title: Migrant's access to immunization in Mediterranean Countries.
abstract: Countries bordering the Mediterranean are part of a major migration system. The aim of this study is to assess the main access barriers to immunization of mobile populations in the region and propose an action based framework to decrease health access inequalities. A survey on formal and informal barriers to immunization among mobile communities was conducted among public health officials formally appointed as focal points of the EpiSouth Network by 26 Mediterranean countries. Twenty-two completed the questionnaire. Thirteen countries reported at least one vaccine preventable disease (VPD) outbreak occurring among mobile populations since 2006 even though their legal entitlement to immunization is mostly equivalent to the general population's. Informal barriers, particularly lack of information and lack of trust in authorities, and disaggregation of data collection are the major issues still to be addressed. Mediterranean countries need to fill the gap in immunization coverage among pockets of susceptible individuals in order to prevent VPD outbreaks. Having for the most part ensured free entitlement, introducing more migrant friendly approaches, increasing information availability among mobile communities, building trust in public health services and disaggregating data collection to monitor and evaluate service performance among mobile groups are key aspects to address in the region.
authors.affiliation: Istituto Superiore di Sanità, National Centre for Epidemiology, Surveillance and Health Promotion, Viale Regina Elena, 299 00161 Rome, Italy. flavia.riccardo@iss.it
authors.forename: Flavia
authors.initials: F
authors.lastname: Riccardo
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Dente
authors.forename: Mira
authors.initials: M
authors.lastname: Kojouharova
authors.forename: Massimo
authors.initials: M
authors.lastname: Fabiani
authors.forename: Valeria
authors.initials: V
authors.lastname: Alfonsi
authors.forename: Anna
authors.initials: A
authors.lastname: Kurchatova
authors.forename: Nadezhda
authors.initials: N
authors.lastname: Vladimirova
authors.forename: Silvia
authors.initials: S
authors.lastname: Declich
mesh_terms: D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D019083:Mediterranean Region / Q000453:epidemiology; D011635:Public Health Administration / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data