THE federal government’s COVID-19 vaccination roll-out is underway, with the promise to provide the vaccine free of charge to everyone in Australia, including those without a Medicare card, such as refugees and asylum seekers.
Although the vaccine itself may be cost-free to an individual, other barriers may limit vaccine acceptance and uptake. An understanding of these barriers is necessary to create and deliver equitable services across the nation.
Culturally and linguistically diverse (CALD) communities are distinct yet heterogenous groups with unique health delivery needs. There is growing evidence that public health messaging around COVID-19 has failed to capture the CALD audience in Australia, thereby risking poorer health outcomes for the individual, community and beyond. Indeed, it has been suggested that inadequate communication with the CALD community contributed to the COVID-19 outbreak in Melbourne’s social public housing towers in July 2020.
The refugee and asylum seeker population of Australia is a subset of the CALD community. It is comprised of a diverse collection of people and cultures, again with complex and varied health and social needs. The United Nations High Commissioner for Refugees has declared that all displaced people worldwide have access to COVID-19 vaccines and coordinates international efforts to do so. It declares that not only does the vaccine provide tangible protection risks for individuals, but it also affords herd immunity to the wider community, which is necessary to end the pandemic.
Refugees* are vulnerable because of the multiple and ongoing challenges they face both before and after resettlement. Everyday stressors such as language and cultural pressures compound more obvious obstacles: employment, finance, housing, transport and education. Moreover, medical and mental health issues related to the unique refugee experience requires the ability to navigate an unfamiliar and convoluted health system with limited understanding. This perpetuates refugees’ susceptibility to a variety of health mishaps. The health system may be even more troublesome for those resettled in regional areas, where service access and a multilingual workforce are not as readily available.
Low health literacy and poor education are expected consequences of the refugee experience. Undertaking a new life in a foreign language and culture, often coupled with fragmented and basic education pre-migration, makes this population even more exposed to poorer health outcomes (here and here). Concerningly, it has been shown that those with lower health literacy are more reluctant to engage with vaccination.
Circulating myths and misinformation about the COVID-19 vaccine efficacy and purpose are breeding fear within many CALD communities. With increasing concerns about vaccine hesitancy, meaningful community engagement in vaccine roll out is considered to be of paramount importance.
Furthermore, the growing trend to relocate refugees away from urban locations within Australia has resulted in an increasing number of refugees in regional and rural towns. On average, Australians in these areas have poorer health outcomes compared with their urban counterparts. Undeniably, the disadvantages related to education, employment and health care access are widespread problems affecting regional dwellers.
Distinct refugee communities in regional settings are often more dispersed and smaller than those in urban regions. This suggests that community identity, social supports and communications in this population may be unconventional and atypical, requiring specific tailoring of health programs.
Much can be done to support the refugee community’s uptake of COVID-19 vaccines.
Health related communiques need to reach the population. Messages must be relevant and understandable. Stronger partnerships are required between health services, community organisations and community members. It is becoming overwhelmingly apparent that among CALD communities, community leaders hold a pivotal role in distributing and endorsing health messages. Equipping and partnering with community leaders will help reach those community members who may otherwise not be able to access the information by other means. Equally important is the connection and dialogue obtained by collaboration with leaders. This allows community concerns to be voiced, channelled and actioned, thereby increasing consumer participation and capacity building.
The production of more culturally specific promotional audiovisual materials in language is necessary. A shift away from written materials safeguards those with lower literacy levels. The social media boom provides a welcomed opportunity to propagate reliable and acceptable messages, in a most efficient and widespread manner. However, this is only possible if the individual has access to technology and is digitally literate enough to use it.
Mobile clinics are a well known and versatile method used worldwide to bridge various gaps in health care delivery by direct contact with the community, particularly in remote settings. Usually delivered in the form of a van, outreach clinic or home visit, the service meets community members in a safe and comfortable place providing numerous possibilities for health care. Complete with a health professional and interpreter, mobile clinics can overcome barriers such as transport and language and curb associated costs. Health education material could be delivered verbally or by demonstration via a mobile clinic. Also, a clinic may operate as a hub for question time, or perhaps a location where a known community leader can partner with health staff to share the same message. The delivery of mass vaccination clinics may also be considered. Such services would benefit from coordination with local health departments, who know their community best.
Understanding the particular needs of each refugee community provides a foundation for health services to create and supply specific, more equitable and acceptable services. The importance of studying discrete populations and creating tailored vaccination programs and policies is an approach developed by the World Health Organization’s Tailoring Immunisation Program.
The permutations of trials faced daily by refugees makes it virtually impossible to create an equitable service without understanding the local community at hand. To date, however, there is a paucity of literature examining barriers specific to discrete refugee groups within Australia, even less so, those in regional settings.
Finally, health care professionals providing direct service to the refugee community, such as local refugee or multicultural health services, possess skills that can be harnessed to maximise vaccination participation. These staff are already well trained to provide high quality clinical practice and advice to this very community. Local services often have special insight into their refugee population’s circumstances. They also hold valuable client details, making them well equipped to target individual needs, track uptake, recall and collect data. Engaging these services and allocating them a role in accountability is a factor for achieving high vaccination rates.
Refugees and asylum seekers throughout Australia can be better supported during this time of COVID-19 vaccination roll-out. Particular attention should be paid to those in regional settings. Strategies to enhance communication about the vaccine, by connecting with community via collaboration with leaders, expansion of mobile clinics and providing meaningful resources is necessary.
Additionally, opportunities exist for the local refugee needs to be explored and actioned appropriately, especially those in regional locations. State government participation in the national COVID-19 vaccination roll-out plan is a small step to shaping a system which could be better refined to capture the needs of marginalised groups. Tailored solutions to minimise barriers are best created by those familiar with the local communities, such as the Multicultural Health departments and other refugee-specific services. Utilising the skillset of these experienced services will likely benefit the COVID-19 vaccine uptake in this minority community within Australia.
*In this article, the term “refugee” has been used to denote both refugees and asylum seekers.
Dr Rebecca Healey is a Staff Specialist Paediatrician with Refugee Health at Hunter New England LHD, Associate Lecturer at University of Newcastle and an affiliate of Hunter Medical Research Institute.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.