Photo Credit: Screenshot from website
Bar-Ilan's Azrieli School of Medicine.

High-profile COVID-19 vaccination campaigns have put a spotlight on the organization and delivery of vaccination services in the European Union. While there are particular challenges to mass COVID-19 vaccinations, many of the challenges are also common to routine vaccination programs, such as communication, availability of services, and adequate training of health professionals.

Many systemic elements of national immunization programs influence vaccination rates. This is particularly true for ethnic, religious, and cultural minorities who may face more barriers, such as restricted access to, or information about, health services, digital exclusion, exclusion from population registers, and culturally inappropriate messaging around vaccination.

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RIVER-EU (“Reducing Inequalities in Vaccine uptake in the European Region – Engaging Underserved communities”), a new initiative funded by the Horizon 2020 Research Program, is a five-year project that will collect evidence on health system determinants of high and low vaccine uptake in eight specific contexts, which will be used to identify and/or develop interventions to reduce barriers in underserved communities and increase trust in the health system.

“Despite high vaccine coverage in Europe overall, certain groups and communities are not fully benefiting from the opportunity to be protected from vaccine-preventable diseases and as a result are often disproportionately affected by infections. RIVER-EU will develop interventions specifically designed to ensure that these underserved groups receive the vaccines they are entitled to,” says deputy project leader Michael Edelstein, Associate Professor of Public Health at Bar-Ilan University’s Azrieli School of Medicine in Tsfat.

RIVER-EU will work to improve access to two vaccines — measles-containing vaccines and the human papillomavirus (HPV) vaccine — among specific underserved communities in Greece (refugees and migrants), the Netherlands (adolescents of Turkish and Moroccan origins), Poland (Ukrainian economic migrants) and Slovakia (Roma populations). The project will collect evidence on health system determinants of low vaccine uptake (barriers) in the five aforementioned communities, as well as on high vaccine uptake (enablers) in three underserved communities in the United Kingdom (the Bangladeshi community), Finland (the Somali community), and Israel (the Arab Israeli community).

In Israel, despite socio-economic disparities, the Israeli Arab population achieves very high vaccine uptake. The RIVER-EU consortium is focusing on this population to understand what enables this phenomenon because socio-economic deprived groups normally have lower vaccine uptake.

Based on the gathered evidence, insight from enabling factors in the UK, Israeli and Finnish contexts will be “translated” to provide useful insight to design interventions addressing health system barriers in the five target communities. RIVER-EU will design, implement and evaluate interventions to improve access to vaccination using a co-creative and collaborative approach. The lessons learned will be collected in a set of evidence-based guidelines and implementation recommendations and disseminated to health policymakers and professionals across Europe to improve the performance of vaccine programs and reduce vaccine inequalities.

“Our research focuses on changing healthcare and how we can increase vaccination coverage with targeted interventions,” says UMCG researcher and project leader Daniëlle Jansen. “To do this, we need to identify and remove barriers in the health care system. We will do this by adapting existing interventions and developing new interventions that are tailor-made with and for disadvantaged communities. Consider, for example, the extra training of professionals in approaching and convincing certain groups or addressing barriers posed by poverty, a different language, limited health skills or social exclusion.”

RIVER-EU’s diverse and highly-experienced consortium includes 13 project partners in addition to Bar-Ilan University’s Azrieli Faculty of Medicine: University Medical Center Groningen, Public Health England, the Institute of Preventive Medicine, Environmental and Occupational Health, EuroHealthNet, Connaxis, Vienna Vaccine Safety Initiative, Maastricht University, the European Academy of Paediatrics, University of Zielona Góra, Pavol Jozef Šafárik University in Košice, the London School of Hygiene and Tropical Medicine, the Finnish Institute for Health and Welfare, and the European Public Health Association.

The current pandemic has reinforced the central role vaccines play in protecting public health. It is fundamental to improve the responsiveness of health systems to ensure equitable access and uptake of vaccines against all vaccine-preventable diseases.

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