Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

Winifred Ekezie, Samy Awwad, Arja Krauchenberg, Nora Karara, Łukasz Dembiński, Zachi Grossman, Stefano Del Torso, Hans Juergen Dornbusch, Ana Neves, Sian Copley, Artur Mazur, Adamos Hadjipanayis, Yevgenii Grechukha, Hanna Nohynek, Kaja Damnjanović, Milica Lazić, Vana Papaevangelou, Fedir Lapii, Chen Stein-Zamir, Barbara Rath*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.

Original languageEnglish
Article number1038
Number of pages24
Issue number7
Early online date28 Jun 2022
Publication statusPublished - 1 Jul 2022

Bibliographical note

Copyright © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (

Funding Information:
The ImmuHubs project is co-funded by European Union’s Health Programme (2014–2020) and coordinated by the Vienna Vaccine Safety Initiative (, accessed on 13 June 2022), in collaboration with academic institutions, NGOs and public health agencies in Europe as well as the European Academy of Paediatrics and the European Parents’ Association.


  • disadvantaged groups
  • Europe
  • health services
  • immunisation programs
  • inequalities
  • migration
  • vaccination


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