Precarity, agency and trust: vaccination decision-making in the context of the UK asylum system

Those living in initial asylum accommodation are at increased risk of vaccine-preventable disease, yet confidence in vaccination may be low. We aimed to understand vaccine confidence and decision-making among those going through the UK asylum system from a sociological perspective. In-depth semi-structured interviews were done on views and experiences around vaccination (09/2020-08/2021) with asylum seekers or those recently granted asylum (<10 yrs in UK). Interviews were conducted remotely, audio-recorded, transcribed and analysed through reflexive thematic analysis in NVivo 12. 25 participants were interviewed (mean age 37 years [SD:7], mean time in UK 6 years [SD:3], 72% female), of whom 13 were living in asylum accommodation at the time of interview. Preliminary analysis has indicated candidate themes relating to trauma, social isolation, agency and precarity running through discussions around vaccination decisions. Past trauma, such as discrimination at healthcare facilities or feeling forced to receive vaccinations in asylum accommodation, often directly impact trust and decisions to reject future vaccination. Participants described how their struggle for basic necessities, social isolation and precarious living situations imposed by the asylum system left them with other priorities than vaccination. Participants who perceived they have been well cared for in the healthcare system or who described feeling empowered to make their own decision about vaccination often suggested they would be likely to accept vaccination if offered. Asylum seekers and refugees have often experienced substantial trauma, precarity and have a lack of agency directly imposed on them by the asylum system, which are likely to impact trust and decision-making around healthcare. Formative experiences in the UK are key to establishing trust; a trauma-informed approach should be central in developing vaccination interventions for these groups, particularly in asylum accommodation. KEY MESSAGES: • Trauma, precarity and lack of agency imposed by asylum systems are likely to impact trust and decision-making around healthcare. • A trauma-informed approach should be central in developing vaccination interventions for asylum seeking and refugee groups, particularly in initial accommodation settings.