Attitudes and experiences of asylum seekers and refugees to the COVID-19 vaccination

Background COVID-19 disproportionately affected asylum seeker and refugee (ASR) populations due to language and cultural barriers, lower health literacy, polytraumas and mental health needs, and increased exposure. Despite this, there was vaccine hesitancy and low vaccination rates in ASR populations.

Aim Explore the attitude to, and experiences of the COVID-19 vaccination among ASRs.

Design & setting Qualitative study of 12 diverse purposively recruited ASRs in Bristol.

Method Semi-structured interviews transcribed verbatim and analysed thematically to identify emergent themes.

Results Eight refugees and four asylum seekers were recruited, five of whom were females and seven male, aged between 23 and 48 ; together representing seven countries. Six were part of a home office resettlement programme, and six had arrived in the United Kingdom by independent means. Analysis showed delayed uptake rather than vaccine refusal due to three main themes; fear (secondary to social isolation, misinformation and mental illness), trust (surrounding access to care and community relationships) and systemic asylum issues (repeated relocation, uncertainty, and dependency on the charity sector).

Conclusions Fear, trauma, and isolation propagated by systemic issues are primary factors impacting healthcare decision-making, and standard approaches to increasing vaccination uptake must be reconsidered in light of this. General practice must appreciate, and invest in providing security in healthcare access for ASR populations. Barriers to practice registration must be overcome to enable ASRs to access care both around vaccination and afterwards. Communication must be clear and accessible to aid individuals in making informed decisions balancing benefits and potential risk of vaccinations.