Description
Introduction
Refugees and migrants faced heightened vulnerabilities during the COVID-19 pandemic, making them more susceptible to its physical, mental health, and socioeconomic impacts. Despite this, limited knowledge exists about the health needs of those "in transit," encompassing refugees, migrants in regular situations (MIRS), or migrants in irregular situations (MIIS). COVID-19 vaccines are crucial for preventing disease spread, with remarkable progress in research and development. Previous studies highlighted the structural and individual-level barriers to vaccine uptake among migrants and refugees.
The World Health Organization's (WHO) Strategic Advisory Group of Experts (SAGE) prioritized low-income migrant workers, irregular migrants, and those unable to distance, like those in camps for COVID-19 vaccination. Insufficient evidence on vaccination needs among refugees, MIRS, and MIIS hindered advocacy for inclusive policies. This study aimed to understand stakeholders' perspectives, explore barriers and facilitators, and highlight successful vaccination practices in Nepal. The national vaccination policy was also analyzed for complementary insights.
Methodology
We performed a brief policy review on COVID-19 vaccination, followed by key informant interviews (KIIs) with relevant stakeholders in Nepal's COVID-19 vaccination program. 9 key informants (KIs) from government sectors and humanitarian non-governmental organizations (NGOs) were purposively selected based on saturation principles. The interviews were conducted face-to-face from March to May 2022 following COVID-19 preventive measures and were audio-recorded with participants' consent, lasting 30-45 minutes each. Thematic analysis, combining inductive and deductive approaches, was manually performed on MS-Excel to extract insights on COVID-19 vaccination policies, barriers, facilitators, and examples of successful vaccination practices for refugees and migrants in Nepal.
Results and Discussions
The Nepalese government achieved a notable milestone by prioritizing the vaccination of vulnerable groups in accordance with the WHO guidance. Following the immunization of health workers and the elderly nationwide, the campaign extended to hard-to-reach communities, encompassing refugees and migrants. The Ministry of Health and Population (MoHP) formulated the National Deployment and Vaccination Plan (NDVP) for COVID-19 vaccines, outlining prioritization criteria and guiding allocation. The NDVP served as the primary policy for Nepal's COVID-19 vaccination program, and operational guidelines for the campaigns.
The KIs expressed uncertainty about estimating COVID-19 vaccination coverage among migrants and refugees initially, as they were excluded in the first wave due to a registration issue, later amended. Barriers identified by KIs included the need for identity documents during the initial vaccination phase, insufficient vaccine supply, lack of information about vaccination points, center inaccessibility, inconvenience, and language barriers. On a positive note, KIs highlighted inclusive national vaccination policies, free access, mobile vaccination teams, and fixed sites as facilitators. Effective coordination among central, provincial, and local governments, along with non-governmental organizations, played a crucial role in managing COVID-19 cases and achieving high vaccination coverage.
Conclusions
Nepal's inclusive vaccination policy promotes equitable COVID-19 vaccine access. This study highlights heightened vulnerabilities of refugees and migrants, emphasizing vaccines' crucial role. Despite commendable efforts, persistent gaps impede inclusive policies, requiring ongoing research and collaboration for global vaccination equity.
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