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Item type:Publication, The importance of confidence, complacency, and convenience for influenza vaccination among key risk groups in large urban areas of Peru(Taylor & Francis, 2020-08-04)Influenza vaccination has been available under Peru's national immunization program since 2008, but vaccination coverage has decreased lately. Surveys and focus groups were conducted among four risk groups (pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥65 years) to identify factors affecting influenza vaccine hesitancy in Peru. The 3Cs model (Confidence, Complacency, and Convenience) was used as a conceptual framework for the study. Most pregnant women and mothers of young children (70.0%), but less than half (46.3%) of older adults and adults with risk factors were vaccinated against influenza. Vaccine confidence and complacency were positively associated with educational level. Complacency was the most deficient of the 3Cs. Pregnant women and mothers were the most informed and least complacent among risk groups. Focus groups revealed the misconceptions behind the high level of complacency observed, including the perception of influenza risk and the role assigned to vaccination in preventing the disease. Interviews with officials identified that most strategies are directed to vaccination availability and hence to convenience, with opportunities for strategies to improve vaccination uptake and community engagement. The results highlight the importance of implementing in Peru communication strategies to increase perceptions of vaccine safety and effectiveness thus improving confidence and reducing complacency. The establishment of explicit incentives should also be considered to increase vaccination uptake, particularly to health personnel. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates(Public Library of Science, 2020-12-01)INTRODUCTION: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. METHODS: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. RESULTS: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. CONCLUSIONS: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Health policy and systems research publications in Latin America warrant the launching of a new specialised regional journal(BioMed Central Ltd, 2020-06-05)Background: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies. Methods: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables. Results: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome. Conclusion: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Migration and health in Latin America during the COVID-19 pandemic and beyond(Elsevier, 2021-04-03) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The response of health systems to the needs of migrants and refugees in the COVID-19 pandemic: A comparative case study between Mexico, Colombia and Peru(Elsevier Ltd, 2024-12-01)Protecting the health of migrants and refugees during the pandemic was a significant challenge in the Latin American region. We aimed to describe and contrast the response of the health systems of Mexico, Colombia and Perú to migrants' and refugees’ health needs during the COVID-19 pandemic, and to situate the response in the context of the migration and health policies of each country. Methods: We conducted case studies of the three countries. The data collected for each case included: 1) policy documents; 2) peer-reviewed and grey literature; 3) qualitative interviews with key informants. Findings: The three countries issued policies to detect COVID-19 cases among migrants and refugees, and granted them access to COVID-19 care regardless of their migration status or facilitated regularization as a way to improve access to care. However, other health care needs were not considered, some groups of migrants remained invisible in the policies, and policies rarely considered the increased social and economic vulnerability of migrants and refugees during this period. Pre-existing barriers to care were made worse during the pandemic. All three countries’ response to migrants was reliant on non-governmental organizations, with international cooperation being especially active in Colombia, and local civil society organizations in Mexico. Interpretation: The response of each country was a continuation of their previous approach to migration and health. Developing plans for pandemic response that consider migrants and refugees’ particular needs will be important to improve response capacities in the future. Funding: Funding was provided by USA for the International Organization for Migration (IOM) under an agreement with the Johns Hopkins Center for Humanitarian Health. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Defining drivers of human papillomavirus (HPV) vaccine uptake in migrant populations globally and strategies and interventions to improve coverage: a systematic review(2025-02-02)Background The Cervical Cancer Elimination Initiative by the World Health Organization (WHO) has set a target of 90% human papillomavirus (HPV) vaccination coverage among girls by age 15 by 2030 to dramatically reduce deaths from cervical and other HPV-related cancers. However, progress has been slow, with only 27% global coverage in 2023. Migrants are considered an under-immunised group globally for many vaccine-preventable diseases, with data showing that they may experience a high burden of HPV infection and widespread HPV under-immunisation. Better understanding of the factors influencing the ability of these communities to get vaccinated for HPV is important. We aimed to systematically synthesise evidence on drivers of HPV vaccination uptake in migrants, and explored recommended approaches, strategies, and best practices to promote uptake in these communities. Methods We searched seven databases (e.g., Medline, Global Health) and websites (WHO, IOM, Google Scholar) for literature on drivers of HPV vaccination uptake among migrants globally, published between January 2006 and December 2024 in any language. Data on influencing factors for HPV vaccination uptake in migrants were extracted for an integrated approach to synthesising findings, and recommended strategies to improve it were compiled. We conducted a hybrid thematic analysis using the WHO BeSD model and assessed risk of bias with Joanna Briggs Institute checklists. PROSPERO protocol: CRD42023401694. Findings We identified 1,806 database records and 1,756 records from websites, ultimately including 117 studies with 5,638,836 participants across 16 countries and one territory (including 933,187 first- and second-generation migrants, mostly defined as foreign-born in high-income countries). Factors negatively influencing vaccine uptake included concerns about vaccine safety, cultural beliefs, uncertainty about HPV vaccines/infection, low knowledge of HPV/HPV vaccine, gender/sex, inter-generational and family dynamics, exposure to negative information, and lack of recommendations from healthcare providers. Practical barriers included limited information on services, language issues combined with a lack of skilled interpreters, logistical challenges, and the high cost of the vaccine. Enablers mainly included positive perceptions and trust in the vaccine and healthcare providers, realistic expectations from parents regarding the sexual activity of adolescents, a sense of responsibility, as well as recommendations from healthcare providers and support from social networks. Other positive predictors of vaccine uptake included being female, and having a history of vaccine-preventable diseases or abnormal Pap test results. Findings highlighted that free-of-charge and school-based schemes were effective in increasing uptake, while mandatory or optional schemes were less popular. Key recommended approaches included culturally sensitive messaging and tailored communication for different target groups (e.g., parents/caregivers, adolescents), with an emphasis on strength framing. Deploying trusted mediators (e.g., peer school health promoters, religious champions, community health workers) and implementing practical solutions to address missed opportunities (e.g., bundling HPV vaccination with other services) and for mobile migrants (e.g., eHealth) were also emphasised. Additionally, strong provider recommendations and reducing access barriers through measures including walk-in, mobile, and outreach services were recommended, alongside addressing broader cross-cutting issues, such as strengthening vaccine monitoring systems. Interpretation This review showed that migrants worldwide face complex individual, family/social, and provider/system-level barriers to HPV vaccination, resulting in missed opportunities for protection. In many low- and middle-income countries (LMICs), the vaccine is either unavailable or has to be paid for. Achieving global commitments for universal and equitable immunisation across the life-course, making progress toward cervical cancer elimination, requires addressing these barriers through multi-pronged strategies. This includes combining effective health communication to build trust and address negative perceptions, along with efforts to eliminate physical barriers to vaccine access. Given the lack of data from LMICs, future research must urgently explore specific drivers of HPV vaccination among migrants in these regions where they are more concentrated and access to the HPV vaccine is limited, as well as develop solutions to system-level problems. Collaborative efforts with migrant communities are essential to co-develop effective, tailored delivery models that meet their unique needs. Funding This research was funded by the NIHR (NIHR300072), the Academy of Medical Sciences (SBF005\1111), and the Medical Research Council (MRC/N013638/1).1 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 265 Migration and health research in turbulent times: navigating and strengthening evidence and politics, for improved evidence-based policy across regions(Oxford University Press, 2025-12-01)WKS 27: Impact of a changing political environment on research on migration and health in Europe and Latin America: Challenges and opportunities, B305 (FCSH), September 5, 2025, 09:00 - 10:00 Amidst rising political polarization and widespread funding cuts, migration and health research is increasingly constrained, with growing implications for evidence-informed policymaking. This round table convenes experts from the European and Latin American Regional Hubs of Lancet Migration, a global initiative launched following the 2018 UCL–Lancet Commission on Migration and Health and from WHO Health and Migration to reflect on how best to jointly respond to these challenges. The session aims to foster dialogue on how researchers can respond to today's complex geopolitical realities and safeguard the integrity and impact of migration health research. Guided by the WHO Research Agenda on health, migration and displacement and its implementation, the discussion will explore global, regional and national experiences and strategies for adapting to shifting priorities, and the role of research agenda setting in a constrained funding environment. Panellists will examine the role of researchers and policy makers in prioritising the topic of health and migration in politically unstable environments, the use of evidence and opportunities for translation by policymakers, and the ethical tensions surrounding objectivity and independence in research. This session underscores that evidence dissemination and translation into policy in migration and health is under threat. It calls for collective action by global academics and policy makers to anticipate and respond to evolving political and financial pressures to continue to prioritise this topic. By sharing cross-regional and global insights and strengthening networks, the round table seeks to equip researchers with tools to remain effective and resilient in their work—despite mounting external constraints.2