Perceived Barriers of Migrants and Refugees to Vaccinate Their Children against Measles and Polio: A Study in Iran

"The identified barriers may provide a perspective for developing effective efforts in this area."

Children from migrant families are at a higher risk for certain vaccine-preventable diseases (VPDs). Despite the fact that Iran's primary healthcare network provides free access and free-of-charge to a majority of healthcare services, including immunisation, for refugees and migrants, the prevalence of partial immunisation in non-Iranian children was reported to be six times higher than in Iranian children (11.9% vs. 2%). Iran is at risk of a polio reemergence as it accommodates approximately 2.5 million Afghan refugees, while neighbouring countries Afghanistan and Pakistan continue to experience incidents of wild poliovirus cases. This study examined the perceived barriers of migrants and refugees to vaccinating their children against measles and polio in Iran.

This cross-sectional study was conducted in Iran from October 2022 to April 2023. First, an instrument was developed and validated through several steps. Next, 1,067 parents who had not vaccinated their children against polio and measles or had delayed receiving any dose of these two vaccines until the age of 15 were selected from 16 provinces and completed the instrument. Finally, the data were analysed, and the perceived barriers affecting vaccination against polio and measles vaccines were categorised into five factors:

1. Low knowledge: Parents of migrant and refugee children possess lower knowledge regarding measles and polio vaccines compared to non-migrant parents, which may be attributed to factors such as lower literacy, language and communication barriers, and limited access to training opportunities in migrants and refugees. As such, the health system in Iran should prioritise raising awareness and knowledge of polio and measles vaccinations among parents of refugees and migrants through targeted campaigns and educational initiatives.
2. Unfavorable attitudes: The researchers recommend implementing collaborative educational programmes, such as peer education, to enhance the positive attitude of refugee and migrant parents towards measles and polio vaccines in Iran. They also suggest conducting periodic needs assessments to understand the vaccine-related attitudes of all population groups, including refugees and migrants, and designing suitable communication interventions accordingly.
3. Communication challenges: Common rumours about the possibility of paralysis in children and other negative consequences after receiving the polio and measles vaccines, lack of trust in the recommendations of Iranian health providers, and living in the outskirts of cities and remote areas have been recognised as challenges that contribute to the delay or non-vaccination of children against measles and polio among the study participants. In Iran's health system, non-Iranian volunteers participate as health liaisons for non-Iranian nationals. They transmit information and follow up on cases of vaccination delays among migrants and refugees in all parts of the country, including suburbs and remote areas. Since some non-Iranian migrants and refugees place more trust in these contacts due to shared language and culture, the health system should take steps to empower these individuals on childhood vaccination and address vaccination rumours.
4. Lack of participation in vaccination programmes: In the present study, a small number of participants reported they had not been invited to participate in the implementation of polio and measles vaccination programmes for children of migrants and refugees. Childhood immunisation coverage has been attributed in other studies to improved mobilisation and participation in the delivery of immunisation services. Empowerment of the aforementioned non-Iranian volunteers could strengthen their role as intermediaries between the health system and migrants and refugees. It is necessary to provide training for this group on the positive effects of community participation on childhood vaccination coverage, as well as strategies for increasing it.
5. Problems related to migration and refugee status: Some of the reported challenges faced by participants included regular changes in the geographical area of residence, unfamiliarity with Iran, lack of birth certificates, and absence of the child's previous vaccination card. These barriers limit their access to healthcare and make it challenging to track their vaccination status, leading to missed opportunities for vaccination. When planning to increase vaccination coverage in migrant and refugee children, the researchers urge authorities to pay attention to immigration-related problems and to integrate refugees and migrants into the health system by incorporating them into immunisation policies, planning, and service delivery.

The findings of the multiple linear regression revealed that education level, nationality, and self-reported economic status variables were significant predictors of perceived barriers to vaccination of children against polio and measles. To achieve full coverage of measles and polio vaccines among refugees and migrants in Iran, the researchers stress the need to prioritise parents with low education or income levels. Specific vaccination strategies should be implemented to enhance access to these communities.

In conclusion: "These results can provide insights for researchers and policymakers at various levels in developing tailored and targeted programs for caregivers of refugee and migrant children, taking into consideration the barriers to vaccinating children as a whole."