Information inequities |
• Limited access to health information leading to inadequate knowledge about vaccinations and vaccine-preventable diseases [11, 12] |
• Information not accessible or not provided in an acceptable format [11] |
• Inadequacy of public health vaccination campaigns targeting migrant groups [16] |
• Confusion related to vaccine eligibility [17] |
Personal beliefs |
• Low risk perception of vaccine-preventable disease [13] |
• Vaccine-specific hesitancy (e.g. fears of adverse effects, vaccine safety concerns) [1, 11, 18] |
Previous systems experiences |
• Experiences of racism, discrimination, or social exclusion within health systems [1, 10, 11, 15, 19] |
• Distrust of the health/medical system and/or government systems [10, 12, 15] |
• Fear of accessing the healthcare system based on legal status (e.g., undocumented migrants) [14, 17] |
Structural inadequacies |
• Inadequate vaccine delivery coordination by public health authorities [11, 14] |
• Gaps in national policies on migrant/refugee health services and vaccinations [1, 11, 19] |
• Lack of vaccine coverage in the country of origin [14] |
• Barriers or inequities to accessing healthcare in general that translate to vaccine access [1, 19] |
Accessibility of vaccine services |
• Lack of awareness and/or physical access to immunization services [11] |
• Low digital literacy and lack of access to technology for booking and accessing information [11] |
• Financial barriers accessing vaccination; including indirect costs such as taking time off work [1, 9, 11, 19] |
Intersecting risk factors for under-vaccination |
• Level of education [13] |
• Family size, birth order of child [11] |
• Age [7] |
• Geographic location (e.g., rural/urban, neighbourhood) [7, 21] |
• Legal status [14] |