Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Saad B. Omer


BackgroundIn 2020, approximately 26 million refugees resettled in a new country—fleeing their homes due to conflict, persecution, violence, and human rights violations. Refugees often migrate from developing countries with limited access to adequate health care, routine immunizations, and public health resources. Because of low immunization coverage and potentially underlying health conditions, including stress, trauma, overcrowding during transit, poor hygiene and sanitation services, and malnutrition, refugees face a greater risk of contracting vaccine-preventable diseases (VPDs). This presents a key public health challenge and ethical imperative to serve the health needs of refugees resettling each year.

ObjectiveThe purpose of our study was to collect, analyze, and compare policies and guidelines related to routine immunizations for refugees across 20 low- and middle-income countries (LMICs) and 20 high-income countries (HICs), with the highest number of refugees per 1000 residents.

MethodsPrimary and secondary data sources were used to collect policy evidence from LMICs. Primary data were obtained from WHO-country officers, who were emailed between November and December 2020 to confirm data collected, provide additional information, and/or recommend different contact person(s). Secondary data for both LMICs and HICs were collected systematically through searches of information from government health ministries, public health agencies, non-governmental organizations, and the medical and public health literature.

ResultsAmong the 20 LMICs, the number of refugees per 1000 residents ranged from 8 to 209 refugees, while for the 20 HICs it ranged from 2 to 15 refugees. Across the policy data collected for 20 LMICs, 13 countries specified standing routine immunization policies and guidelines applicable nationwide for refugees, five countries reported refugee vaccination guidelines only in response to specific infectious disease outbreaks, and six countries published guidelines on time-limited vaccination campaigns for refugees. Among the 20 HICs, 14 countries included refugees in their national routine immunization programs, 10 countries required a basic clinical screening prior to arrival, and 18 countries required a basic clinical screening upon arrival. Additionally, 15 HICs implemented local, community refugee clinics to provide routine immunizations, seven HICs required refugees to pay out of pocket for their vaccinations, and 11 HICs required refugees to receive specific vaccinations upon arrival.

DiscussionRefugees are at increased risk of contracting infectious diseases. Our review of routine immunization policies and guidelines for refugees in 20 LMICs and 20 HICs, with the highest number of refugees per 1000 residents, found significant variations in how countries provide and deliver immunizations to their refugee communities. LMICs and HICs must strongly consider including refugees in their national routine immunization programs, providing easily accessible and affordable vaccinations, and collecting routine immunization data for refugees to reduce vaccine-preventable diseases and protect the health of refugee populations—especially during the COVID-19 pandemic.


This is an Open Access Thesis.

Open Access

This Article is Open Access