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Increasing Vaccination Rates in Immigrant Communities—A One-Size-Fits-All Approach Doesn’t Work

May 22, 2024

There are multiple structural barriers to health care for children who are born to parents who are not US-born or who speak a language other than English, and these can lead to poorer health outcomes. Identification of communities for which these barriers are impacting specific health indicators, such as vaccination rates, is an important first step in making health care more accessible to these communities.

Given that one-quarter of children born in Washington state have at least one parent who is not US-born, Azadeh Tasslimi, MPH, and colleagues at Washington State Department of Health and the University of Washington did a deep dive into child vaccination rates by parental birth country to identify specific communities that might be experiencing lower vaccination rates and better understand the specific barriers to care. Their results are being early released this week in Pediatrics, in an article entitled, “Vaccine Coverage at 36 Months and 7 Years by Parental Birth Country, Washington State” (10.1542/peds.2023-064626).

The authors linked data from birth certificates (which include parental self-reported country of birth) and vaccine records for >900,000 children born in Washington state in 2006–2019. Vaccination status was assessed for MMR (measles, mumps, and rubella) at 36 months, and DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus) at 36 months and 7 years of age. Data for children with at least one parent born in Mexico, India, Ukraine, the Philippines, Somalia, Russia, Moldova, Romania, the Marshall Islands, and Micronesia were compared with data from those with 2 US-born parents.

Compared to children with 2 US-born parents, those with at least one parent born in the Philippines, India, and Mexico were 3–10% more likely to be up-to-date on those 3 vaccines. Children with at least one parent born in one of the other countries were less likely to be up-to-date, with those born to a Moldovan-, Russian-, and Ukrainian-born parent being the least likely (35–51% less likely) to be up-to-date.

In the discussion, the authors reflect upon reasons for these differences, which are very community specific. In an invited commentary, Dr. Elizabeth Dawson-Hahn from the University of Washington and Dr. Andrea Green from the University of Vermont suggest that cultural safety—a concept that goes beyond “cultural humility” and “cultural competence” to include recognition of “social, historical, political, and economic circumstances that create power differences and inequities in health”—should be considered when thinking about these community-specific differences (10.1542/peds.2023-065190).

If a parent has lived previously in another country, that might influence:

  • their views of the US healthcare system (is it better or worse than healthcare in their country of birth?)
  • trust in healthcare providers and governmental systems
  • trust in vaccines (do they have lived experience with vaccine-preventable diseases?)

Most of us work with families who are not US-born, and we use interpreters and translated materials to communicate with these families. However, while it is important to assure that information is translated appropriately, that is often not enough. We have to consider other barriers, and these barriers are often community specific.

I encourage you to read this article and the accompanying commentary. They will spur your thinking about how to approach your patients in a culturally safe manner.

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