A Scoping Review Of The Challenges In Healthcare Access And Vaccination among migrants arriving and settling In The UK Post 2015

Absract

Background: Although healthcare is a fundamental human right, most migrant populations in the UK face many barriers to accessing essential services such as vaccination. These barriers, legislative changes, and other sociopolitical determinants have been blamed for notable disparities in vaccine coverage. This scoping review seeks to critically assess how UK policies and legislation align with the public health needs of migrants, specifically for vaccine-preventable diseases. Methods: This is a scoping review study in methodology using the PCC (Population, Concept, and Context) framework. Search terms were entered into critical databases: Web of Science and MEDLINE, capturing documents between 2015 and 2024. The documents were then screened for relevance, charted, and analysed thematically to pull up emerging themes on barriers, facilitators, and disparities in vaccination among migrants. Results: The review underscores the profound barriers migrant populations face in accessing vaccinations. Language and communication challenges, entrenched cultural beliefs, mistrust in healthcare systems, and structural issues like difficulties registering with healthcare services are prevalent. These obstacles are particularly severe in regions such as Wales and Northern Ireland. Despite these challenges, the review highlights effective strategies, such as culturally tailored communication and community engagement, which have been successful in specific contexts but need to be more consistently applied across the UK. Conclusions: This review identifies significant shortfalls in the UK health policy framework related to meeting the needs of migrant populations and the continuation of health inequalities. Solutions to this problem include the urgent need for regionally inclusive research, adopting trauma-informed care practices, and expanding language services. Improved multiagency collaboration is vital for the equitable access of all migrants to care, particularly for the control of vaccine-preventable diseases. The neglect of such issues poses a severe threat to the health and human rights of migrant communities.

Keywords: Vaccination, Migrants, Barriers, Disparities, Policy, healthcare-Access, Language, Mistrust, Integration, Equity

Chapter 1. Introduction

Vaccine-preventable diseases continue to be an ever-looming threat to global public health, no more so than in regions with inconsistent access to routine vaccinations and adequate public health infrastructure (Rodrigues & Plotkin, 2020). Diseases like measles, polio, diphtheria, and hepatitis B have seen a resurgence in politically unstable and crisis-ridden areas of the world (Adriano et al., 2024). The World Health Organisation (WHO) has stressed the necessity of maintaining high vaccination coverage in these vulnerable areas. This suggestion fits well with the WHO's Global Vaccine Action Plan. The plan aims to prevent outbreaks by ensuring that immunisation efforts remain a priority, even under very trying conditions (World Health Organisation, 2021). This is a challenge in places where a region's healthcare system is fragmented or suffering from mass disruption due to crises, just like the COVID-19 pandemic (Angawi, 2023). The health vulnerabilities of migrants in the UK are intensified by their initial lack of formal access to the health system and their unfamiliarity with it (Mudyarabikwa et al., 2021). They tend to come from overcrowded living conditions, a lack of good nutrition, and language barriers. They also come with the compounded stress of some migration journeys, making them more likely to get sick (Abbas et al., 2018). The COVID-19 pandemic brought many of these issues to the forefront, revealing that migrants were among the least likely to receive vaccinations due to misinformation and fear of government interaction (Hussain et al., 2022).

The post-pandemic surge in migration to the UK has again brought these challenges into sharp focus. Net migration to the UK in 2023 reached 685,000 individuals, driven by an increase in non-EU citizens coming to the UK. Most of the rise in non-EU arrivals from 2019 to 2023 occurred through the work and study routes, with health and care as the primary industry driving the growth in work migration (ONS, 2024). The health of migrants and the public health of the community they integrate are intrinsically linked; inadequate health provisions for one can lead to public health crises affecting all (Nanakali et al., 2023). This is evidenced by the outbreak of diphtheria in asylum-seeker accommodation in the UK, which spread throughout the small asylum-seeker community, with over 50 individuals being infected (UKHSA, 2024). The UK's obligation to effectuate the health rights of all people within its borders is underscored by events of this kind. The UK must ensure health rights under international law, such as the European Convention on Human Rights, to everyone within its borders (British Medical Association, 2022). These international obligations are particularly urgent to realize when public health emergencies occur since neglecting the health rights of anyone in society can lead to significant adverse public health outcomes for everyone (Martines et al., 2013).

Ethically, non-discriminatory healthcare is a foundational principle of modern public health policy. However, legislative changes enacted by the UK's previous Conservative government, such as the Nationality and Borders Act 2022, which aims to deter irregular migration, have had significant implications for the overall health of migrants. This legislation has raised concerns about its impact on the rights and health of migrants, with critiques focusing on its potential to exacerbate vulnerabilities by limiting access to asylum and essential services (Doctors of The World, 2022). The WHO Immunisation Agenda 2030 highlights the significance of offering and ensuring that catch-up vaccinations are given to migrants and other marginalised groups across their life course. These groups often miss immunisations during critical periods in their lives. However, the extent to which groups like refugees and asylum seekers align with the UK's immunisation schedules is relatively low and varies due to a multitude of variables such as age, nationality, the country in which the health assessment took place, and the disease itself—with substantial implications for policy and practice. This review will critically examine the UK legal and policy context that governs migrants' access to healthcare. We aim to provide a current and intelligent overview of the legal and policy framework in the UK regarding both direct access to healthcare and immigration. Additionally, we will highlight where the current framework appears to fall short and may put both Migrant and local populations at risk.

Chapter 2. Methods

2.1 Introduction and Rationale

A scoping review is a specialised form of evidence synthesis that seeks to comprehensively map the landscape of existing literature across diverse study designs oriented toward a focused area or topic. The methodology particularly fits in when drawing on various variables to identify gaps in research, essential themes, and patterns within an existing body of knowledge. Such an approach paves the way for informed practice and policy changes, further research agendas, and addresses the concerns laid by Levac et al. (2010) and Colquhoun et al. (2014). A scoping review allows the consideration of an extensive range of literature with no strict study selection criteria and inclusion and exclusion criteria to provide a dynamic research development as it proceeds through a flexible exploration approach such as this one (Peterson et al., 2017). This makes this research methodology immensely beneficial for neglected areas in academic studies or for regions where publication needs more focus. The area under consideration here is UK health policies and legislative measures in addressing vaccine-preventable diseases among migrants entering the UK, which is not considered by existing literature. It is also an essential exercise for identifying policy gaps and inefficiencies and, hence, serves as a base for further targeted research and policy development. The central research question guiding this scoping review's conduct is: What are the challenges and gaps in current UK policies and legislation addressing vaccine-preventable diseases among migrants in the UK?

2.2 Research question and search strategy

To ensure that this scoping review was conducted with its exploratory purpose, a framework used a Population, Context, Concept (PCC) framework that acted as a structure to organise the review. The framework was described at a high level to support a systematic examination before formulating the search strategy. The population consists of migrants, including asylum seekers and refugees who enter the UK. The context is the post-2015 UK health policy environment with significant migration flows. What is in question is research regarding the policies, laws, and regulations of vaccine-preventable diseases. The specific point of research is relative to identifying potential barriers to access and determining the effectiveness of vaccination programs targeting this population of migrants.

This search strategy was developed based on the Population, Context, and Concept (PCC) framework and carried out with an academic librarian. It has been designed with minimal inclusion and exclusion criteria for the project. These searches were used to inform the grouping and selection of search terms in line with the predefined framework. The developed search strings for this scoping review will use a search strategy and combine them using Boolean operators to ensure the comprehensive inclusion of all the variables of interest. The following is the search string for this scoping review:

1. "United Kingdom" OR “England” OR “Scotland” OR “Wales” OR “Northern Ireland” AND Migrant* OR refugee* OR “asylum seeker*” OR “undocumented migrant*” OR “migrant populations” AND “Vaccine-preventable disease*” OR “vaccine-preventable illness*” OR vaccination OR “access to vaccines” AND “health policy*" OR "health legislation" OR "public health" OR guidance

PCC Framework	Search Reference	Search Terms
Population (P)	Migrants	Migrant* OR refugee* OR “asylum seeker*” OR “undocumented migrant*” OR “migrant populations”
Concept (C)	Vaccine-preventable disease	“Vaccine-preventable disease*” OR “vaccine-preventable illness*” OR vaccination OR “access to vaccines”
Context (C)	Health Policy	health policy*" OR "health legislation" OR "public health" OR guidance

(Table 1 – Table shows search terms Utilised)

In August 2024, peer-reviewed studies were searched using LJMU Discover, Web of Science, and MEDLINE databases. These searches were focused on identifying literature that examines the intersection of UK policies and legislation with vaccine-preventable diseases among migrants entering the UK—supplementary searches of grey literature sources, including GOV.UK and Google were conducted to capture relevant guidelines, reports, and policy documents. This search aimed to provide insights into the current landscape of UK policies and legislation concerning infectious disease control methods among migrants entering the UK

2.3 Data management

All records were managed using the bibliographic software EndNote. All duplicates were manually removed, and the deduplicated records were exported to Rayyan for title and abstract screening. Following this initial screening, the full-text document was retrieved for all eligible records and accessed in a second screening process. Exclusions were made if the research did not meet the eligibility criteria.

2.4 Data analysis

 As a result of the secondary screening process and the application of the exclusion criteria, a total of (n=39) reports were retained for analysis, made up of peer-reviewed articles and grey literature. Following Levac et al. (2010), in the methodology used for thematic analysis, data charting involved systematically collecting and organising critical information in each record using an Excel spreadsheet. The spreadsheet was designed to capture various details such as the study design, sample size, population characteristics, exposure or intervention, period and frequency of the intervention, primary and secondary outcomes, key findings, and any other relevant information. Such an approach allowed for structured retrieval and organisation of all pertinent details required for further analysis. With the data charting format already established, an entire charting process covering the 39 records was completed to analyse the data thoroughly and systematically. The PRISMA flow diagram was also used to elaborate on the data analysis process by following the guidelines set out by Moher et al. (2009).

The chart depicts the way the records flow from one review stage to another review stage before finally being included in the analysis stage.

(Figure1 – PRISMA flow diagram)

2.5 Inclusion And Exclusion Criteria

The selection criteria were designed to clarify what constituted relevance and quality in the inclusion and exclusion of documents. The emphasis was on selecting documents from governmental and non-governmental sources, grey literature, and academic publications from the last 15 years. Only papers in English or those translated into English were included to ensure accessibility and comparability. The focus was on the literature on migrants, asylum seekers, or refugees, particularly concerning vaccination policies, barriers to access, or program efficacy within the post-2015 UK health policy environment. Documents were excluded if they were irrelevant to vaccine-preventable diseases or the populations of interest, targeted non-migrant populations, contained opinions without empirical evidence, or were in languages other than English without a reliable translation. Additionally, documents that did not consider relevant legislative aspects or needed to be updated regarding the post-2015 UK health policy environment were excluded. This approach ensured that the review focused on the most current, appropriate, and high-quality sources.

Chapter 3. Results

The results spreadsheet, which contains detailed data and findings from the included reports, can be found at the following link: here.

3.1 Profile

The review was conducted at a whole UK level, drawing on available data from the entire United Kingdom. The review encompasses data from England, Scotland, and Wales and studies that consider the United Kingdom as a whole. The literature review specifically consisted of 39 studies, with a significant skew towards England, as shown in Figure 2.

(Figure 2 – Map Showing Reginal Distribution of Research focus)

Most of the research focuses on England, with 19 studies originating there. In contrast, Wales and Northern Ireland seem relatively under-researched, with only 1 study originating in Wales and no specific studies from Northern Ireland identified. Scotland contributes moderately to the research base, with five studies indicating the review. The uneven distribution of research is further underscored by the 15 documents that take the whole UK approach, as these still reflect an English-centric perspective. England's prominence in the literature likely signals the presence of a large proportion of the population, resources, academic institutions, and the concentration of government within this region. However, this situation also raises some long-standing concerns about the coverage and comprehensiveness of the knowledge base relating to the unique contexts of Wales and Northern Ireland. Figure 2 shows just how little research has been done outside of England. This is a severe oversight that future researchers must remedy to achieve a balanced and representative understanding of the UK.

3.2 Study methods

This review examined 39 documents, including 27 research studies and 12 policy documents. The research methods of these studies varied, with qualitative studies being the most prevalent, making up eight studies (20.51%) in the review. Retrospective cohort studies comprised four studies (10.25%), and mixed methods research was utilised in Three studies (7.69%) included in the review. Community-Based Participatory Research and cross-sectional studies appeared in Three studies (7.69%), reflecting an interest in collaborative and snapshot data collection approaches. Intervention studies were present in Two studies (5.12%), focusing on evaluating the effectiveness of specific programs or treatments. Review studies, totaling three (7.69%), synthesised existing literature to provide overviews of current knowledge and identify research gaps. The sample included a retrospective observational study (2.56%), which analysed existing data without intervention. The 12 policy documents (30.76%) provided the broader context, detailing the regulatory, institutional, and policy frameworks that shape the health environment. This analysis strongly emphasises qualitative research, complemented by various other methodologies. Including policy and Guidance documents ensures the research is grounded in the broader context, offering a well-rounded understanding of the subject matter.

3.2  Barriers to Vaccination

Language and Communication Barriers: Language barriers emerged as a significant impediment to vaccination uptake among migrant populations. For example, Polish and Romanian communities struggled with accessing accurate vaccination information in their native languages, complicating their navigation of the English healthcare system and contributing to the lower acceptance of vaccines, particularly for the influenza vaccine (Bell et al., 2019). Refugee populations faced similar challenges, with language barriers compounded by reduced face-to-face consultations during the COVID-19 pandemic, which further limited access to vaccination services (Angawi, 2023). Guidance from the Language interpreting and translation section of the migrant health guide underscores the importance of overcoming these barriers by recommending professional interpreting and translation services rather than relying on informal interpreters like family members (Public Health England, 2021).

Cultural Beliefs and Healthcare Mistrust: Mistrust in healthcare systems, often rooted in negative past experiences, was identified as a recurring barrier to vaccination among migrant communities. Romanian communities, for instance, exhibited significant distrust in healthcare services, which directly led to an active decline in vaccination uptake (Bell et al., 2020). Similarly, Polish parents in Edinburgh expressed concerns regarding vaccine safety. They perceived impersonal care within the UK healthcare system, leading to lower uptake of vaccines such as influenza and HPV vaccines among Polish and Eastern European girls (Bielecki et al., 2020) (Bielecki et al., 2019). Guidance from the Assessing New Patients from Overseas section of the migrant health guide outlines the use of trauma-informed practice. It highlights the importance of addressing such mistrust through culturally sensitive and trauma-aware care, essential for building trust and improving healthcare engagement among migrant populations (UKHSA, 2014a).

Structural and Access Barriers: Structural barriers, including difficulties in registering with general practices and inadequate access to primary care, were prevalent among migrant populations (Crawshaw et al., 2024a). Refugees faced substantial obstacles, such as fear of deportation and restricted healthcare access, which were exacerbated during the pandemic (Burns et al., 2024). These challenges were reflected in the significantly lower vaccination coverage among asylum-seeking children compared to local populations, with notable disparities in vaccination rates for measles and tetanus (Perry et al., 2019). The NHS entitlements section of the migrant health guide emphasises the need for healthcare practitioners to provide clear explanations about the NHS, migrants' entitlements, and how to access healthcare services, aiming to reduce these structural barriers and improve access to care (Public Health England, 2014).

3.3  Facilitators and Strategies for Enhancing Vaccination Uptake

Tailored Communication and Community Engagement: Culturally tailored communication strategies and community engagement initiatives effectively improved vaccination uptake among migrant populations. For instance, community codesign and targeted outreach efforts in Southwest England significantly increased COVID-19 vaccine uptake among high-risk and hard-to-reach populations (Berrou et al., 2022). Similarly, participatory approaches in developing interventions for Congolese migrants ensured that the solutions were culturally relevant and responsive to the community's specific needs (Crawshaw et al., 2023a). The NHS entitlement section of the migrant health guide reinforces this approach, recommending that healthcare providers invest time in explaining how the NHS works and the particular entitlements of migrants, thus fostering better engagement and trust (Public Health England, 2014).

Trust-Building and Educational Interventions: Establishing trust between healthcare providers and migrant communities was identified as a crucial factor in overcoming vaccine hesitancy. In Romanian and Roma Romanian communities, building trust was vital to mitigating the negative impact of healthcare mistrust on vaccination uptake (Bell et al., 2020). The dissemination of updated health literature in native languages, as observed among Polish parents, led to improved vaccine uptake and underscored the importance of precise, accessible educational interventions (Gorman et al., 2020). Guidance from the Assessing New Patients from Overseas section of the migrant health guide outlines how trauma-informed practice further supports the need for trust-building by encouraging healthcare professionals to recognise the impact of trauma on migrants' ability to trust healthcare providers and engage with services (UKHSA, 2014a).

3.4 Disparities in Vaccination Coverage

Ethnic and Migrant Group Disparities: Significant disparities in vaccination coverage were observed among different ethnic and migrant groups. For instance, vaccination uptake among Polish pupils (25.0%) was markedly lower than that of White British pupils (70.7%), with a much higher decline rate among Polish families (36.8%) (Bielecki et al., 2019). Similarly, HPV vaccine uptake among Polish and Eastern European girls in Scotland was significantly lower than among their UK counterparts, highlighting the need for targeted interventions to address these disparities (Pollock et al., 2019). The Assessing new patients from the Overseas section of the migrant health guide acknowledges these disparities, emphasising the importance of tailored healthcare assessments that consider ethnic and migrant group-specific health risks, such as the higher prevalence of chronic conditions like diabetes and cardiovascular disease in specific populations (UKHSA, 2014a).

Socioeconomic Determinants and Living Conditions: Socioeconomic factors, including social deprivation and homelessness, were strongly associated with lower vaccination rates. Migrants and asylum seekers living in crowded or inadequate conditions were found to be at higher risk of under-immunisation, as illustrated by studies on latent tuberculosis infection (LTBI), where overcrowded living conditions were identified as a significant risk factor (Lule et al., 2020). The diphtheria outbreak among asylum seekers further highlighted the vulnerability of these populations, exacerbated by poor living conditions and limited access to healthcare services (Ryan et al., 2023). Guidance from the Assessing New Patients from Overseas section of the migrant health guide suggests that healthcare providers consider these socioeconomic factors during patient assessments and offer support through referrals to appropriate social and housing services to mitigate these risks (UKHSA, 2014a).

3.5 Recommendations for Policy and Practice

The table below summarises the key strategies and recommendations identified in the review for improving vaccination coverage and healthcare outcomes among migrant populations. It highlights the integration of vaccination programs with broader healthcare services, the implementation of systematic screening and vaccination initiatives, and the importance of collaborative public health interventions. As recommended in various studies and policy documents, these approaches are essential for addressing gaps in vaccination coverage, ensuring comprehensive care, and reducing health disparities among vulnerable migrant groups.

(Table 2 - The table below summarises the key strategies and recommendations identified in the review for improving vaccination coverage and healthcare outcomes among migrant populations)

Chapter 4. Discussion

This review emphasises the need for thorough research and context-specific public health strategies. The existing literature base focuses heavily on England, possibly due to the country's concentration of resources and academic institutions. This English-centric view may, however, overlook the unique challenges migrants face in Wales and Northern Ireland, where there is a specific lack of research. The lack of representation of these regions in the literature highlights quite an urgent need for comprehensive research to ensure equitable public health strategies across the UK. The absence of relevant research may lead to unmet healthcare needs and inconsistent healthcare provision for migrants in these areas, exacerbating health disparities. 

Language and communication barriers are crucial in limiting migrant populations' access to vaccination and healthcare services, with significant implications for public health (Abba-Aji et al., 2022). The review highlights the challenges faced by migrants, especially those from Polish and Romanian communities, in navigating an English-dominated healthcare system (Bell et al., 2020). These barriers are not just logistical but are closely linked to a migrant's ability to understand healthcare instructions, make informed decisions, and fully engage with the NHS (NHS England, 2023). The COVID-19 pandemic further exacerbated these challenges as the shift to remote consultations left many migrants without the necessary support to access vaccination services (Knights et al., 2021). During this crisis, vulnerabilities within migrant communities were revealed, where the combined impact of language barriers and reduced face-to-face healthcare interactions likely contributed to the observed disparities in vaccination rates (Mudyarabikwa et al., 2021). The assessment suggests that healthcare practices should incorporate professional interpreting services as a public health necessity, as instances of the use of informal interpreters lead to poor health outcomes in migrant populations. Professional interpreting services can and should be used to ensure that migrant populations receive accurate information and that the right decisions regarding their health are made and upheld (Public Health England, 2021). Addressing these language barriers is essential for improving individual health outcomes and maintaining public health by ensuring high vaccination coverage across all population groups.

Cultural beliefs and healthcare mistrust are significant factors contributing to vaccine hesitancy within migrant communities. This review highlights that mistrust in the healthcare system, often stemming from negative experiences in migrants' home countries, significantly hinders their engagement with health services in the UK (Hussain et al., 2022). For example, the Romanian and Roma communities exhibit considerable distrust towards the healthcare system, influenced by their experiences with corrupt or inadequate medical practices in their home countries (Bell et al., 2020). This mistrust is compounded by the perception that UK healthcare professionals do not fully understand or respect their cultural needs, leading to disengagement and lower vaccine uptake (Moore et al., 2024). Similarly, Polish parents in the UK have expressed concerns about vaccine safety, influenced by misinformation and a perceived lack of culturally sensitive care within the NHS (Bielecki et al., 2020). Addressing these issues requires a nuanced approach, with trauma-informed care emerging as a crucial strategy for building trust and encouraging vaccine uptake among migrant communities (Beeston, 2022). Healthcare providers can create a more supportive environment conducive to the greater acceptance of health interventions by recognising and addressing the factors contributing to mistrust in healthcare, including historical and cultural nuances. This strategy is essential when it comes to improving migrant health outcomes, as they might be coming from a range of experiences that have caused them to be distrustful of the healthcare system. (Nair and Adetayo, 2020).

Migrant populations face a multitude of added problems that make it difficult for them to receive vaccinations and access critical health services. Migrants often struggle to gain the primary healthcare access most people take for granted. Even when successfully registering with a general practitioner, they frequently encounter other structural barriers that make accessing vital primary care difficult (Burns et al., 2022b). Registering with a general practice is often the first step in accessing the UK's healthcare system. Still, many migrants face obstacles such as needing proof of address, language barriers, and a lack of understanding of the NHS registration process (Worthing et al., 2022). These challenges are worsened by administrative burdens and fears of engaging with government services (Goldberg, 2023). The COVID-19 pandemic worsened these challenges, as the shift to online registration and telehealth consultations created more obstacles for migrants, many of whom lacked access to technology or struggled to understand the new procedures (Knights et al., 2021a). This led to a significant drop in vaccine uptake among migrant communities during the pandemic, illustrating the urgent need for more accessible and migrant-friendly healthcare services.

In the United Kingdom, vaccination rates among migrant populations are rising, thanks to the detailed work of public health officials and healthcare providers. This rise can be attributed to constructed tailored communication strategies used when engaging with migrant communities about vaccination. These strategies consider the varied cultures of the communities involved and have resulted in successful engagement and increased vaccine uptake (Ekesie et al., 2023). tailored strategies recognise the importance of cultural context and aim to bridge the gap between healthcare providers and migrant communities, resulting in better engagement and trust. In Southwest England, community engagement initiatives using culturally accurate messaging while involving local leaders significantly increased COVID-19 vaccination rates among high-risk and hard-to-reach migrant populations (Burns et al., 2022a). Interventions such as this highlight the importance of using trusted community figures to convey health messages and help overcome skepticism and misinformation around vaccinations.

Similarly, targeted outreach efforts in the Congolese migrant community also showed the effectiveness of tailored communication. Healthcare providers worked closely with community members and leaders to design interventions that were easy to understand and aligned with the Congolese community's cultural norms and values. This approach ensured that the health messages were considered relevant and trustworthy, leading to higher engagement and acceptance of vaccinations (Crawshaw et al., 2023a). Community codesign plays a crucial role in these initiatives by involving community members in planning and implementing health interventions. This ensures their voices are heard, and their needs are met (Crawshaw et al., 2023b). Community leaders and members play a vital role in successful communication strategies for health interventions. Involving them in designing and delivering health messages allows them to serve as cultural interpreters, helping ensure that health messaging targeted in their communities is appropriately shared (Heward-Mills et al., 2018).

The review highlights significant differences in vaccination coverage among various ethnic and migrant groups in the United Kingdom, showing the need for a more proactive approach to vaccination among migrant communities. Ethnic minority and migrant populations face unique healthcare challenges that can lead to lower vaccination rates when compared to the general population of the UK. Research has found that Polish pupils in the UK have lower vaccination rates than their White British counterparts, with only 25% of Polish pupils being vaccinated. In comparison, 70.7% of White British pupils reported being wholly aligned with the UK's immunisation schedule (Gorman et al., 2020). The study identifies differences in cultural resistance, language barriers, and misinformation within the Polish community, leading to lower uptake rates. Similarly, Eastern European girls in Scotland have lower uptake rates for the HPV vaccine, which prevents cervical cancer (Pollock et al., 2019).

Cultural beliefs about immunisation impact young women from migrant and ethnic communities. They often find it difficult to access a healthcare system that they deem not capable or accessible to serve their unique healthcare needs and concerns. The study showed that interventions are needed to bridge this deficit and meet the needs of these young women in their communities at their points of access. Targeted health education programs, culturally sensitive translated materials, and providing interpreters equipped with the necessary skill sets for effective communication available at the time and place where it is needed all showed a significant impact in raising HPV vaccination among this group. It was noted that building trust in the community was a driving factor in improving the immunisation rates of the young women in these communities (Deal et al., 2023). Interventions such as these should be developed in collaboration with the communities they aim to serve, ensuring they are effective, respectful of cultural differences, and responsive to each group's specific challenges.

Socioeconomic factors, such as social deprivation and homelessness, have both been shown to have a significant impact on vaccination coverage among migrant populations in the United Kingdom, contributing to health disparities seen in the section of the UK's migrant population. These factors create barriers to accessing healthcare services, making first contact with the NHS, and registering with a GP, which has further implications for accessing vaccinations essential for preventing vaccine-preventable disease outbreaks among an extremely high-risk section of the migrant community (Sacre et al., 2023). The social deprivation that many migrants experience manifests in their lives by bringing challenges in acquiring adequate living conditions, insecurity of food, and a lack of sustainable housing, all of which place them at higher risk of being under-vaccinated (Rabie et al., 2023). Poverty, poor accessibility to reliable healthcare, and unstable living situations create a perfect storm in which individuals are all the more likely to contract infectious diseases (Mallorie, 2024). The diphtheria outbreak among asylum seekers in the UK provides a microcosm of how socioeconomic determinants and living conditions can directly impact the health of migrants. This outbreak occurred in overcrowded asylum seeker accommodations, where the combination of poor sanitation, limited access to healthcare, and the stress of displacement created an environment ripe for the spread of disease (Ryan et al., 2023). Asylum seekers, who often live in conditions of extreme poverty and social isolation, face significant barriers to accessing vaccinations, including logistical challenges, language barriers, and mistrust of healthcare providers (Khanom et al., 2021a). The outbreak highlighted the critical need for targeted public health interventions that address the specific needs of socially deprived populations, particularly those living in high-density, unstable housing situations. It also underscored the broader public health risks posed by inadequate vaccination coverage in marginalised communities, as outbreaks in these populations can quickly spread to the wider public (O’Boyle et al., 2023). Addressing the social determinants of health is essential for improving vaccination coverage among these vulnerable populations.

Integrating vaccination programs with broader healthcare services offers many benefits to migrant communities by significantly improving access to care and overall health outcomes for migrant populations (NHS England, 2023b). This approach combines vaccination with routine healthcare services, such as general health screenings, chronic disease management, and preventive care. By embedding vaccination within the broader context of healthcare delivery, these programs can reach more individuals, especially those who might not otherwise seek out vaccination services on their own (NHS, 2023a). Adapting to a more holistic approach has been shown to increase vaccination coverage. It ensures that individuals receive comprehensive care that addresses multiple health needs simultaneously, leading to better long-term health outcomes and creating a more efficient health service that can deal with the UK's ever-growing population. For instance, one recommendation involves combining vaccination campaigns with routine health screenings, such as tuberculosis (TB) testing or diabetes management, in community health settings (Lule et al., 2020). By offering these services together, healthcare providers can maximise the use of each patient interaction, ensuring that individuals receive preventive vaccinations and necessary medical care in one visit. This model has been particularly effective in reaching underserved populations who may face barriers to accessing healthcare. The integration of services helps to streamline care, reduce missed opportunities for vaccination, and ensure that patients have access to essential health services they might otherwise miss (NHS England, 2017). Vaccination as a component of a more comprehensive health service delivery can significantly impact the public; vaccinations help underscore the importance of engaging with the healthcare system. For many migrant populations whose lives may have been affected by trauma, chronic conditions, or long-standing barriers to healthcare, integrated programs can provide a seamless and supportive entry into the healthcare system with a more direct pathway to improved health.

The complex healthcare needs of migrant populations require a collaborative approach involving multiple agencies to address the root cause of infectious disease susceptibility fully. Collaboration is crucial for addressing challenges such as language barriers, cultural differences, socioeconomic disadvantages, and limited access to healthcare. By leveraging the expertise and resources of various stakeholders, more effective interventions can be created to meet the specific needs of migrant communities (Alderwick et al., 2021). This approach improves health outcomes and creates a more inclusive healthcare environment for migrants. A successful example of multiagency collaboration is the diphtheria vaccination campaign for asylum seekers in the UK. Healthcare providers, local authorities, and community organisations worked together to organise and implement a targeted vaccination campaign in response to a diphtheria outbreak in overcrowded asylum-seeker accommodations (UKHSA, 2024). This effort involved administering vaccines, providing educational materials in multiple languages, addressing cultural concerns, and effectively managing logistical aspects such as transportation and access to vaccination sites (Knights et al., 2022). The success of this campaign demonstrates the power of coordinated, multiagency efforts in responding to public health crises and protecting vulnerable populations from preventable diseases. Enhancing collaboration between healthcare providers, social services, and community organisations is critical to replicating and expanding the success of such interventions.

Collaboration can be improved by establishing formal partnerships and lines of communication among different organisations. Frequent joint meetings, training sessions, and data-sharing platforms guide the practice of inclusive service delivery to and coordination with migrant populations. For instance, social services and healthcare providers can forge tight collaborations to identify migrants at risk of slipping under the radar of healthcare services, such as people experiencing homelessness or housing instability. This information and resource sharing also allows these agencies to coordinate efforts and provide a comprehensive care package that looks after both the medical and social needs of the Migrant. (Namata & Hatsidimitriadou, 2023). Another essential strategy is to involve community organisations in designing and implementing public health interventions. These organisations often have strong connections within migrant communities and can provide valuable insights into their needs and challenges (Haldane et al., 2019). Working with community organisations helps healthcare providers and social services develop interventions that are more culturally sensitive and accessible to migrants, and organisations can also play a critical role in outreach and education.

4.1 Strengths and limitations

This literature review comprehensively analyses healthcare access and vaccination among migrant populations across the UK, highlighting several strengths and limitations. The broad scope, incorporating studies from England, Scotland, and Wales, allows for an inclusive understanding of the challenges faced by migrants. At the same time, the diverse methodological approaches, with particular emphasis on qualitative research, provide deep insights into the complex social, cultural, and structural barriers to vaccination. However, the review is limited by a significant regional imbalance, with a heavy focus on England and insufficient representation from Wales and Northern Ireland, potentially limiting the generalisability of the findings. While valuable, reliance on qualitative data restricts the ability to draw broad, statistically significant conclusions, and the lack of longitudinal studies hinders the evaluation of the long-term impact of public health interventions. The review's focus on broad migrant categories may overlook certain subgroups' specific challenges, such as undocumented migrants. Despite these limitations, the evaluation effectively identifies gaps in current research. It provides actionable recommendations, emphasising the need for trauma-informed care, expanded language services, and integrated healthcare approaches to improve health outcomes for migrants across the UK.

4.2 Conclusion

The ever-present threat of vaccine-preventable diseases among vulnerable migrant populations highlights the critical need for more comprehensive and inclusive public health strategies in the UK. The existing literature highlights significant gaps in research and practice concerning the unique challenges faced by migrants in accessing vaccination and healthcare services. Still, regional imbalance in research, with a predominant focus on England, indicates a need for more comprehensive studies encompassing Wales and Northern Ireland to ensure equitable healthcare across the UK. Language barriers, cultural mistrust, and socioeconomic factors have been identified as significant obstacles to vaccination uptake among migrants. Addressing these challenges requires a multifaceted approach that includes the implementation of professional interpreting services, the adaption of culturally sensitive care, and enhancing targeted public health interventions along with integrating vaccination programs with broader healthcare services, which has shown to be effective in improving access and outcomes, particularly when combined with community engagement and trust-building efforts. The review also highlights the importance of multiagency collaboration in addressing the complex healthcare needs of migrants.

5. Ethics approval and consent to participate

 “Not applicable”

6. Consent for publication

“Not applicable”

7. Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author upon reasonable request.

8. Competing interests

None Declared

9. Funding

“Not applicable”

11. References

Abba-Aji, M., Stuckler, D., Galea, S. and McKee, M., (2022) Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators. Journal of Migration and Health, 5, p.100086.

Abbas, M., Aloudat, T., Bartolomei, J., Carballo, M., Durieux-Paillard, S., Gabus, L., Jablonka, A., Jackson, Y., Kaojaroen, K., Koch, D., Martines, E., Mendelson, M., Petrova-Benedict, R., Tsiodras, S., Christie, D., Saam, M., Hargreaves, S. and Pittet, D., (2018) Migrant and refugee populations: a public health and policy perspective on a continuing global crisis. Antimicrobial Resistance & Infection Control, [online] 71. Available at: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-018-0403-4.

Adriano Focus Lubanga, Akim Nelson Bwanali, Kangoma, M., Matola, Y., Moyo, C., Byenala Kaonga, Ssebibubbu, S., Tumaini John Makole, Kambili, F., Gertrude Diana Chumbi, Munthali, L., Atupele Mwale, Kaphesi, F., Simfukwe, R., Msati Mphepo, Thandiso Kapatsa, Gracian Harawa and Mpinganjira, S.L., (2024) Addressing the re-emergence and resurgence of vaccine-preventable diseases in Africa: A health equity perspective. Human Vaccines & Immunotherapeutics, [online] 201. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238914/ [Accessed 11 Aug. 2024].

Alderwick, H., Hutchings, A., Briggs, A. and Mays, N., (2021) The Impacts of Collaboration between Local Health Care and non-health Care Organisations and Factors Shaping How They Work: a Systematic Review of Reviews. BMC Public Health, [online] 211, pp.1–16. Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10630-1.

Aleshia Louise Borley, (2023) A reflection on the NHS, health security, and refugees. Journal of global faultlines, 101.

Angawi, K., (2023) Immigrants, health, and the impact of COVID-19: A narrative review. F1000Research, [online] 12, pp.176–176. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10665605/.

Beeston, A., (2022) How to increase vaccination uptake among migrant communities. [online] NIHR Evidence. Available at: https://evidence.nihr.ac.uk/alert/how-to-increase-vaccination-uptake-migrant-communities/.

Bell, S., Edelstein, M., Satoński, M., Ramsay, M. and Mounier-Jack, S., (2019) ‘I don’t think anybody explained to me how it works’: a qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England. BMJ Open, 97, p.e028228.

Bell, S., Saliba, V., Ramsay, M. and Mounier-Jack, S., (2020) What have we learnt from measles outbreaks in 3 English cities? A qualitative exploration of factors influencing vaccination uptake in Romanian and Roma Romanian communities. BMC Public Health, [online] 201. Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8454-x.

Berrou, I., Hamilton, K., Cook, C., Armour, C., Hughes, S., Hancock, J., Quigg, S., Hajinur, H., Srivastava, S., Kenward, C., Ali, A., Hobbs, L., Milani, E. and Walsh, N., (2022) Leaving No One Behind: Interventions and Outcomes of the COVID-19 Vaccine Maximising Uptake Programme. Vaccines, 106, p.840.

Bielecki, K., Craig, J., Willocks, L.J., Pollock, K.G. and Gorman, D.R., (2020) Impact of an influenza information pamphlet on vaccination uptake among Polish pupils in Edinburgh, Scotland and the role of social media in parental decision making. BMC Public Health, 201.

Bielecki, K., Kirolos, A., Willocks, L.J., Pollock, K.G. and Gorman, D.R., (2019) Low uptake of nasal influenza vaccine in Polish and other ethnic minority children in Edinburgh, Scotland. Vaccine, 375, pp.693–697.

British Medical Association, (2022) Health and human rights in the new world (dis)order. [online] Available at: https://www.bma.org.uk/media/5491/20220104-bmas-human-rights-report-v4-compressed.pdf.

Burns, R., Campos-Matos, I., Harron, K. and Aldridge, R.W., (2022a) COVID-19 vaccination uptake for half a million non-EU migrants and refugees in England: a linked retrospective population-based cohort study. The Lancet, 400, p.S5.

Burns, R., Stevenson, K., Miller, A. and Hargreaves, S., (2022b) Migrant-inclusive healthcare delivery in the UK: Lessons learned from the COVID-19 Pandemic. The Lancet Regional Health - Europe, 21, p.100505.

Burns, R., Wyke, S., Eyre, M.T., Yamina Boukari, Sørensen, T.B., Tsang, C., Campbell, C.N.J., Beale, S., Senner, D., Hargreaves, S., Campos-Matos, I., Harron, K. and Aldridge, R.W., (2024) Author Correction: COVID-19 vaccination coverage for half a million non-EU migrants and refugees in England. Nature Human Behaviour.

Carter, J., Mehrotra, A., Knights, F., Deal, A., Crawshaw, A.F., Farah, Y., Goldsmith, L.P., Wurie, F., Ciftci, Y., Majeed, A. and Hargreaves, S., (2022) ‘We don’t routinely check vaccination background in adults’: a national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care. BMJ Open, 1210, p.e062894.

Colquhoun, H.L., Levac, D., O’Brien, K.K., Straus, S., Tricco, A.C., Perrier, L., Kastner, M. and Moher, D., (2014) Scoping reviews: time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology, [online] 6712, pp.1291–1294. Available at: https://www.sciencedirect.com/science/article/pii/S0895435614002108.

Crawshaw, A.F., Goldsmith, L.P., Deal, A., Carter, J., Knights, F., Seedat, F., Lau, K., Hayward, S.E., Yong, J., Fyle, D., Aspray, N., Iwami, M., Yusuf Ciftci, Wurie, F., Majeed, A., Forster, A.S. and Hargreaves, S., (2024a) Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study. BMC medicine, 221.

Crawshaw, A.F., Hickey, C., Lutumba, L.M., Kitoko, L.M., Nkembi, S., Knights, F., Ciftci, Y., Goldsmith, L.P., Vandrevala, T., Forster, A.S. and Hargreaves, S., (2023a) Codesigning an intervention to strengthen COVID-19 vaccine uptake in Congolese migrants in the UK (LISOLO MALAMU): a participatory qualitative study protocol. BMJ open, [online] 131, p.e063462. Available at: https://pubmed.ncbi.nlm.nih.gov/36639215/ [Accessed 13 Feb. 2023].

Crawshaw, A.F., Lusau Mimi Kitoko, Nkembi, S., Laura Musinga Lutumba, Hickey, C., Deal, A., Carter, J., Knights, F., Tushna Vandrevala, Forster, A.S. and Hargreaves, S., (2023b) Codesigning a theory‐informed, multicomponent intervention to increase vaccine uptake with Congolese migrants: A qualitative, community‐based participatory research study (LISOLO MALAMU). Health Expectations.

Crawshaw, A.F., Tushna Vandrevala, Knights, F., Deal, A., Laura Musinga Lutumba, Nkembi, S., Lusau Mimi Kitoko, Hickey, C., Forster, A.S. and Hargreaves, S., (2024b) Navigating vaccination choices: The intersecting dynamics of institutional trust, belonging and message perception among Congolese migrants in London, UK (a reflexive thematic analysis). PLOS Global Public Health, 47, pp.e0002620–e0002620.

Deal, A., Crawshaw, A.F., Carter, J., Knights, F., Iwami, M., Darwish, M., Hossain, R., Immordino, P., Kanokporn Kaojaroen, Santino Severoni and Hargreaves, S., (2023) Defining drivers of under-immunisation and vaccine hesitancy in refugee and migrant populations to support strategies to strengthen uptake of COVID-19 vaccines: a rapid review. Journal of Travel Medicine, 305.

Deal, A., Crawshaw, A.F., Salloum, M., Hayward, S.E., Carter, J., Knights, F., Seedat, F., Oumnia Bouaddi, Nuria Sanches-Clemente, Laura Musinga Lutumba, Lusau Mimi Kitoko, Nkembi, S., Hickey, C., Mounier-Jack, S., Majeed, A. and Hargreaves, S., (2024) Understanding the views of adult migrants around catch-up vaccination for missed routine immunisations to define strategies to improve coverage: A UK in-depth interview study. Vaccine.

Deal, A., Hayward, S.E., Crawshaw, A.F., Goldsmith, L.P., Hui, C., Dalal, W., Wurie, F., Bautista, M.-A., Lebanan, M.A., Agan, S., Hassan, F.A., Wickramage, K., Campos-Matos, I. and Hargreaves, S., (2022) Immunisation status of UK-bound refugees between January, 2018, and October, 2019: a retrospective, population-based cross-sectional study. The Lancet Public Health, [online] 77, pp.e606–e615. Available at: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00089-5/fulltext.

Doctors Of The World, (2022) The medical consequences of the new ‘Illegal Migration Bill’. [online] Available at: https://www.doctorsoftheworld.org.uk/wp-content/uploads/2023/04/Illegal-Immigration-Bill-Briefing_FINAL.pdf.

Ekesie, W., Connor, A., Gibson, E.L., Kamlesh Khunti and Kamal, A., (2023) A Systematic Review of Behaviour Change Techniques within Interventions to Increase Vaccine Uptake among Ethnic Minority Populations. Vaccines, 117, pp.1259–1259.

Fong, W.L.E., Nguyen, V.G., Burns, R., Boukari, Y., Beale, S., Braithwaite, I., Byrne, T.E., Geismar, C., Fragassy, E., Hoskins, S., Kovar, J., Navaratnam, A.M., Oskrochi, Y., Patel, P., Tweed, S., Yavlinsky, A., Hayward, A.C. and Aldridge, R.W., (2024) The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study. Journal of Migration and Health, [online] p.100218. Available at: https://www.sciencedirect.com/science/article/pii/S2666623524000084?utm_campaign=STMJ_219742_AUTH_SERV_PA&utm_medium=email&utm_acid=223712674&SIS_ID=&dgcid=STMJ_219742_AUTH_SERV_PA&CMX_ID=&utm_in=DM452632&utm_source=AC_ [Accessed 29 Feb. 2024].

Goldberg, E., (2023) Is Immigration Harming the NHS? | NHS Confederation. [online] www.nhsconfed.org. Available at: https://www.nhsconfed.org/articles/immigration-harming-nhs.

Gorman, D.R., Bielecki, K., Larson, H.J., Willocks, L.J., Craig, J. and Pollock, K.G., (2020) Comparing vaccination hesitancy in Polish migrant parents who accept or refuse nasal flu vaccination for their children. Vaccine.

Gorman, D.R., Bielecki, K., Willocks, L.J. and Pollock, K.G., (2019) A qualitative study of vaccination behaviour amongst female Polish migrants in Edinburgh, Scotland. Vaccine, 3720, pp.2741–2747.

Haldane, V., Chuah, F.L.H., Srivastava, A., Singh, S.R., Koh, G.C.H., Seng, C.K. and Legido-Quigley, H., (2019) Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PLoS One, [online] 145. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510456/.

Heward-Mills, N.L., Atuhaire, C., Spoors, C., Pemunta, N.V., Priebe, G. and Cumber, S.N., (2018) The role of faith leaders in influencing health behaviour: a qualitative exploration on the views of Black African Christians in Leeds, United Kingdom. The Pan African Medical Journal, [online] 30199. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294965/.

Hussain, B., Latif, A., Timmons, S., Nkhoma, K. and Nellums, L.B., (2022) Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies. Vaccine, 4025.

Khaled, I., R. Cauda, Takac, B., K. Buriancova, S. Putekova, J. Martinkova, M. Komlosi, P. Ondova, M. Jackulikova, H. Svobodova, J. Kafkova, S. Nevolna, M. Bibsa, M. Kolibaba, G. Mikolasova, K. Sollerova, A. Murgova, L. Tkacova, M. Jankechova and M. Popelova, (2016) Screen or not to screen? 7 questions in prevention of infection from refugees and migrants. Clinical social work journal, 73, pp.16–18.

Khanom, A., Alanasy, W., Cousens, L., Evans, B.A., Fagan, L., Fogarty, R., John, A., Khan, T., Kingston, M.R., Moyo, S., Porter, A., Rhydderch, M., Richardson, G., Rungua, G., Russell, I. and Snooks, H., (2021) Asylum seekers’ and refugees’ experiences of accessing health care: a qualitative study. BJGP Open, [online] 56. Available at: https://bjgpopen.org/content/early/2021/10/11/BJGPO.2021.0059.

Knights, F., Carter, J., Deal, A., Crawshaw, A.F., Hayward, S.E., Jones, L. and Hargreaves, S., (2021) Impact of COVID-19 on migrants’ access to primary care and implications for vaccine roll-out: a national qualitative study. British Journal of General Practice, 71709, p.BJGP.2021.0028.

Knights, F., Munir, S., Ahmed, H. and Hargreaves, S., (2022) Initial health assessments for newly arrived migrants, refugees, and asylum seekers. BMJ, [online] 377377, p.e068821. Available at: https://www.bmj.com/content/377/bmj-2021-068821.

Laurenson-Schafer, H., Spence, J., Watson, M. and Louise Kifer Myers, (2022) 1287 Improving care for refugees at a ‘Bridging Hotel’.

Levac, D., Colquhoun, H. and O’Brien, K.K., (2010) Scoping studies: Advancing the Methodology. Implementation Science, 51, pp.1–9.

Lule, S.A., Gupta, R.K., Krutikov, M., Jackson, C., Southern, J. and Abubakar, I., (2020) The relationship between social risk factors and latent tuberculosis infection among individuals residing in England: a cross-sectional study. BMJ Global Health, [online] 512, p.e003550. Available at: https://gh.bmj.com/content/5/12/e003550.

Mallorie, S., (2024) The Relationship Between Poverty And NHS Services. [online] The King’s Fund. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/relationship-poverty-nhs-services.

Martines, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Diegues, A., Pinto, R., Rhodes, S., Moya, E. and Chaves-Baray, S., (2013) Evaluating the Impact of Immigration Policies on Health Status among Undocumented Immigrants: a Systematic Review. Journal of Immigrant and Minority Health, [online] 173, pp.947–970. Available at: https://link.springer.com/article/10.1007/s10903-013-9968-4.

Miles, S., Renedo, A., Kühlbrandt, C., McGowan, C., Stuart, R., Grenfell, P. and Marston, C., (2023) Health risks at work mean risks at home: Spatial aspects of COVID‐19 among migrant workers in precarious jobs in England. Sociology of Health and Illness.

Moher, D., Liberati, A., Tetslaff, J. and Altman, D.G., (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLoS Medicine, 67.

Moore, S., Amendah, E.R., Clamp, C., Carter, N., Burns, C. and Martin, W., (2024) Understanding vaccine hesitancy in US and UK frontline workers – The role of economic risk. Safety science, 170, pp.106350–106350.

Mudyarabikwa, O., Regmi, K., Ouillon, S. and Simmonds, R., (2021) Refugee and Immigrant Community Health Champions: a Qualitative Study of Perceived Barriers to Service Access and Utilisation of the National Health Service (NHS) in the West Midlands, UK. Journal of Immigrant and Minority Health, 241.

Nair, L. and Adetayo, O.A., (2020) Cultural Competence and Ethnic Diversity in Healthcare. Plastic and Reconstructive Surgery - Global Open, [online] 75. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571328/.

Namata, C. and Hatsidimitriadou, E., (2023) Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study. Primary Health Care Research & Development, 24.

Nanakali, S.S., Hassan, O., Silva, L., Amani Al-Oraibi, Chaloner, J., Mayuri Gogoi, Qureshi, I., Pankhuri Sahare, Manish Pareek, Chattopadhyay, K. and Nellums, L.B., (2023) Migrants’ living conditions, perceived health needs and implications for the use of antibiotics and antimicrobial resistance in the United Kingdom: A qualitative study. Health science reports, [online] 610. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10599099.

NHS England, (2017) Involving People in Their Own Health and Care. [online] NHS England. NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-involving-people-health-care-guidance.pdf.

NHS England, (2023a) NHS England» A national framework for NHS – action on inclusion health. [online] www.england.nhs.uk. Available at: https://www.england.nhs.uk/long-read/a-national-framework-for-nhs-action-on-inclusion-health/.

NHS England, (2023b) Publication reference: PR00339 Classification: Official Shaping the future delivery of NHS vaccination services. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2023/12/PRN00339-nhs-vaccination-strategy.pdf.

NHS, (2023) NHS England» NHS vaccination strategy. [online] www.england.nhs.uk. Available at: https://www.england.nhs.uk/long-read/nhs-vaccination-strategy/.

Nuray Yasemin Osturk, Syeda Sakia Hossain, Mackey, M., Adam, S. and Brennan, P., (2024) HPV and Cervical Cancer Awareness and Screening Practices among Migrant Women: A Narrative Review. Healthcare, 127, pp.709–709.

O’Boyle, S., Barton, H.E., D’Aeth, J.C., Cordery, R., Fry, N.K., Litt, D., Southgate, R., Verrecchia, R., Mannes, T., Wang, T.Y., Stewart, D.E., Olufon, O., Dickinson, M., Ramsay, M.E. and Amirthalingam, G., (2023) National public health response to an outbreak of toxigenic Corynebacterium diphtheriae among asylum seekers in England, 2022: a descriptive epidemiological study. The Lancet Public Health, [online] 810, pp.e766–e775. Available at: https://www.sciencedirect.com/science/article/pii/S2468266723001755?via%3Dihub.

Office For Health improvement & Disparities, (2022) Afghan refugees and newly displaced populations: overview and principles. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/individual-health-assessments-for-afghan-refugees/afghan-refugees-and-newly-displaced-populations-overview-and-principles.

Office for Health Improvement and Disparities, (2017) Vulnerable migrants: Migrant Health Guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/vulnerable-migrants-migrant-health-guide.

ONS, (2024) Long-term international migration, provisional - Office for National Statistics. [online] www.ons.gov.uk. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/internationalmigration/bulletins/longterminternationalmigrationprovisional/yearendingdecember2023.

Perry, M., Townson, M., Cottrell, S., Fagan, L., Edwards, J., Saunders, J., O’Hare, R. and Richardson, G., (2019) Inequalities in vaccination coverage and differences in follow-up procedures for asylum-seeking children arriving in Wales, UK. European Journal of Pediatrics, 1791, pp.171–175.

Peterson, J., Pearce, P.F., Ferguson, L.A. and Langford, C.A., (2017) Understanding Scoping Reviews. Journal of the American Association of Nurse Practitioners, 291, pp.12–16.

Pollock, K.G., Tait, B., Tait, J., Bielecki, K., Kirolos, A., Willocks, L. and Gorman, D.R., (2019) Evidence of decreased HPV vaccine acceptance in Polish communities within Scotland. Vaccine, 375, pp.690–692.

Public Health England, (2014) NHS entitlements: Migrant Health Guide. [online] Gov.UK. Available at: https://www.gov.uk/guidance/nhs-entitlements-migrant-health-guide.

Public Health England, (2020) PRE-ENTRY HEALTH ASSESSMENTS FOR UK BOUND REFUGEES HEALTH PROTOCOL PRE-ENTRY HEALTH ASSESSMENTS FOR UK-BOUND REFUGEES. [online] Available at: https://assets.publishing.service.gov.uk/media/5ee8ed9ce90e070435f5aa12/Badged_HA_protocol_IOM_HO_PHE_-_June_2020.odt.pdf.

Public Health England, (2021) Language interpretation: migrant health guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/language-interpretation-migrant-health-guide.

Rabie, Somerville, J., Abuadas, F.H., Rubinat-Arnaldo, E. and Mette Sagbakken, (2023) Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review. [online] 11. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169615/ [Accessed 18 May 2023].

Rodrigues, C.M.C. and Plotkin, S.A., (2020) Impact of vaccines; health, economic and social perspectives. Frontiers in Microbiology, [online] 111526. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371956/.

Ryan, R., Eisen, S., Patel, D. and Longley, N., (2023) Perspectives on the current diphtheria outbreak among asylum seekers in the UK. Journal of Travel Medicine, 305.

Sacre, A., Bambra, C., Wildman, J.M., Thomson, K., Bennett, N., Sowden, S. and Todd, A., (2023) Socioeconomic inequalities in vaccine uptake: A global umbrella review. PLOS ONE, [online] 1812, pp.e0294688–e0294688. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718431/ [Accessed 17 Jan. 2024].

UKHSA, (2014a) Assessing new patients from overseas: migrant health guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/assessing-new-patients-from-overseas-migrant-health-guide.

UKHSA, (2014b) Immunisation: migrant health guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/immunisation-migrant-health-guide.

UKHSA, (2014c) Sexually transmitted infections (STIs): migrant health guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/sexually-transmitted-infections-stis-migrant-health-guide.

UKHSA, (2014d) Women’s health: Migrant Health Guide. [online] GOV.UK. Available at: https://www.gov.uk/guidance/womens-health-migrant-health-guide.

UKHSA, (2023a) Infectious diseases in asylum seekers: actions for health professionals. [online] GOV.UK. Available at: https://www.gov.uk/guidance/infectious-diseases-in-asylum-seekers-actions-for-health-professionals.

UKHSA, (2023b) Outbreak management in short term asylum seeker accommodation. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/outbreak-management-in-short-term-asylum-seeker-accommodation [Accessed 19 Aug. 2024].

UKHSA, (2024) Diphtheria: cases among asylum seekers in England, health protection report (data to 25 November 2022). [online] GOV.UK. Available at: https://www.gov.uk/government/publications/diphtheria-cases-among-asylum-seekers-in-england-2022/diphtheria-cases-among-asylum-seekers-in-england-2022.

World Health Organisation, (2021) Global Vaccine Action Plan. [online] www.who.int. Available at: https://www.who.int/teams/immunisation-vaccines-and-biologicals/strategies/global-vaccine-action-plan.

Worthing, K., Seta, P., Ouwehand, I., Berlin, A. and Clinch, M., (2022) Reluctance to register: an exploration of the experiences and perceptions of general practice staff in North East London. British Journal of General Practice, p.BJGP.2022.0336.