Target communities: Migrants and refugees.

Vaccine(s): Measles, mumps, and rubella (MMR) and Human Papilomavirus (HPV).

Description of the target community

According to UNICEF, in June 2019 an estimated 29,000 migrant children were present in Greece. The migrant/refugee crisis which started in 2015 continues to date with frequent escalations of flows occurring such as ones originating from Turkey. For instance, in March 2020 thousands of migrant refugees gathered on the Greek/Turkish land border seeking entrance into Europe. Since then and due to the COVID-19 pandemic this crisis has temporarily subsided. However, the flows show another increase as summer months draw near. According to 2019 data, about one out of three refugees in Greece are children while the female: male ratio is 1:2 (UNHCR, 2019). The majority of children are from Afghanistan (45,2%) and Syria (22,8%).

Vaccine uptake

Until March 2017, vaccination of migrant/refugee children was mainly performed by non-governmental organisations (NGOs) under the coordination of the Greek Ministry of Health (MoH). According to the latest data, in 2018 approximately 80% of the children among the migrant/refugee community 1-14 years old had received the first dose of MMR vaccine, while 45% received the second one. Among children aged 0-4, almost 50% had been vaccinated with the first dose of MMR and below 25% with the second.1Mellou, K., Silvestros, C., Saranti-Papasaranti, E., Koustenis, A., Pavlopoulou, I. D., Georgakopoulou, T., … & Terzidis, A. (2019). Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018. Eurosurveillance, 24(27). As HPV vaccination is not available in Greece for refugee/migrant children, no vaccination rates are available for this vulnerable community. The Mig-HealthCare project – Minimize health inequalities and improve the integration of vulnerable migrants and refugees into local communities is a 3-year EU project coordinated by RIVER-EU consortium partner PROLEPSIS. Within the project a survey was conducted in 10 EU MS among 1300 refugee/migrants over the age of 18 years old. 73.3% of migrants (874 out of 1,193 valid answers) did not have a vaccination card (26.7% do so). Specifically, for measles 13% of the sample responded that they had been vaccinated against measles, 16% said they did not know while 70% had not received vaccination for measles.

Contextual factors:

The 29,000 migrant and refugee children present in Greece are spread over several locations across the country in different living circumstances: 60% live in urban areas (apartments, hotels, shelters for Unaccompanied and Separated Children (UASC, self-settled, etc.), 26% live in accommodation sites and 1% live in safe zones, and a further 13% are in Reception and Identification Centers. Being one of the countries on the outside borders of Europe, Greece has a great influx of migrant refugees seeking access to Europe. This influences the number of migrant refugee children present in the country a great deal and as long as one of the routes to Europe is via Greece, the vaccination issue among refugee children will be present.

Health system barriers:

With regard to Greek migrants/refugees, including children, young people and their parents, there is little relevant data collected about them entering the health and care system. There is a lack of documentation of vaccination and medical history of Greek migrants. 2Hargreaves Sally, Nellums Laura B, Ravensbergen Sofanne J, Friedland Jon S, Stienstra Ymkje, on behalf of the ESGITM Working Group on Vaccination in Migrants. Divergent approaches in the vaccination of recently arrived migrants to Europe: a survey of national experts from 32 countries, 2017. Euro Surveill. 2018;23(41):pii=1700772. Migrants and refugees in Greece experience barriers in communication with healthcare professionals due to intercultural communication  Healthcare professionals who are trained on provision of health care to culturally diverse patients are able to provide vaccination services to an increasing number of culturally and linguistically diverse parents and their children, leading to improved service delivery and enhanced access to services. Until recently, migrants/refugees were issued with a Social Security Number (AMKA) which enabled them to access health care in Greece. This has been suspended, however, due to a change in government. In January 2020 the Ministry of Migration and Asylum decided to provide migrants/refugees who applied for asylum with a provisional social security number. Provisional Insurance and Health Care Number (PAAYPA) is not the same as the Social Security Number (AMKA). PAAYPA ensures the asylum seekers’ access to healthcare, social security and the labor market following the submission of their application. If their application is accepted PAAYPA will turn into AMKA, while in case of rejection PAAYPA will be automatically deactivated. Last but not least, migrants without documents may be discouraged from accessing government-associated health services, because of their links with immigration authorities. The Mig-HealthCare project revealed that in 10 MS during their interactions with healthcare services 60.1% of migrants/refugees stated that they needed translation always or most of the time, 61.0% were helped by a professional, 15.3% by a family member and 7.9% by nobody.