Poland

Target communities: Ukrainian migrants

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

Description of the target community

It has already been recognized that immigration from Ukraine to Poland became a phenomenon that implies remarkable economic, political and social consequences. The target community in Poland are the Ukrainian migrants. As a result of the Russian invasion in 2014, the deep economic crisis in Ukraine and the rise in unemployment, mainly economic migrants flowed into Poland. The most spectacular numbers related to seasonal migration; for instance, it amounted to 1.6 million documents issued in 2018. In 2019, 212,730 people from Ukraine were registered as migrants in Poland.1Migration in Poland in 2019, https://migrace.gov.//en/statistics/scope/poland/type/statuses/view/tables/year/2019/ [accessed 19 2
2020].
owever, analysis of mobile telephone use in 2018, indicated that the true number was in the range of 1.25 million.2Ilu Ukrainców 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-ztelefonowk
omokowych.html
This community consisted primarily of male migrants of working age. In the early stages of migration, many fell 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 returned, they did not go back to the same place they worked to begin with. If they secured a permanent job in Poland, they often had their children and family join them. Once settled in Poland, many continued to return to Ukraine to access healthcare there. Considering this instability, numbers of Ukrainian migrants were fluctuating weekly. Over recent years, due to the Russian aggression against Ukraine in 2022, refugees, mainly women and children, have been arriving from the areas involved in the fighting or those at risk of conflict. It is therefore a forced migration. According to the Polish Border Guard Report (8.02.2024) since the beginning of the war, more than 18.8 million Ukrainians have entered Polish-Ukrainian border and 16.9 million people have returned to Ukraine. The latest data published by Eurostat indicate that at the end of October 2023, the number of Ukrainian refugees in our country was over 957,000.

Vaccine uptake

Overall, the HPV vaccine uptake has been increasing in the last 10 years: results of our study demonstrated that only 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.3 Owsianka 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. According to the National Institute of Public Health report, 41,195 girls up to 20 years of age (general population) were vaccinated against HPV in 2022 in Poland.4 Vaccinations 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. Of note, an important HPV vaccination strategy has been initiated in Poland in June 2023 which is the game changer not only regarding the positive change in the National Oncologic Strategy plan, but also the RIVER-EU project. Poland joined the group of countries that have been conducting reimbursed HPV vaccinations for many years, in order to reduce the incidence of cervical cancer. Two vaccines are available free of charge in the universal HPV vaccination program for 12-year-olds (girls and boys): the 2-valent Cervarix vaccine and the 9-valent Gardasil 9 vaccine. Furthermore, from 1 September 2023, patients from 9 years of age up to the age of 18 are also eligible for the 100% reimbursement of the Cervarix vaccine. Official data on HPV vaccine uptake in Ukrainian girls is lacking.5Chernyshov PV, Humenn I. Human papillomavirus: vaccination, related cancer awareness, and risk of trasmission 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.6 WHO vaccine-preventable diseases: monitoring system (2019 global summary) https://apps.who.int/immunization_monitoring/globalsummary/countries?Zcountrycriteria[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 trasmission 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, and then subsequent to Russian aggression in 2022. Ukrainian migrants are a mobile community, with low immunization rates, moving from a country with negative attitudes towards immunization and high measles incidence. In the beginning of their stay in Poland, they typically live in crowded refugee shelters or 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:

A summary of barriers identified across Ukrainian migrants in Poland for each WHO health system building block is highlighted below.

The ability of the Polish health system to address the vaccination beliefs and attitudes 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, as well as on the schools’ engagement in the active promotion of  vaccinations.

Addressing health system barriers to HPV and MMR vaccine uptake

To tackle health system barriers hindering the uptake of human papillomavirus (HPV) and measles, mumps, rubella (MMR) vaccines among Ukrainian migrants in Poland, our project draws upon insights from various stakeholders, including Polish health professionals, researchers, and members of the Ukrainian community. Through this collaboration, we have identified two key barriers: inadequate information delivery and lack of awareness-raising initiatives. While language barriers were recognised as significant, they were deemed less feasible to address in the RIVER-EU project. On the other hand, health professional training was deemed feasible but less significant as a barrier. Guided by these findings, our pilot interventions are designed to directly confront these identified health system barriers to vaccine uptake among Ukrainian migrants in Poland.

MOST SIGNIFICANT BARRIERS

inadequate information delivery

lack of awareness-raising initiatives

The pilot interventions consist of three main components: 1) Health professionals undergo specialised training that equips them with the knowledge and skills necessary to conduct educational sessions for parents. 2) Trained health professionals then lead educational meetings for parents, providing them with essential information about HPV and MMR vaccines. Online materials are disseminated through school platforms to supplement the educational meetings. 3) This process is complemented by navigators who actively engage with parents, sending vaccine reminders and helping in finding their way around the vaccination system. Together, these efforts aim to enhance vaccine uptake among Ukrainian migrants in Poland.

Training

 

Based on our evidence collection, Ukrainian migrants expressed mistrust towards individuals lacking a medical background when it comes to vaccination advice. Therefore, actors engaged in this intervention must have both a medical background and Ukrainian origin. They play diverse roles within the Polish healthcare system, including general practitioners, gynaecologists, medical students, vaccination point nurses, midwives, and healthcare coordinators.

These health professionals will receive comprehensive online training designed to deepen their understanding of HPV and MMR-related diseases, vaccination pros and cons as well as its protocols, and the organisation of vaccination programmes in Poland. Emphasis is placed on developing effective communication and presentation skills to convey information in simple, culturally appropriate language. This training also addresses contextual characteristics, including specific barriers faced by Ukrainian migrants and their common beliefs.

Education

 

Defining target groups

Once health professionals complete their training, they will engage with specific target groups. These groups consist of parents or legal guardians of vaccine-eligible children aged 12 to 17 with Ukrainian migration backgrounds, including both registered refugees, and legal migrants. This focus on the specified age group aligns with the project’s aim to promote HPV vaccinations that are accessible and free of charge.

Educational content and settings

The interventions will be implemented in three major cities in Poland with a significant number of Ukrainian migrants, taking into account potential regional differences: Rzeszów and Lublin in the southeast and Zielona Gora in the west. There, trained health professionals will host meetings with parents to deliver culturally adapted knowledge on HPV and MMR vaccinations. These sessions aim to address common beliefs, offering an opportunity to correct any misinformation. Additionally, parents will be equipped with communication skills to discuss vaccination with their children. These meetings will take place in conference rooms at family medicine practices. Furthermore, online educational materials will be distributed via existing school platforms that parents and teachers use to communicate with each other. They will be presented in simplified language and available in Ukrainian.

Navigation

 

On top of this, our intervention will benefit from navigators. They are executive managers from medical centres, including the Medical Training Centre for Foreigners, individuals with master’s degrees in physiotherapy, and PhD students who are fluent in Ukrainian language. They will actively reach out to parents of vaccine eligible children with a Ukrainian migration background. These children are registered at family medicine clinics and eligible for 100% reimbursement but have not yet received vaccination. Through phone calls and text messages, these navigators send reminders and offer assistance in navigating the national vaccination system.

Quality assurance

Health workers’ training will be assessed based on their knowledge, attitudes, and practical skills before and after courses. Continuous feedback will be sought throughout the process to facilitate ongoing improvements.
For parents, knowledge and intention towards vaccination will be measured using pre- and post-questionnaires. Additionally, the vaccination status of participants’ children will be checked after three months. In cases where vaccination has not occurred, direct calls will be made to inquire about vaccination intentions.

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