Despite being underserved, often experiencing wide gaps in health outcomes and health and social service provision, some disadvantaged minority communities across Europe and beyond have achieved high vaccination uptake. Understanding the enablers that drive this success can help inform equitable vaccine strategies for other marginalised groups. In this article, we examine common themes from three studies that explored enablers of high vaccination uptake in the Somali community in Finland , the Arab community in Israel , and the Bangladeshi community in East London. We then examine how implementing countries are applying similar approaches to improve vaccine equity.
Trust in healthcare professionals as a central enabler
One of the most significant enablers of vaccine uptake across all three studies was strong trust in healthcare professionals. In these communities, healthcare providers are viewed as authoritative and reliable sources of health information, which directly influences vaccination decisions. The perception that doctors, nurses, and midwives act in the best interest of families encourages parents to follow their guidance without hesitation.
I don’t know how to explain it. They just believe in it and believe in us. They trust us- whatever we tell them. They deeply believe that we act for their own good and wellbeing. (nurse in Israel)
"If the nurse tells me this is a good thing, I trust her completely." (Somali Mother Finland)
"I don’t know how to explain this, but I find that a lot of Bangladeshi parents that I come in contact with, they kind of think, ‘Okay, if I listen to the health professional, nothing can go bad’, it’s that attitude where they know best, you should just listen to them." (Paediatric Nurse in London
Cultural sensitivity and representation in healthcare
Another shared enabler was culturally competent healthcare delivery, which includes respectful engagement, acknowledgment of concerns, and tailored solutions that align with religious and cultural beliefs. Providing alternative vaccine formulations (e.g. halal vaccines), translation services, and culturally aware healthcare staff makes the vaccination process more inclusive and accessible. These adaptations strengthen trust and reduce barriers to vaccine acceptance.
"We have to respect cultural sensitivities and acknowledge fears—if a mother says she wants to consult her husband or extended family before vaccinating, we don’t push, we explain and give space. This helps build long-term trust." (Arab public health nurse, Israel)
"When I used to speak to the nurses, […]. When I didn’t understand, they used to say, ‘Do you want an interpreter?’ and they would get an interpreter. Sometimes I would have a Bengali doctor, but not always, and then they would get an interpreter to translate." (Bangladeshi parent, East London)
"I didn’t used to take the gelatine one, but one time, maybe last year, when I explained that I didn’t want to give them, they gave me the other one and said it was a flu vaccine without gelatine, there’s a halal one. So, if I want to, I can take it. So, this is the first time I heard there is a halal one." (Bangladeshi parent, East London)
"In my opinion what affects this [the MMR vaccination uptake of Somali children] is being open, talking about things that are on your mind and we can ask questions and we can talk constructively about them. I think it’s a terribly good thing that families bring up their potential concern, for example does it [MMR vaccine] affect their child’s speech development. The fact that people dare to say it out loud, we can talk about it, leading to the wrong misconceptions or rumours being corrected or we can at least talk about what we [public health nurses] think and what does current research say." (Nurse, Finland)
Integrated care
Beyond interpersonal trust, systematic healthcare approaches also play a critical role in ensuring high vaccine uptake. The integration of vaccination into routine healthcare visits, such as maternal care and child check-ups, reduces missed opportunities and normalises vaccination as part of overall health maintenance. Additionally, reminder systems and proactive outreach ensure that families stay on schedule.
"Our vaccination programme is well-integrated into national child healthcare services, with funding and policy support ensuring every child gets access to vaccines at no cost." (Public health official, Israel)
"They call me; the easiest thing is they call me. I didn’t have to bother, I didn’t have to be reminded about their vaccine and stuff but they called me to book my next appointment, the time for my children to get their next vaccine. They remember me, I didn’t remember them." (Bangladeshi parent, East London)
"Well usually during the first visit [prenatal counseling], I give them [the parents] the vaccination guide and I go through it a bit then and there, we tell them about the national vaccination programme and at which age do we start […]. Then when we start the vaccinations at the age of two months, I usually make sure that the parents have thought about this, is it OK to vaccinate their child, and not so that the parents start thinking about this at the time of the vaccination." (Nurse, Finland)
Vaccination as a social norm
In all three communities, vaccination was viewed as a natural, expected health behaviour, reinforced by social expectations, generational norms, and community-wide acceptance. Parents saw vaccinating their children as an essential responsibility, protecting their children’s rights and encouragement from family and friends further reduced hesitation.
"We do it because it’s for their health, for their future. It’s what all responsible parents do."— (Arab parent, Israel)
"I want my child to receive what they are entitled to have."— (Somali parent, Finland)
"It was compulsory because, as I said, I’ve had it, my siblings have had it, we’ve been born and brought up in this country, so it almost felt like it was just the thing to do. And I think everywhere you go, everybody would ask, ‘Have you had your childhood immunisations?’ … So it was quite just the given thing really, that you just have it done."— (Bangladeshi parent, East London)
How are these enablers coming to life in RIVER-EU implementing countries?
1. Community driven intervention to build and maintain trust in vaccination services:
The Roma health mediators programme operates under Healthy Regions, an initiative supported by the Slovak Ministry of Health. These mediators, often from the same communities they serve, engage in consistent and culturally sensitive health communication, and help to overcome barriers of mistrust and misinformation. Their presence along with healthcare professionals allows for more open, relatable, and accessible healthcare interactions.
2. Prioritising cultural sensitivity in healthcare professionals’ trainings:
In the Netherlands, an nationwide intervention focuses on training doctors, nurses, and health promotion workers to provide tailored, culturally sensitive communication to Turkish and Moroccan communities. This accredited e-learning course is designed to help healthcare workers: deepen their understanding of HPV and the HPV vaccine, gain insights into the National Immunisation Programme and its organisation, and learn how to deliver culturally and religiously appropriate information that aligns with the beliefs and preferences of Turkish and Moroccan populations.
3. Minimising missed opportunities by integrating vaccination services in schools:
Ensuring that vaccination is seamlessly integrated into everyday touchpoints—such as schools and routine healthcare visits—reduces the likelihood of missed opportunities. RIVER-EU has been addressing this challenge in Greece, particularly among refugee and migrant children, by bringing vaccination education into schools and improving health literacy among students, teachers, and families. The Multicultural School of Athens, working in collaboration with RIVER-EU partner Prolepsis, serves as a local pilot site where vaccination is promoted as part of broader educational and integration efforts.
“The training and education in health that is provided by RIVER-EU is very important for all those who work with children, and particularly refugee and migrant children, in order for them to feel safe and to achieve their smooth integration into Greek society.” (Eugenie Gargalestou, Teacher, Greece).
4. Building new norms through familiar faces
In Poland, RIVER-EU is supporting Ukrainian migrants as they adapt to a different vaccination system; one where vaccines are free, closely monitored, and integrated into routine public healthcare. For families navigating a new country and healthcare structure, familiar faces can make all the difference.
By engaging Ukrainian doctors now working in Poland, the project helps bridge cultural and informational gaps. These trusted professionals provide reassurance, answer questions, and explain how the Polish vaccination system works. Through these trusted messengers new norms around vaccination are built, turning an unfamiliar system into one that feels approachable, safe, and routine.
The RIVER-EU project is proof that enablers to equitable vaccine uptake are not unique to one place or population. With the right investments and partnerships, they can be adapted and scaled to support every community.