Fairness-based techniques to optimize vaccine allocation among migrants during pandemics: A scoping review

Abstract

Introduction. Migrants face significant barriers to vaccination due to disparities in access and coverage, necessitating fairness-based strategies and inclusive healthcare infrastructure to ensure equitable immunization, especially during pandemics. This study investigates fairness-based vaccination strategies, focusing on migrant vaccination status during pandemics, and migrant specific vaccine distribution models. Methods. The authors employed established scoping review methods to explore the research question: How have fairness-based strategies for vaccine allocation affected vaccination coverage among migrants during pandemics in urban and rural areas? A scoping review was conducted following the PRISMA and expectation, client group, location, impact, professionals, and service (ECLIPSE) guidelines, utilizing the Joanna Briggs Institute’s Checklist for Qualitative Research. The review involved a comprehensive database search across PubMed, Scopus, Web of Science, Cochrane Library, and Ovid MedLine. The eligibility criteria for publications included at least one of the following aspects related to migrants: access to vaccines or frequency of vaccine uptake, vaccine hesitancy, vaccine modeling and optimization approaches, or discussions grounded in principles of fairness. Searches were limited to the articles published in English between 2000-2022. Initially, 5,653 articles were identified, which were reduced to 305 after title screening. Following abstract screening, 19 articles meeting the inclusion criteria—focused on vaccination modeling, allocation, fairness optimization, and behaviors or attitudes in migrant populations—were selected for full-text evaluation. Results. Vaccination rates among migrants range from 42.7% to 87%, which are lower compared to the host population. Although the willingness to vaccinate is around 70%, significant barriers such as language obstacles, lack of access to healthcare services, and insufficient information remain critical challenges. While 19 of the studies defined fairness through the use of health services, four of them discussed it on community participation, and two employed modeling approaches. Various techniques, including community involvement, digital health messages and national refugee centers, have been employed to allocate vaccines fairly and consistently. The concept of equity has been addressed inconsistently across studies, and there is insufficient data to develop a fair vaccine distribution strategy for migrant populations. Conclusion. This study highlights the following: (1) the challenges migrants face, including limited access to healthcare, language barriers and poor living conditions, which complicate equitable vaccine allocation; (2) the lack of specific, systematic national vaccine allocation programs targeting migrants; and (3) the need for a targeted, fairness-based approach, along with further research on national policies and vaccine delivery models that prioritize migrants and address their unique vulnerabilities.