SRA-E Lisbon 2017

Immigrant and refugee populations are often particularly susceptible to vaccine preventable diseases because they may be lacking adequate immunization and/or may be more vulnerable to disease. Immunization access and uptake for these populations are known to be influenced by different government policies and procedures. These include access to health services, immunization costs, and communication (including provision of appropriate and accessible information). Furthermore, policies and procedures to monitor immigrant and refugee immunization coverage are important in identifying specific under- and un-immunized populations. Past and present immigrant and refugee specific policies and practices in Canada were assessed against known information on vaccine coverage and incidence of vaccine preventable diseases, and the factors influencing immunization decision-making, in these populations. Canada has no current mechanism to monitor immigrant vaccine coverage. However, one study found that more than one-third of new immigrants and refugees were susceptible to measles, mumps and rubella. Rates of vaccine preventable diseases for immigrants are significantly higher than in the native-born population, and tend to increase with years in Canada. Although knowledge of factors related to immigrant and refugee immunization decision making is limited, a study of immigrant mothers in Canada found that access to health care professionals and appropriate immunization information were critical to mothers and their children being immunized. Based on this information, a 2012 Canadian government decision to limit health care benefits for immigrant and refugee populations posed a major barrier to immunization access and uptake. This decision was overturned in 2016. Immunization schedules differ between provinces and territories, and not all immunizations are publicly funded. Some efforts are made to provide immunization information in multiple languages – for example, A Parent’s Guide to Vaccination provided by the Public Health Agency of Canada is available in more than 13 languages. These results and others provide valuable insights into the effects of various government decisions, policies and procedures as barriers or facilitators to immigrant and refugee immunization access and uptake, and evidence on means of improving immunization for these populations.