Vaccine Hesitancy and Its Determinants among Refugee Parents Resettled in Aotearoa New Zealand

"Vaccine information tailored to former refugee parents' concerns are required to reduce vaccine hesitancy and improve vaccine uptake."

As per Aotearoa New Zealand (NZ)'s human rights framework, the country has been welcoming refugees since World War II. NZ's refugee resettlement strategy includes a health outcome goal to increase uptake of age-appropriate vaccinations among quota refugee children, post-arrival. If an immunisation programme is available, and efforts are directed to reduce access barriers, yet immunisation services remain underutilised, vaccine hesitancy could be a contributor to low acceptance of vaccines. Therefore, this study investigates vaccine hesitancy among former refugee children in NZ.

The cross-sectional survey was conducted from November 2020 to January 2021 with former refugee parents who resettled in NZ. The Parent Attitudes about Childhood Vaccines (PACV) was offered in Somali, Oromo, Arabic, and English languages, and the reliability of the four versions was evaluated. The prevalence of parental vaccine hesitancy was explored, and the association between vaccine hesitancy and sociodemographic factors was examined using logistic regression.

The rate of parental vaccine hesitancy among the 178 people included in the final analysis was 16.3% (95% confidence interval (CI) 10.7, 21.3). Less than a quarter (21%) of parents had delayed their child receiving a vaccine, and 12% had refused to vaccinate their child for reasons other than medical exemptions. Most of the respondents identified as being from the African region. In African countries, various vaccination controversies (e.g., boycott of the polio vaccine in northern Nigeria in 2003) have resulted in people delaying or refusing recommended vaccines, thereby increasing the potential for infectious disease outbreaks.

Most caregivers surveyed in the NZ study were concerned about vaccine side effects (47%), safety (43%), and efficacy (40%). Given these concerns, some participants noted the need for more parental education about the side effects and benefits of vaccination in the language of the parents. In response to an open-ended question, one participant noted the racism and discrimination present within the NZ healthcare system and how this impacts refugees' access to and utilisation of health services, including their perceptions of vaccinations.

Most parents (88%) indicated some trust in their children's doctors, and 86% agreed they could discuss concerns about childhood vaccines with doctors. Most caregivers (83%) also trusted information they received about childhood vaccines. Three-quarters of parents considered official sources, such as health professionals (doctors and nurses) and brochures, as their primary sources of information. Other parents (12%) turned to media sources (e.g., internet, tv, radio, and social media platforms), and 6% of parents turned to family, friends, and their community for information.

After adjusting for covariate/s, media as a primary source of vaccine information and low education status were associated with higher vaccine hesitancy. Specifically, parents who used media (mass media and electronic media) as their primary source of vaccine information were about 5 times more likely to be hesitant compared to parents who accessed official sources (health professionals and brochures) [odds ratio (OR) = 4.87, 95% CI 1.36, 17.38]. Parents with primary education only were almost 9 times more likely to be vaccine hesitant than parents with tertiary education (OR = 8.97, 95% CI 1.48, 54.33). Moreover, compared to parents with tertiary qualifications, parents with secondary education were nearly 3 times more likely to be vaccine hesitant (OR = 2.9, 95% CI 1.02, 8.29).

In short, the study found that vaccine hesitancy among former refugee caregivers in NZ is determined by interrelated and modifiable factors, including educational status and primary source of information. As access to formal education is a long-term strategy, health professionals might consider targeted vaccine literacy efforts, coupled with effective communication. Since vaccine literacy goes beyond improving knowledge, it is important to embrace former refugees' values in vaccine education. For example, a communication strategy that was supported by religious leaders was found in earlier research cited here to be effective in shifting negative views of vaccines among minorities.

In conclusion: "To address vaccine hesitancy among resettled refugees, health and vaccine literacy that is tailored to their concerns about vaccine side-effects, safety and efficacy are required."