Key Concept

Key Evidence: Children born to North Korean refugee women in China have much lower vaccination rates than local Chinese or migrant children — with full immunization rates of 14% compared to 93% for local ethnic Chinese children and 55% for migrant children. While all ethnic Chinese children are registered and provided with free vaccinations and there are specific programs targeting migrant children, children born to Korean refugees have no legal status and are thus excluded from the public health care system.

Chung HJ, Han SH, Kim H, et al. 2019. Childhood immunizations in China: disparities in health care access in children born to North Korean refugees. BMC International Health and Human Rights. 16.
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Key Evidence: In contrast to non-Somalis, family wealth did not significantly affect the likelihood of being fully vaccinated among Somali refugee children living in Kenya. This may point to systemic barriers to vaccination that cut across all socio-economic levels of the Somali refugee population.

Masters NB, Wagner AL, Carlson BF et al. 2018. Childhood vaccination in Kenya: socioeconomic determinants and disparities among the Somali ethnic community. International Journal of Public Health. 64(3).
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Key Evidence: Native populations experience barriers to health care access such as limited knowledge, stigma, community social isolation, and geographic isolation. As a result, Inuit populations in Canada suffer 300 times higher rates of TB than the Canadian-born non-Indigenous population.

2018. CPHO Spotlight on Eliminating Tuberculosis in Canada. Public Health Agency of Canada.
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Key Evidence: An analysis of survey data in Latin America and Caribbean countries found that DPT3 coverage rates among indigenous children were significantly lower than in children of European or mixed ethnicity in three out of 14 countries, while significant inequities between these groups in coverage of maternal health services, such as antenatal care and delivery by a skilled birth attendant, existed in most of the countries. The greater equity in access to childhood vaccination by ethnic group may be because vaccinations are often delivered in the communities through immunization campaigns, whereas maternal health services require accessing health facilities, which may incur user fees and transportation costs.

Mesenburg MA, Restrepo-Mendez MC, Amigo H et al. 2018. Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin America and Caribbean countries. Lancet Global Health. 6(8).
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Key Evidence: Children of Maori and Pacific Island ethnicities in New Zealand had lower rates of age-appropriate vaccination than other ethnic groups, according to a large retrospective study.

Charania NA, Paynter J, Lee AC et al 2018. Exploring immunisation inequities among migrants and refugee children in New Zealand. Human Vaccines & Immunotherapeutics. 14.
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Key Evidence: A study among parents from diverse minority groups in Utah, U.S. — two-thirds of whom were born outside of the U.S. — found extremely low rates of HPV vaccination among their adolescent children. Only 20% had vaccinated at least one child with one or more doses of HPV vaccine compared to 60% nationally. A larger percent of the unvaccinated were from certain minority groups, had lower household income and educational levels, and cited a lack of knowledge about the vaccine, its cost and concerns about side effects as major reasons for not vaccinating. The study points to the need for community approaches to HPV education for a diverse set of caregivers.

Kepka D, Bodson J, Lai D, et al. 2018. Factors associated with human papillomavirus vaccination among diverse adolescents in a region with low human papillomavirus vaccination rates. Health Equity. 2(1).
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Key Evidence: Screening tests given to more than 300 newly-arrived economic migrants and asylum seekers in Italy — the majority from sub-Saharan Africa — found high rates of chronic hepatitis B infection and latent and active tuberculosis (with 8% having signs of current infection or active TB). These findings underscore the important of universal screening for infectious diseases for all newly-arrived migrants.

Cuomo G, Franconi I, Riva N et al. 2019. Migration and health: a retrospective study about the prevalence of HBP, HIV, HCV, tuberculosis and syphilis infections amongst newly arrived migrants screened at the Infectious Diseases Unit of Modena, Italy. Journal of Infection and Public Health. 12(2).
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Key Evidence: In a study of invasive pneumococcal disease in neonates in New Zealand following the introduction of pneumococcal conjugate vaccine (PCV) for infants, 67% of the cases in children <7 days old were of Maori ethnicity, while Maoris make up only 27% of New Zealand’s population. This over-representation of Maoris may be due to poverty and crowded living conditions and suggests that crowded households may be slower to experience the benefits of population-wide pneumococcal vaccination.

Mount V, Burton C, Jackson C, et al. 2017. Neonatal invasive pneumococcal disease: New Zealand experience in the era of pneumococcal vaccination. Aust NZ J Obstet Gynaecol. 57(3).
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Key Evidence: In New Zealand, Maori and Pacific children have historically suffered high hospitalization rates for invasive pneumococcal disease (IPD), all cause pneumonia (ACP), and otitis media. Following the introduction of conjugate vaccines in the country, Maori and Pacific children’s rates of admission for IPD dropped by 79% and 67%, respectively, while significant reductions in ACP and otitis media admissions were also noted, resulting in reductions in disparities for these populations.

Petousis-Harris, H., Howe, A.S., Paynter, J., et al. 2018. Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006-2015. Clinical Infectious Diseases. 68(5).
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Key Evidence: Coverage rates of HPV vaccination in England, which is provided to 12-13 year old girls through a government-funded, school-based program, were significantly lower in areas with higher proportions of migrant families and non-whites than in areas that are predominantly native-born and white.

Jean S, Elshafei M, Buttenheim A 2019. Social determinants of community-level human papillomavirus vaccination coverage in a school-based vaccination programme. Sex Transm Infect. 94.
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