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Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers—including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals—for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants.

Migrant populations are one of several underimmunised groups in the EU or European Economic Area (EU/EEA), yet little is known about their involvement in outbreaks of vaccine-preventable diseases. This information is vital to develop targeted strategies to improve the health of diverse migrant communities. We did a systematic review (PROSPERO CRD42019157473; Jan 1, 2000, to May 22, 2020) adhering to PRISMA guidelines, to identify studies on vaccine-preventable disease outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, varicella, Neisseria meningitidis, and Haemophilus influenzae) involving migrants residing in the EU/EEA and Switzerland. We identified 45 studies, reporting on 47 distinct vaccine-preventable disease outbreaks across 13 countries. Most reported outbreaks involving migrants were of measles (n=24; 6496 cases), followed by varicella (n=11; 505 cases), hepatitis A (n=7; 1356 cases), rubella (n=3; 487 cases), and mumps (n=2; 293 cases). 19 (40%) outbreaks, predominantly varicella and measles, were reported in temporary refugee camps or shelters. Of 11 varicella outbreaks, nine (82%) were associated with adult migrants. Half of measles outbreaks (n=11) were associated with migrants from eastern European countries. In conclusion, migrants are involved in vaccine-preventable disease outbreaks in Europe, with adult and child refugees residing in shelters or temporary camps at particular risk, alongside specific nationality groups. Vulnerability varies by disease, setting, and demographics, highlighting the importance of tailoring catch-up vaccination interventions to specific groups in order to meet regional and global vaccination targets as recommended by the new Immunisation Agenda 2030 framework for action. A better understanding of vaccine access and intent in migrant groups and a greater focus on co-designing interventions is urgently needed, with direct implications for COVID-19 vaccine delivery.

ObjectiveMigrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake.DesignA systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021.Eligibility criteria for study selectionResearch reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19.Data extractionWe extracted data on key outcomes, study design, country, population under study and sample size.Results1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups.ConclusionsSocial media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake.RegistrationThis study has been registered with PROSPERO (CRD42021259190).

ObjectivesTuberculosis (TB) and mental illnesses are highly prevalent globally and often coexist. While poor mental health is known to modulate immune function, whether mental disorders play a causal role in TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures.DesignSystematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Search strategy and selection criteriaMEDLINE, PsycINFO and PsycEXTRA databases were searched alongside reference list and citation searching. Inclusion criteria were original research studies published 1 January 1970–11 May 2020 reporting data on the association between mental health and TB risk.Data extraction, appraisal and synthesisData were extracted on study design and setting, sample characteristics, measurement of mental illness and TB, and outcomes including effect size or prevalence. Studies were critically appraised using Critical Appraisal Skills Programme (CASP) and Appraisal Tool for Cross-Sectional Studies (AXIS) checklists.Results1546 records published over 50 years were screened, resulting in 10 studies included reporting data from 607 184 individuals. Studies span across Asia, South America and Africa, and include mood and psychotic disorders. There is robust evidence from cohort studies in Asia demonstrating that depression and schizophrenia can increase risk of active TB, with effect estimates ranging from HR=1.15 (95% CI 1.03 to 1.28) to 2.63 (95% CI 1.74 to 3.96) for depression and HR=1.52 (95% CI 1.29 to 1.79) to RR=3.04 for schizophrenia. These data align with evidence from cross-sectional studies, for example, a large survey across low-income and middle-income countries (n=242 952) reports OR=3.68 (95% CI 3.01 to 4.50) for a depressive episode in those with TB symptoms versus those without.ConclusionsIndividuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally.PROSPERO registration numberCRD42019158071.

Background Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. Methods The ‘Vacc on Track’ study (May 2021–September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. Results Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews ( n  = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff ( n  = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. Conclusions Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.

BackgroundThough tuberculosis (TB)-related stigma is a recognized barrier to care, interventions are lacking, and gaps remain in understanding the drivers and experiences of TB-related stigma. We undertook community-based mixed methods stigma assessments to inform stigma intervention design.MethodsWe adapted the Stop TB Partnership stigma assessment tool and trained three peer research associates (PRAs; two TB survivors, one community health worker) to conduct surveys with people with TB (PWTB, n = 93) and caregivers of children with TB (n = 24) at peri-urban and rural clinic sites in Khayelitsha, Western Cape, and Hammanskraal, Gauteng Province, South Africa. We descriptively analyzed responses for each stigma experience (anticipated, internal, and enacted), calculated stigma scores, and undertook generalized linear regression analysis. We conducted 25 in-depth interviews with PWTB (n = 21) and caregivers of children with TB (n = 4). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organized using the Constraints, Actions, Risks, and Desires (CARD) framework.ResultsSurveys revealed almost all PWTB (89/93, 96%) experienced some form of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in the rural setting (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and together as key constraints to impede care, leading to decisions not to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through the understanding that TB can affect anyone and should not diminish self-worth. Risks of stigma, driven by fears related to disease severity and infectiousness, led to care disengagement and impaired psychological well-being. Participants desired counselling, identifying a specific role for TB survivors as peer counselors, and community education.ConclusionsStigma is highly prevalent and negatively impacts TB care and the well-being of PWTB, warranting its assessment as a primary outcome rather than an intermediary contributor to poor outcomes. Multi-component, multi-level stigma interventions are needed, including counseling for PWTB and education for health workers and communities. Such interventions must incorporate contextual differences based on gender or setting, and use survivor-guided messaging to foster stigma resilience.

IntroNovel screening methods are needed to increase access to cervical screening, and migrant Muslim women in the UK are particularly at risk of screening non-attendance. In anticipation of the introduction of high-risk human papillomavirus (hrHPV) self-sampling into the UK programme, this study explored views of migrant Muslim women in southwest London on understanding of cervical screening, barriers and motivators to engagement and acceptability of vaginal self-sampling.MethodsQualitative in-depth semi-structured individual interviews were carried out via MS Teams video call of 18 Muslim migrant women, with purposive and snowball recruitment. Framework analysis was carried out using NVivo 14 and coding matrix developed using MS Excel.ResultsMigrant Muslim women felt that self-sampling for hrHPV was likely acceptable and beneficial for some women in their community. Only 44% preferred self-sampling over healthcare worker (HCW)–taken samples because of concerns over technique and inadequate results. There was a lack of understanding of the screening programme, role of HPV and cultural taboo of sexual activity outside of marriage. These barriers may be mitigated by evidence-based information in their own language by a trusted HCW or community champion. Taking their own respiratory swabs during the COVID-19 pandemic made participants more open-minded to self-sampling.ConclusionsLow vaginal self-sampling is acceptable to migrant Muslim women; however, over half may still prefer HCW-taken samples. Key strategies for overcoming barriers to self-sampling are prioritising linguistically appropriate materials, partnership with community leaders, flexible access points to screening and confidential modes of result delivery.

Background Participatory research (PR) approaches are increasingly prioritised globally, particularly in the UK, where many funders have emphasised meaningful collaboration with those with lived experience to improve health research relevance, translation and impact. Despite this, marginalised groups, such as migrants, remain underrepresented in research, perpetuating health inequities. Migrants, who comprise 16% of the UK population, face systemic barriers to engagement, including distrust, hierarchical academic structures, and lack of inclusivity. PR approaches offer a collaborative framework for empowering migrant voices, balancing research and action, and fostering trust to address these disparities. This case study describes the development of the Migrant Health Community Research Network (MHCRN), a collaboration between migrant community groups, individuals, academics and health professionals from the Migrant Health Research Group, City St Georges University of London (MHRG). Aim MHRG sought to develop a sustainable model for engaging migrants in health research through a co-created network addressing power imbalances and ensuring inclusivity. Methods MHRG adopted PR principles, reflecting on the groups collective experience of prior engagement practices and systematically reviewing best practices. A five-phase approach was used: (1) defining agenda and aspirations through group reflection; (2) identifying concerns and challenges through internal reflection and community consultation; (3) conducting community exploratory workshops with co-facilitation; (4) establishing initial network structure based on collectively agreed principles; (5) co-developing a lived experience advisory panel. Findings The process has resulted in the following outputs: the “Migrant Health Community Research Network” (MHCRN) with guiding principles (equity, diversity, respect, decolonisation, empowerment, community), a network steering group (LEAP, Lived Experience Advisory Panel), community-based collaborations embedding migrant voices at all research stages, capacity building through training and peer researcher roles, and award-winning projects. Key challenges identified include structural inequalities, funding limitations, and institutional barriers. Opportunities emerged around trust-building, shared leadership, and sustainable relationship development. Conclusions While the MHCRN represents an important step in embedding meaningful collaboration, challenges persist. This initiative highlights the need for systemic change in academia to support equitable partnerships and inform similar innovative initiatives. By prioritizing non-tokenistic engagement and co-production, the MHCRN sets a foundation for sustained, impactful collaboration to address health inequities and inform policy and practice. Plain English summary Many health research projects fail to involve people they aim to help, especially marginalised groups such as migrants. This often results in research that is neither relevant nor useful. We recognised that the way we have worked with people with lived experience of migration could be improved. Our aim was to create a way to work together long-term so that migrant voices are heard and acted on from the development of research ideas all the way to the delivery and sharing of findings. We decided after talking to many researchers, migrants, community organisations and health care professionals that a migrant health research network that brought together all these voices through relationship building and creative ways of working and sharing ideas would be a good way to do this. We established the Migrant Health Community Research Network (MHCRN) which brings together people living in the United Kingdom with lived experience of migration from all over the world, healthcare professionals working in the National Health Service (NHS) and researchers from City St George’s University of London to improve migrant health. Our network was built step-by-step, starting with open conversations with migrants, healthcare professionals and researchers about challenges they had experienced in involving migrant communities in research and how these could be overcome. We then ran a workshop to shape our vision and agreed on shared principles. The network aims to be long-term, inclusive, and led by those with lived migration experience. Although there are ongoing challenges, this process has taught us valuable lessons about working together in a meaningful way. Take home messages Sustained relationship building and transparency are essential : Meaningful engagement of migrants in health research requires moving beyond tokenistic involvement to true sustained partnership and shared leadership to create safe spaces which avoid “data extraction” and instead facilitate authentic participation. Creative methods, community leadership and practical support (childcare, accessible venues) can enhance engagement: Cultural sensitivity, people with lived experience in leading roles, and the use of arts-based and other innovative approaches can bridge gaps, enrich dialogue, and create inclusive spaces for collaboration and diverse participation. Structural challenges require systemic change: Traditional academic structures and funding mechanisms can impede sustainable community engagement, requiring institutional change through the recognition and proactive response to the resource implications (both time and funds) of doing participatory research well. Reflexivity is crucial : Academic researchers must continuously examine their own roles and privileges, ensuring that where possible power imbalances are addressed and avoided.