Abstract
BACKGROUND: COVID-19 disproportionately affected asylum seeker and refugee (ASR) populations owing to language and cultural barriers, lower health literacy, polytraumas and mental health needs, and increased exposure. Despite this, there was vaccine hesitancy and low vaccination rates in ASR populations. AIM: To explore the attitudes to and experiences of the COVID-19 vaccination among ASRs. DESIGN & SETTING: Qualitative study of 12 diverse purposively recruited ASRs in Bristol. METHOD: Semi-structured interviews were conducted, transcribed verbatim, and analysed thematically to identify emergent themes. RESULTS: Eight refugees and four asylum seekers were recruited, five of whom were female and seven male, aged between 23 years and 48 years; together representing seven countries. Six were part of a UK Home Office (UKHO) resettlement programme, and six had arrived in the UK by independent means. Analysis showed delayed uptake rather than vaccine refusal owing to the following three main themes: systemic asylum issues (repeated relocation, uncertainty, and dependency on the charity sector); fear (secondary to social isolation, misinformation, and mental illness); and trust (surrounding access to care and community relationships). CONCLUSION: Fear, trauma, and isolation propagated by systemic issues are primary factors impacting healthcare decision making, and standard approaches to increasing vaccination uptake must be reconsidered in light of these issues. General practice must appreciate and invest in providing security in healthcare access for ASR populations. Barriers to practice registration must be overcome to enable ASRs to access care both around vaccination and afterwards. Communication must be clear and accessible to aid individuals in making informed decisions, balancing the benefits and potential risks of vaccinations.