An immunization program for US-bound refugees: Development, challenges, and opportunities 2012–present

BACKGROUND: US-bound refugees undergo required health assessments overseas to identify and treat communicable diseases of public health significance—such as pulmonary tuberculosis—before migration. Immunizations are not required, leaving refugees at risk for vaccine-preventable diseases. In response, the US Centers for Disease Control and Prevention and the US Department of State developed and co-funded a global immunization program for US-bound refugees, implemented in 2012 in collaboration with the International Organization for Migration. METHODS: We describe the Vaccination Program for US-bound Refugees, including vaccination schedule development, program implementation and procedures, and responses to challenges. We estimate 2019 immunization coverage rates using the number of age-eligible refugees who received ≥1 dose of measles-containing vaccine during overseas health assessment, and calculated hepatitis B infection prevalence using hepatitis B surface antigen testing results. We report descriptive data on adverse events following immunization. RESULTS: By September 2019, the program was active in >80 countries on five continents. Nearly 320,000 examined refugees had ≥1 documented vaccine doses since program inception. During federal fiscal year 2019, 95% of arriving refugees had ≥1 documented measles-containing vaccine. The program’s immunization schedule included eleven vaccines preventing fourteen diseases. In 2015–2019, only two vaccine preventable disease-associated refugee group travel cancellations occurred, compared to 2–8 cancellations annually prior to program initiation. To maintain uniform standards, dedicated staff and program-specific protocols for vaccination and monitoring were introduced. CONCLUSIONS: An overseas immunization program was successfully implemented for US-bound refugees. Due to reductions in refugee movement cancellation, lower cost of immunization overseas, and likely reductions in vaccine preventable disease-associated morbidity, we anticipate significant cost savings. Although maintaining uniform standards across diverse settings is challenging, solutions such as introduction of dedicated staff, protocol development, and ongoing technical support have ensured program cohesion, continuity, and advancement. Lessons learned can benefit similar programs implemented in the migration setting.