Novel ways to drive catch-up vaccination of adult migrants in UK primary care: a pilot study

Adult and adolescent migrants to Europe may have missed routine vaccinations and must be aligned with European schedules, but awareness and implementation of catch-up guidelines in UK primary care is poor. We conducted a pilot study of novel primary care mechanisms (May ‘21-Sept ‘22) to explore under-immunisation and increase catch-up vaccination of migrants ( > =16 years, born outside W. Europe, N. America, Australia, or New Zealand) in 2 London boroughs. We recorded vaccination history, past vaccine-preventable diseases (VPD), and prompted staff to offer MMR, Td/IPV, HPV, MenACWY vaccines according to UK guidelines on uncertain or incomplete immunisation status. Data were analysed in STATA12. We included 57 participants (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) from 18 countries. Demographic distributions were not significantly different between boroughs (sites) for age, sex, or years in UK, but differed by birth region (p < 0.0001). Nearly all participants required vaccination for MMR (86%) and Td/IPV (88%), suggesting migrants would benefit from catch-up vaccination on arrival.12/22 participants reported a past VPD (15 cases including measles, rubella, pertussis, active TB, HPV, hepatitis A, HPV, meningitis). 93% of participants were referred for catch-up vaccination and 81% had at least one dose (at study end). Start of vaccination was higher in Site 2 (100%) than Site 1 (44%). Half (30, 59%) of those referred for MMR completed the course (2 doses) by study end. Less than half (17, 41%) referred for Td/IPV had received at least 1 dose at study end. Direct and indirect barriers exist to delivering catch-up vaccines to migrants, including staff knowledge/training; incomplete vaccination records; lack of incentives, time and care pathways. Designated staff champions, financial incentives and awareness are needed to drive catch-up vaccination in primary care, alongside novel ways to deliver vaccinations at scale and in the community. KEY MESSAGES: • Designated staff champions, incentives and other mechanisms to raise staff awareness and willingness to engage with guidelines are needed to drive catch-up vaccination in primary care. • Novel ways to deliver vaccinations at scale and use of community-based or community-led interventions are needed to advance vaccine equity and ensure inclusion of marginalised migrant groups.