Periodic Reporting for period 1 - RIVER-EU (Reducing Inequalities in Vaccine uptake in the European Region - Engaging Underserved communities)
Période du rapport: 2021-06-01 au 2022-11-30
What is the problem/issue being addressed?
Vaccine uptake in most minority or ethnic communities in Europe is substantially and unacceptably lower compared to the general population. Members from these communities - in RIVER-EU: (1) the migrant community in Greece, (2) the Turkish females and (3) Moroccan females in the Netherlands, (4) the Ukrainian minority in Poland and (5) the Roma community in Slovakia - are likely to encounter health system barriers to accessing health care services. As a result, the vaccine uptake in these communities is low. To increase vaccine uptake and coverage in underserved communities, health system barriers must be removed.
Why is it important for society?
Removing health system barriers will on the one hand lead to a higher vaccine uptake in the underserved communities and will thereby improve protection against vaccine-preventable diseases at the national and European levels. On the other hand, barriers in vaccination services often indicate barriers in general health system functioning. So, with removing health system barriers in accessing vaccination services, RIVER-EU improves access to health services in general for all communities. A high vaccine uptake will decrease the burden of disease and therefore improve health and well-being for all children and adolescents in Europe. Equitable access to and use of vaccines will prevent infectious diseases in children and adolescents, thus allowing them to continue their development towards a healthy adulthood and preventing infection related cancers in later life.
What are the overall objectives?
The overall aim of the RIVER-EU project is to make access to MMR (Measles-Mumps-Rubella) and HPV (Human Papillomavirus) vaccination equitable, improving access to these vaccines among underserved communities in Greece, the Netherlands, Poland and Slovakia by identifying and removing health system barriers. We will do that by adjusting existing and/or developing new interventions tailored to underserved communities. To that purpose the project takes a co-creative and collaborative approach, where the underserved communities as well as the health care workers providing the health services are given a voice in all phases of the project. By doing so, we ensure that the perspectives and experiences of the communities and the vaccination services are acknowledged and that the current mismatch between health services and communities is repaired.
Vaccine uptake in most minority or ethnic communities in Europe is substantially and unacceptably lower compared to the general population. Members from these communities - in RIVER-EU: (1) the migrant community in Greece, (2) the Turkish females and (3) Moroccan females in the Netherlands, (4) the Ukrainian minority in Poland and (5) the Roma community in Slovakia - are likely to encounter health system barriers to accessing health care services. As a result, the vaccine uptake in these communities is low. To increase vaccine uptake and coverage in underserved communities, health system barriers must be removed.
Why is it important for society?
Removing health system barriers will on the one hand lead to a higher vaccine uptake in the underserved communities and will thereby improve protection against vaccine-preventable diseases at the national and European levels. On the other hand, barriers in vaccination services often indicate barriers in general health system functioning. So, with removing health system barriers in accessing vaccination services, RIVER-EU improves access to health services in general for all communities. A high vaccine uptake will decrease the burden of disease and therefore improve health and well-being for all children and adolescents in Europe. Equitable access to and use of vaccines will prevent infectious diseases in children and adolescents, thus allowing them to continue their development towards a healthy adulthood and preventing infection related cancers in later life.
What are the overall objectives?
The overall aim of the RIVER-EU project is to make access to MMR (Measles-Mumps-Rubella) and HPV (Human Papillomavirus) vaccination equitable, improving access to these vaccines among underserved communities in Greece, the Netherlands, Poland and Slovakia by identifying and removing health system barriers. We will do that by adjusting existing and/or developing new interventions tailored to underserved communities. To that purpose the project takes a co-creative and collaborative approach, where the underserved communities as well as the health care workers providing the health services are given a voice in all phases of the project. By doing so, we ensure that the perspectives and experiences of the communities and the vaccination services are acknowledged and that the current mismatch between health services and communities is repaired.
In the past 18 months, evidence has been collected about the health system barriers that underserved communities experience and about interventions that could be used to remove these health system barriers. To this end, literature studies were carried out (both into health system barriers and into interventions) and interviews and focus group discussions were held with young people, their parents and grandparents and with health care professionals. The aim of this data collection was to find out which barriers young people, their (grand)parents and health care professionals experience in the healthcare system, which in some cases lead to people not being vaccinated. The data collection took place both in communities with low vaccination coverage (migrant population in Greece, Turkish and Moroccan population in the Netherlands, Ukraine speaking population in Poland and the Roma population in Slovakia) and in communities where vaccination coverage is high, despite being an underserved community (so called empowering examples: Bangladesh community in the UK, Somali population in Finland and Arab-Muslim population in Israel). On the one hand, the results of the literature study, the interviews and focus group discussions show many different health system barriers across the communities, such as costs of HPV vaccination for the patient (Poland) and lack of training for interpreters in health care communication (Greece). On the other hand, we also see health system barriers that occur in all communities, such as information provision that is insufficiently in line with the wishes and background of underserved communities. In the underserved communities where the vaccination rate is high, we see various enablers in health systems, such as trust in the government and health care professionals and the ability of health care professionals to connect well with the underserved community. With regard to evidence-based interventions, the most important finding is that these can mainly be found with regard to HPV. Interventions that increase the vaccination coverage of MMR are hardly available. We believe this is caused by MMR being implemented by local public health services who don’t evaluate and therefor publish on these interventions. Also, MMR is part of routine vaccines given in the first year of life, so when it comes to programme improvement it may get lumped with other vaccines so it won’t appear in MMR specific searches. And, for these interventions the lack of evaluation is also apparent. In addition, many interventions appear to be multi-component, i.e. they try to increase vaccination coverage in several ways, for example via health care provider training, school-based education and consent policy changes. Based on transferability research, we also know that the interventions found are transferable from the context in which they were developed to the context of our underserved communities.
The project has already yielded very rich results. These results form not only the basis for follow-up work in RIVER-EU, but also input for current efforts to increase vaccination coverage. Within RIVER-EU, the next phase is aimed at adjusting the evidence-based interventions so that it is even better suited to our underserved communities. Adapting, but also implementing and evaluating the interventions, will be done in close cooperation with the underserved communities and other stakeholders (public health officials and policy makers, health care workers and academics).