Vaccine Coverage Remains Low Among Forcibly Displaced Children
Researchers conducted a systematic review and meta-analysis to estimate vaccine coverage and identify factors associated with vaccination among forcibly displaced, pediatric populations.
Vaccination coverage for children that have been forcibly displaced continues to show significantly low rates, according to a study published in JAMA Network Open.1 Upon discovery of persistently low pediatric vaccination rates, researchers agree there is an urgent need to close the immunization gap within this displaced population.
“More than one-half of the world’s unimmunized children live in 31 countries characterized by fragile, conflict-affected, and vulnerable settings that heighten the risk for contracting vaccine-preventable diseases (VPD),” wrote authors of the study. “For example, just 16 conflict-affected countries (12% of the global population) accounted for 67% of the world’s polio cases between 2010 and 2015.”
For the individuals living in these conflict-affected locations, forced displacement is a significantly real possibility that can impact hundreds of thousands of people in specific areas. According to the European Commission,2 forced displacement is “when the movement from a person’s region or country is involuntary or coerced, due to persecution, conflict, generalized violence, human rights violations, or the adverse effects of climate change, environmental degradation, or disasters.”
Defined by the United Nations High Commissioner for Refugees, included studies focused on research articles that investigated immunization rates among individuals under 19 who were forcibly displaced. | image credit: Anna / stock.adobe.com
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Based on 2024 data from the end of the year, there are approximately 123.2 million displaced individuals around the world, consisting of refugees, asylum-seekers, other people in need of international protection, and internally displaced people.3 Children are also a notable subset of the world’s displaced individuals, disproportionately making up 40% of the globally displaced population.1
With displaced children as the key population, researchers conducted a meta-analysis to better understand these children’s likeliness to receive vaccines amid ongoing barriers respective of the country or location they’ve been displaced from.
“Optimizing evidence-based public health strategies to improve vaccination among forcibly displaced, pediatric populations requires a greater understanding of current vaccination coverage and of factors that impact uptake of vaccines,” continued authors of the current study.1 “This study aims to assess vaccination coverage among forcibly displaced, pediatric populations and to identify factors associated with vaccination.”
Researchers conducted a database search in November 2023 with keywords focused on vaccination, pediatrics, and displaced populations. Defined by the United Nations High Commissioner for Refugees, included studies focused on all 3 keywords, looking for research articles that investigated immunization rates among individuals under 19 who were forcibly displaced.
Their primary research outcome was overall vaccination coverage of displaced children defined by the proportion of the population that was vaccinated. The final analysis included a total of 39 studies ranging from 24 different countries (22 studies focused on refugees; 31 studies reported vaccination coverage).
“In this systematic review and meta-analysis, we found that forcibly displaced, pediatric populations had a full vaccination coverage of 21%,” wrote the authors.1 “Compared with the host nations’ pediatric populations, the forcibly displaced population had significantly lower odds of vaccination. Although coverage after vaccination campaigns was high at 86%, the overall full immunization coverage remained insufficient, indicating that routine immunization services can be strengthened to achieve comprehensive coverage in this vulnerable group.”
Indeed, based on data from 11 of the 39 included studies, 89% of displaced children were unvaccinated, comprising over 4474 individuals in a population of 5027. Furthermore, researchers identified 5 notable factors contributing to an increased chance of displaced children becoming vaccinated. Those factors included: having 2 or more children in the family, guardian having at least some education, father having employment, stable housing, and having access to more health care services.
Despite these factors, if children were deemed forcibly displaced, their odds of becoming vaccinated were guaranteed to decrease.
“Our findings highlight the necessity of addressing modifiable social factors beyond health factors to more effectively address the immunization challenges faced by displaced populations,” they continued.
Especially in populations that have been forcibly displaced, access to vaccines and odds of getting vaccinated are just as reliant on social factors as they are on health-related factors. And while immunization schedules may not be a key priority for displaced individuals seeking asylum, the results of this study highlight the need to expand vaccination services for displaced children across the world.
“In this systematic review and meta-analysis of vaccination coverage among forcibly displaced, pediatric populations, we found that coverage was consistently low, revealing a substantial gap in health care provision,” concluded the authors.1 “Our findings provide compelling evidence for the urgent need to strengthen immunization services among forcibly displaced populations, a demographic that has expanded over the past decade due to escalating conflicts.”
READ MORE: Immunization Resource Center
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