US immigrants have varied burden of preventable infectious diseases but low vaccine uptake, data reveal – CIDRAP

Report on Vaccine-Preventable Diseases and Sustainable Development Goals Among US Immigrant Populations

Analysis of Communicable Diseases in Detention Facilities in Relation to SDG 3 and SDG 10

Key Findings: Disease Prevalence and Contributing Factors

A case series study conducted from January 2019 to October 2023 across 20 US Immigration and Customs Enforcement (ICE) detention facilities revealed a significant burden of vaccine-preventable diseases. The findings include:

• Influenza: 2,035 cases
• Mumps: 252 cases
• Hepatitis A: 486 cases

Contributing factors to disease transmission were identified, which hinder progress toward global health goals:

• Facility crowding
• Suboptimal sanitation
• Limited access to healthcare
• Poor ventilation
• Inconsistent diagnostic practices

Alignment with SDG 3: Good Health and Well-being

The high prevalence of these diseases directly challenges the achievement of SDG Target 3.3, which aims to end the epidemics of communicable diseases. The lack of mandated vaccination standards for detainees (except for COVID-19) represents a critical gap in fulfilling SDG Target 3.8, which calls for universal health coverage, including access to essential medicines and vaccines for all.

Alignment with SDG 10: Reduced Inequalities

The disproportionate disease burden observed in this vulnerable population highlights significant health disparities. This situation runs counter to SDG Target 10.3, which focuses on ensuring equal opportunity and reducing inequalities of outcome. The conditions within detention facilities exacerbate the health vulnerabilities of migrants and refugees.

Recommendations for Institutional Action (SDG 16)

To address these challenges and align with SDG 16 (Peace, Justice and Strong Institutions), which calls for effective and accountable institutions, the following actions are recommended:

1. Implement decongregation policies and control facility crowding to reduce transmission risks.
2. Establish and fund comprehensive vaccination programs for all vaccine-preventable diseases within detention facilities.
3. Improve institutional health and sanitation standards to protect the health of detained migrants, facility employees, and the broader community.

Assessment of Vaccination Gaps in Primary Care and Implications for SDG 3

Key Findings: Low Tetanus/Diphtheria Vaccine Series Completion

A second study, analyzing health records from 2017 to 2022, found critically low vaccination rates among adult immigrants and refugees in primary care settings. Key data points include:

• Only 28.0% of 50,829 patients had documented completion of the three-dose tetanus/diphtheria vaccine series.
• Vaccination coverage was lowest among patients aged 65 and older (21.2%).
• Individuals with at least six primary care visits had higher completion rates (36.3%) compared to those with one or no visits (12.6%).

Systemic Barriers and Electronic Health Record (EHR) Deficiencies

A primary obstacle identified was the failure of health information systems to support vaccination efforts. Among 36,612 adults without documented vaccine series completion, the EHR system identified only 34% as being overdue. This indicates that EHR algorithms are not adequately designed to track primary series completion, instead focusing on 10-year booster recommendations.

Implications for SDG 3: Universal Health Coverage

These findings reveal a significant barrier to achieving SDG Target 3.8 (universal health coverage). The failure of health systems to accurately identify and address the vaccination needs of immigrant and refugee populations undermines the goal of providing equitable access to essential vaccines for all. It highlights a systemic weakness in delivering preventative care to diverse populations with varying medical histories.

Recommendations for Health Systems

To improve immunization coverage and advance SDG 3, health systems should:

1. Revise EHR algorithms to accurately identify and flag patients who lack documentation of a primary vaccine series.
2. Integrate protocols that account for variations in childhood vaccination coverage by a patient’s country of birth.
3. Implement systematic processes to confirm prior vaccination history, ensuring that all adult immigrants and refugees receive the necessary immunizations.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s primary focus is on the health of immigrants, refugees, and detainees, specifically concerning the prevalence and prevention of infectious diseases like influenza, mumps, hepatitis A, tetanus, and diphtheria. It directly addresses the need to ensure healthy lives and promote well-being for this vulnerable population.

SDG 10: Reduced Inequalities

• The article highlights significant health disparities. It compares the lower vaccination completion rates of immigrant and refugee adults (“28.0%”) to the U.S.-born population and details the high burden of disease within specific settings like ICE detention facilities. This points to inequalities in health outcomes and access to healthcare based on origin and status.

SDG 16: Peace, Justice and Strong Institutions

• The article critiques the institutional frameworks governing detention centers. It notes that “except for COVID-19, there are no US detention standards for vaccinations,” indicating a weakness in institutional policy and practice. The call for “reviewing compliance with IHSC mandates” and implementing vaccination programs points to the need for more effective and accountable institutions to protect the health of those in their care.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” The article directly addresses this target by investigating the high prevalence of communicable diseases such as influenza (2,035 cases), mumps (252), and hepatitis A (486) within detention facilities and advocating for measures to reduce their transmission.
• Target 3.8: “Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The article highlights a clear gap in achieving this target by revealing that “only 28.0% of immigrant and refugee adults have completed their tetanus and diphtheria vaccine series” and pointing to “suboptimal immunization rates” and “limited health care access” for this population.

SDG 10: Reduced Inequalities

• Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome…” The article identifies an inequality of outcome where “immigrant and refugee adults have lower completion rates for tetanus/diphtheria vaccination series” compared to U.S.-born persons. The lack of vaccination standards in detention centers is a policy gap that contributes to these unequal health outcomes.
• Target 10.7: “Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies.” The health risks faced by migrants in detention centers due to “crowding, suboptimal sanitation, [and] limited health care access” demonstrate a need for better health considerations within migration policies to ensure the safety and well-being of this population.

SDG 16: Peace, Justice and Strong Institutions

• Target 16.6: “Develop effective, accountable and transparent institutions at all levels.” The article’s finding that there are “no US detention standards for vaccinations” for most diseases and its call for “reviewing compliance with IHSC mandates” directly relate to the need for more effective and accountable institutional practices within ICE and its health services to protect detainees.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• Incidence of communicable diseases: The article provides specific data that can be used as indicators, such as the number of cases of influenza (2,035), mumps (252), and hepatitis A (486). It also provides disease rates, for example, the “average monthly facility flu case rate was 17.3 per 100,000 people,” which can be tracked over time to measure progress in combating these diseases (Target 3.3).
• Vaccination coverage rates: The statistic that “only 28.0% of immigrant and refugee adults have completed their tetanus and diphtheria vaccine series” is a direct indicator of vaccination coverage within a specific population. Tracking this percentage is a clear way to measure progress towards universal access to vaccines (Target 3.8).

Indicators for SDG 10

• Disparities in vaccination rates: The article implies an indicator by stating that “immigrant and refugee adults have lower completion rates for tetanus/diphtheria vaccination series” compared to the U.S.-born population. The gap between these two groups’ vaccination rates can be measured to track progress in reducing health inequalities (Target 10.3).

Indicators for SDG 16

• Existence of public health policies and standards in institutions: The article points to a clear indicator: the presence or absence of vaccination standards in detention facilities. The statement that “there are no US detention standards for vaccinations” for most diseases serves as a baseline. The implementation of such standards would be a direct indicator of institutional improvement (Target 16.6).

4. Table of SDGs, Targets, and Indicators

Source: cidrap.umn.edu