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York: Childhood vaccination outreach for asylum-seeking families

City of York’s public health team recognised that the children in asylum-seeking families had often missed out on routine vaccinations. When other parts of Yorkshire experienced measles outbreaks, the team worked with local partners to prevent an outbreak in York’s migrant population.

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The challenge

Like other areas, York takes in and looks after its share of people going through the asylum-seeking process. Most of the people placed here are families with dependent children, who are temporarily housed in a city centre hotel which has self-catering apartment accommodation. There is capacity for about 350 people at any one time. 

The children are placed in local schools and families are registered with GP practices. York has a thriving voluntary, community and social enterprise sector, and Refugee Action York (RAY) plays a big part in helping the families to settle in and access community and wellbeing activities. 

Among other things, RAY hosts ‘coffee and chat’ sessions to help people to practice English and make friends. Public health officers attend some of them to promote services such as domestic abuse support and stop smoking support. They share information on how to navigate the health system, such as how pharmacies can help, and highlight free resources including libraries and health walks. 

Jennifer Irving, Public Health Specialist Practitioner at City of York Council, explained how the vaccination outreach work began. “When a child arrives in York, if their vaccination record is incomplete or unknown, their GP will start them on the UK childhood vaccination schedule. As these families have had to move around a lot and may have left their country in a hurry, there is often no evidence that these children have been vaccinated.”   

This became a more pressing issue when there were measles outbreaks in other parts of Yorkshire. As a first step, the team reviewed evidence from neighbouring councils who had done some work looking at the views and attitudes towards vaccination of asylum-seeking populations. 

“We could clearly see that there was no hesitancy towards vaccination in the traditional sense of the term, such as concerns about side effects or safety of the vaccination. That wasn’t the case for this community group at all – it was just that it had never got to the top of their priority list.” 

The solution

The York team decided to make it as easy as possible for these children to receive the MMR vaccine. They knew from work during the COVID-19 pandemic that taking a “needle to arm” approach could work in terms of increasing vaccination uptake.

They asked the Humber and North Yorkshire Integrated Care Board (ICB) to use their access to anonymised healthcare records to count the vaccination coverage, both in February 2024, before the intervention (which confirmed that the number of vaccinations received by this population group was very low) and afterwards to evidence its impact. 

The practical solution was to take two drop-in clinics into the hotel where these families were living. This involved public health working in collaboration with York’s primary care consortium (which brings together 11 GP practices) and Vaccination UK, the school vaccination provider. 

Delivery was a partnership of many organisations: Mears (the accommodation provider) organised space within the building; Refugee Action York led on promotion and advertising with support from public health; and Vaccination UK and the GP practices took charge of the clinical logistics.

The providers worked side-by-side, with primary care vaccinating children aged 0-5 and the school provider vaccinating over-fives. Clinics took place during the school holidays, enabling families to have children of different ages vaccinated at the same time. 

Much of the publicity work was done by RAY and through professionals working with this population group, including an advanced nurse practitioner who visits once a week. Philippa Press, Public Health Specialist Practitioner, said: “We were able to use these trusted people, friendly faces, to tell families about it and invite them along. By holding the clinics in one of the communal spaces at the hotel we took away all the barriers. There was no reason for families not to do it – and that’s why it worked so well.” 

The impact

Prior to the clinics, the total number of vaccinations received by this community group had been 137. By 5 April it had reached 264, almost doubling in a two-month period. Most of the new vaccinations were for MMR and the majority of children were now vaccinated. 

It took time and effort by public health and the providers to get these clinics in place. There was concern from some parts of the system that vaccine hesitancy might prevent families from taking up the offer, but this was not the case. The team are also ensuring that people know about other preventative healthcare such as sexual health, family planning, cervical screening and the stop smoking service.

The York partners now have a vaccination model that can be put in place whenever required. It uses existing contractual arrangements – for example, GP practices receive a per-person payment for infant vaccinations delivered as a catch-up to toddlers; and it is within the school age immunisation service contract to offer MMR at all opportunities. 

To support this work, Humber and North Yorkshire ICB were allocated £18,000 from NHS England for an ongoing vaccination project for asylum seekers arriving at the York contingency accommodation site. This recognised the importance of the work to maintain the population protection against outbreaks of communicable disease. Up to September 2024, the GP consortium had delivered nearly 300 additional vaccinations, with plans to continue into the autumn/winter. 

Jennifer Irving said: “These are families that have been focused on the day-to-day for a long time. Taking this ‘needle to arm’ approach to encourage vaccination uptake better supports our communities who find it more difficult to access health services. This is one small element of our work to reduce health inequalities and support the health and wellbeing needs of asylum seekers in York.” 

Contact

Jennifer Irving: [email protected] or Philippa Press: [email protected], Public Health Specialist Practitioners, City of York Council