Popolazioni migranti, popolazioni vulnerabili e la copertura vaccinale: lo scenario europeo Rome - ISS, 28 May 2013 Dr. Santino Severoni Coordinator Public Health and Migration Division of Policy and Governance for Health and Well-being European Office for Investment for Health and Development WHO Regional Office for Europe
Presentation outlook Overview Immunization & Migration a public health concern? Forced Migration Conclusions and Remarks
Concept & Numbers We are told by newspaper, politician, academies that massive number of people are on the move in the world, there is a global migration crises leading to a clash of civilizations 214 mil International migrants in 2010 (3% of global population) and 740 mil. Internal migrants (UNPD data)
Population movements
Population movements
WHO European Region 53 Member States, 886 million people 77 million migrants (36%) in WHO EURO Region Variation in GDP/person/year (2009): - Tajikistan $ 1,900 [rank192] - Luxembourg $ 79,600 [rank 3]
Complexity, contradictions and multidisciplinary Health is influenced by many factors and policies run by institutions out of the health sector that do not always take into account the health impact of their action
Strategic approach for control of migration While there has been an increasing harmonization of immigration policies in most of WHO member states, the dominant emphasis has been on restriction, control and expulsion Conflicting demands between HR and National Regulations Decree of rigidity of regulations
Legal framework for access to health care services Key question is the legal provision of access to health care for undocumented migrants. In all EU countries documented migrants are entitled to access the health care system, (with specific rules depending on their legal status as permanent settlers, temporary workers, refugees, asylum seekers, etc) Health care for undocumented migrants is addressed within EU in example by Italy, Spain and Sweden with health card provided to all resident regardless of their legal status.
Immunization contributed health improvements in the WHO European Region 99% reduction in polio cases 78% reduction in measles mortality between 2000 and 2008
The World Health Organization s Expanded Programme on Immunization (EPI) Is the first component of An essential public health package, a set of recommendations to improve child health at a low cost. Despite this, the implementation of immunization programmes varies greatly across different communities approximately 34 million children worldwide do not have access to any immunization services
Immunization contributed health improvements in the WHO European Region EURO planning to eliminate measles and rubella from the Region by 2015 increase awareness on achieving/maintaining high childhood immunization coverage special efforts to improve immunization in undervaccinated population groups reviewing cross-border issues, including increasing mobility and migration, which raise a number of health security questions
Percentage of target population vaccinated, by antigen Type 2011 2010 2009 2008 2007 BCG 94 94 94 94 92 DTP1 97 98 97 98 98 DTP3 94 94 95 96 96 HepB3 77 78 78 78 78 Hib3 76 74 72 65 58 MCV 94 93 94 95 95 pab 90 90 71 71 71 PCV3 30 28 4 2 - Pol3 94 95 95 96 96 Rota_last 0 0 0 0 - TT2plus 81 81 82 56 55
NUMBER OF REPORTED CASES 2011 2010 2009 2008 2007
Immunization & Migration why a concern
Immunization & Migration why a concern Vaccine-preventable diseases, including measles, mumps, tuberculosis and hepatitis, are among the main causes of reported disease among the migrant population
Immunization & Migration why a concern high levels of population movement, about 5% migrant population in Europe and another 4% undocumented?? existence of unimmunized groups because of limited access to health care services continuing decline in vaccine acceptance among populations questionable data on actual coverage in some of the developing countries
Immunization & Migration why a concern Children born to immigrant mothers are less adequately vaccinated and settled in areas of low coverage Vaccination coverage of migrants associated with their level of integration in the new society, but also reflect the coverage of the area of origin
Qualitative research based on focus groups Conducted focus groups in 28 countries for a total of 53 focus groups involving 3710 participants. Is the most appropriate methodology for explore people s understandings and perceptions in depth. Sites selected based on the fact that population would be targeted by immunization programmes.
Focus group a representative group of people questioned about their opinions on the subject of research or issues, consumer products, etc.
Barriers identified positive view on immunization but several difficulties they faced when immunizing their children continued migration distance to immunization services fear of side-effects (particularly fever), not remembering immunization appointments, and the necessity of work. Access both geographical and financial was a considerable issue
Migration policies/practices among WHO EURO Member States No specific laws/regulations for migrant immunization No specific immunization requirements for working migrants Not specific migrant personal immunization card policy No cost for immunization for documented migrants. No access to immunization for undocumented migrants in most of the MS Communication barrier addressed in half of EURO MS No promotion material for migrant immunization in most of EURO MS No mechanism to monitor vaccine coverage for migrant population.
Forced Migration, Conflict & Natural disasters Continue to displace people, moving them into temporary displacement, refugee camps, or to urban slums where access to quality health services is limited
Forced Migration, Conflict & Natural disasters Conflicts Economic crises Natural Disasters Manmade disasters Climate changes
Forced migration; Displacement brings with it risks and vulnerabilities such as loss of land and work homelessness food insecurity health risks loss of access to common resources such as education destruction of social networks
S.A.G.E. Working Group on Vaccination during Emergencies Making the management of vaccination services responsive to the needs of migrants could increase vaccination coverage. Vaccination in Acute Emergencies: A Framework for Decision-Making
The Framework: Three Steps 1. An assessment of the epidemiological risk posed by each potentially important vaccinepreventable disease 2. Consideration of the properties of each vaccine to be considered for intervention and the feasibility of a mass vaccination campaign 3. Prioritization of the importance of vaccination in relation to other urgent public health
Conclusions and recommendations In many European countries undocumented migrants face the greatest problems in accessing health services and to cover the full costs medical treatment. Legal entitlements need to be expanded and health systems need to become more migrantfriendly Explicit migrant health policies needed in all European countries with a substantial proportion of migrants in their population.
.Universal citizenship to affirm that the modern society must recognize each individual as such a core of rights, which enable them to live safe from prevarication and in a civilized manner (Norbert Elias 1897-1990, sociologist)