Target communities: Ukrainian migrants

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

Description of the target community

The target community in Poland are the Ukrainian migrants. In 2019 212.730 people from Ukraine were registered as migrants in Poland.1Migration in Poland in 2019, https://migracje.gov.pl/en/statistics/scope/poland/type/statuses/ view/tables/year/2019/ [accessed 19 2 2020]. However, analysis of mobile telephone use in 2018, indicated that the true number of Ukrainians residing in Poland was much higher, in the range of 1.25 million.2Ilu Ukraińców przebywa w Polsce? Obliczono to na podstawie danych z telefonów komórkowych, Forsal.pl, [accessed 30 March 2020].https://forsal.pl/artykuly/1401851,ilu-ukraincow-przebywa-w-polsce-obliczono-to-na-podstawiedanych-ztelefonowkomokowych.html The Ukrainian migrant community consists primarily of economic migrants of working age. In the early stages of migration, many fall into a pattern of working for several months in Poland, and then returning to Ukraine to extend visas before returning back to Poland (visa validity of 3 months). Often when they return, they don’t go back to the same place they worked to begin with. If they secure a permanent job in Poland, they often have their children and family join them. Once settled in Poland, many continue to return to Ukraine to access healthcare there (including childhood check-ups). Considering this instability, numbers of Ukrainian migrants are fluctuating weekly.

Vaccine uptake

According to the National Institute of Public Health report, 22,341 girls up to 20 years of age (general population) were vaccinated against HPV in 2018 in Poland.3Vaccinations in Poland in 2018. http://wwwold.pzh.gov.pl/ oldpage/epimeld/index_p.html#0 The national register of HPV vaccinations operates only on data obtained from the government-provided GP practices. An estimated 10% of girls aged 11-13 years were vaccinated by means of various strategies at national level. Results of our study demonstrated that 7.5% of girls attending the first classes of post-secondary schools were vaccinated against HPV in 2013 in the city of Zgorzelec, in south-western Poland.4Owsianka B, Ganczak M. Evaluation of human papilloma virus (HPV) vaccination strategies and vaccination coverage in adolescent girls worldwide. Przegl Epidemiol. 2015;69(1):53-8, 151-5. HPV vaccine is not among the mandatory vaccines in Poland, and it is not reimbursed. Official data on HPV vaccine uptake in Ukrainian girls is lacking.5Chernyshov PV, Humenn I. Human papillomavirus: vaccination, related cancer awareness, and risk of transmission among female medical students. Acta Dermatovenerol APA 2019;28:75-9. There is no data on HPV immunization rates in Ukraine reported to the WHO vaccine-preventable diseases monitoring system.6WHO vaccine-preventable diseases: monitoring system (2019 global summary) https://apps.who.int/immunization_ monitoring/globalsummary/countries?countrycriteria[country][]=UKR Some cross-sectional studies conducted in Ukraine show 1.7% uptake7Chernyshov PV, Humenn I. Human papillomavirus: vaccination, related cancer awareness, and risk of transmission among female medical students. Acta Dermatovenerol APA 2019;28:75-9.

Contextual factors:

Since early 2014 there has been a rapid increase in migration from Ukraine to Poland, with a dramatic influx of Ukrainian citizens following the eruption of the conflict in the eastern part of Ukraine. Ukrainian migrants are a mobile community, with low immunization rates, moving from a country with negative attitudes towards immunization and high measles incidence. They can be described as incomplete migrants and typically live in crowded, multi-occupancy flats with close cross-generations contacts. Having these large clusters of migrants living together with a high proportion of unvaccinated people, can lead to outbreaks of measles. Recent measles outbreaks related to Ukrainian migrants have been reported in Poland. These outbreaks are evidence that vaccination programmes do not reach all. As long as the political and economic situation in Ukraine remains unstable, the issues related to alarmingly low immunisation uptake among this vulnerable community and its possible consequences regarding public health will need to be addressed.

Health system barriers:

Research has demonstrated that Ukrainian migrants in Poland tend to have negative beliefs about the quality and safety of measles vaccine, which lead parents and their children to refuse or delay vaccination. The ability of the Polish health system to address the vaccination beliefs of the Ukraine community in Poland depends largely on the knowledge, skills, motivation and deployment of the healthcare professionals responsible for organizing and delivering the vaccination services. Firstly, Ukrainian migrants in Poland are not familiar with, or aware of HPV vaccinations in the context of cervical cancer prevention. Secondly, they experience challenges in accessing credible online vaccination information in their native language. Thirdly, self-paid HPV vaccines are not of interest for people living in Ukraine, as well as for the Ukrainian migrants to Poland, due to the high cost. A significant number of adult Ukrainian migrants in Poland have not completed mandatory vaccinations in childhood, but in some cases, they do possess false immunization certificates.