Substantial differences in vaccination rates among immigrant health care workers in Norway

Earlier studies have shown that minority groups tend to have lower vaccination rates compared to the general population. A new preprint examined the coronavirus disease 2019 (COVID-19) vaccination rates among health care workers (HCWs) in Norway, according to immigrant background.

Study: COVID-19 vaccination rates among health care workers by immigrant background. A nation-wide registry study from Norway. Image Credit: Orpheus FX/ ShutterstockStudy: COVID-19 vaccination rates among health care workers by immigrant background. A nation-wide registry study from Norway. Image Credit: Orpheus FX/ Shutterstock

A preprint version of the study is available on the medRxiv* server while the article undergoes peer review.

Background

By 5 September 2021, over 90% of HCWs in Norway had taken one or two doses of a COVID-19 vaccine. However, some minorities tend to have more vaccine hesitancy than the Norwegian population overall.

This is especially true of those who have immigrated from Eastern Europe, Western Asia, and Africa. An early report indicated that people above 75 years who were Scandinavian by birth were likely to be vaccinated in over 90% of cases, vs. 34% in those born in Somalia.

The study included over 356,000 HCWs, of which approximately 80% were women. The median age was 41 years. Of these, about a sixth were immigrants, and only about 5,000 were born in Norway to immigrant parents

What did the study show?

The study showed that 92% of all HCWs had been vaccinated by 31 August 2021, but only 85% of immigrant HCWs were vaccinated. This is nine percentage points lower compared to non-immigrant HCWs, as of 31 August 2021. The highest uptake was for those from Vietnam, Thailand, Sri Lanka, Denmark, the UK, and India, at 94% and upwards.

The latter groups had a higher crude vaccination rate than non-immigrants, and even after adjustment, Thai, Vietnamese, Sri Lankan, and Filipino immigrants continued to show this trend.

Those born in Norway to immigrant parents had an 88% vaccine uptake rate. The vaccination rates were lowest for Russian immigrant HCWs at 71%, increasing gradually but with Serbia, Lithuania, Romania, Poland, Eritrea, and Somalia showing rates between 72-78%.

However, when the occupation was adjusted, it was seen that the presence of a higher proportion of healthcare assistants among the HCW immigrants from Eritrea and Somalia led to higher vaccine uptake.

Overall, a quarter of HCWs were health care assistants, but two-thirds of Syrian immigrant HCWs, half of those from Eritrea or Afghanistan, and over 40% of those from Somalia.

These findings also underline the long-observed association between higher HCW education ad vaccination rates until the last month. While 97% of physicians and specialist nurses were vaccinated, healthcare assistants had the lowest uptake in this occupational group at 89%. Healthcare assistants consistently had a lower vaccination rate throughout the vaccination program, indicating a lower priority.

Within each group, this link is still more obvious, with physicians from Lithuania showing 92% vaccination vs. 66% for healthcare assistants, compared to 94% and 87% respectively for those from Pakistan.

What are the implications?

The study demonstrates marked differences in vaccine uptake rates among HCWs in Norway, based on their immigration background. Some of this discrepancy is because of differences in the occupation, which may have led to lower vaccine access.

The lowest vaccination rates among immigrants were among those from Eastern Europe. They appeared independent of occupational subgroups, while in those from East Africa, the occupational details were related to the vaccine uptake.

Factors related to a lower vaccination rate among certain immigrant subgroups of HCWs may include limited access, lower priority in the vaccine program, younger age, risk factors for severe COVID-19, and geographical location in high-incidence areas. These were adjusted in the current study.

However, factors like lower access to or competence in handling digital services, language barriers, and logistical issues were not addressed separately. Vaccine hesitancy has been found to exist, especially among those born in Eastern Europe, Western Asia, and Africa. Only 40% of those born in Eastern Europe were willing to take the vaccine.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Kraft, K. et al. (2021) "COVID-19 vaccination rates among health care workers by immigrant background. A nation-wide registry study from Norway". medRxiv. doi: 10.1101/2021.09.17.21263619.
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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