Exploring Childhood Immunization Among Undocumented Migrants in Sweden - Using the WHO Tailoring Immunization Programmes (TIP) Guide

Background National vaccine coverage in Sweden is high. Recurrent outbreaks of measles and rubella however highlight that there are immunity gaps in the population. Current knowledge about immunization status of undocumented migrant children is scant. The WHO/Europe has developed the Guide to tailoring immunization programmes (TIP) to assist countries in diagnosing barriers and motivators to vaccination in communities with low vaccination coverage. This study explored determinants to vaccination among undocumented immigrants, using the TIP guide. Methods This was qualitative study featuring interviews of seven undocumented parents recruited at nongovernmental clinics; three nurses at Child Health Centers; and information from key stakeholders retrieved at workshops as part of the TIP process. Findings The content analysis revealed two main themes: parental fear of being questioned and parental acceptance of child immunization. Undocumented parents had a positive view and attitude towards childhood immunization but expressed strong fear of being asked for identification papers at health care facilities. Frequent mobility among undocumented may limit access to complete immunization schedule. Undocumented parents mistrust health care providers and avoid health facilities, further delaying childrens' access to health care, including immunization services. Interpretention The findings of this study confirm the complexity of barriers that undocumented parents face regarding childhood immunization. The TIP guide offers a valuable process for mixed data collection and analysis, for a deeper understanding of the determinants of immunization challenges among undocumented migrants. Funding: The Public Health Agency of Sweden and WHO/Europe. Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: The study received ethical approval for the interviews from the Regional Ethics Committee in Stockholm, Sweden, Dnr 2013/678-31/3.