highlights the potential of social mobilization, vaccine programs, and education campaigns as promising strategies for improving vaccination rates among migrants. Further research is needed to explore the cost-effectiveness of these strategies and address the unique challenges faced by migrant populations. Vaccination of migrants must remain a public health priority in the EU/EEA, ensuring that everyone has the opportunity to protect themselves and their communities from vaccine-preventable diseases.
Trust, Delivery, and Inclusion
Reviews consistently frame vaccine hesitancy among migrant communities as a public health concern because refusing or delaying vaccination can undermine prevention and the eventual elimination of communicable diseases for which safe and effective vaccines are available. A 2024 narrative review describes vaccination reluctance as a worldwide concern and notes that migrant groups have been studied unevenly across countries. A 2022 review of refugee, immigrant, and migrant populations identifies three priorities: describing vaccination rates, identifying key barriers, and evaluating interventions that address hesitancy. A 2025 scoping review examines diverse vaccination delivery models targeting hesitancy and other access barriers.
Structural Barriers to Equity
The CDC describes refugee, immigrant, and migrant communities as often unequally affected by economic, social, and other obstacles to health and healthcare. Research involving more than 50 public health departments, healthcare systems, and community organizations identified systemic and structural barriers that continued to negatively affect vaccination rates among Black and African immigrant communities, even after sustained COVID-19 vaccination campaigns. The study also identified five key themes for vaccination programs that may have implications beyond COVID-19. These findings place vaccine inequity within broader systems of access rather than treating it solely as individual reluctance.
Building Inclusive Life-Course Protection
A life-course vaccination perspective argues that calls for equitable vaccine access during COVID-19 can serve as starting points for inclusive vaccination plans beyond the pandemic. The source specifically notes that both the World Health Organization and the European Centre for Disease Prevention and Control called for equity in access to COVID-19 vaccines. A related review describes vaccination reluctance among immigrants as a major public health concern because it can contribute to disease outbreaks and strain healthcare systems. Together, these sources connect individual access to vaccines with longer-term protection across migrant and refugee populations.