Lack of trust leads to low vaccine uptake among eastern Europeans

More than 90 per cent of Irish-born adults have received two doses of a vaccine and are, therefore, considered to be fully vaccinated. So far, nearly 900,000 people have also accepted a booster jab.

However, the uptake among eastern Europeans living here is much lower, with data compiled by the ESRI indicating that the vaccine take up among people from eastern Europe resident in Ireland is between 56 and 66 per cent, indicating that between almost a half and one third remain unvaccinated.

The challenge of getting reliable information through to foreign-born nationals and thereby building trust has been recognised by the HSE from the early days of the pandemic, but doing so is not easy.

Information has been published in up to 35 languages and advertising through locally produced media targeting immigrant populations, along with using immigrant organisations to spread messages.

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In recent weeks, the HSE has engaged with embassies here and other links to migrant communities through the Department of Justice, says David Leach, HSE deputy national director.

Healthcare is always difficult with marginalised communities,” says Leach. “I wouldn’t underestimate the fact that many of these people are poorer people doing menial jobs our own people don’t want to do.”

The vaccination rate for eastern European-born immigrants is far lower than the figures reached among other immigrant communities, according to research produced by the ESRI's Pete Lunn.

Take-up among UK-born nationals living in Ireland, statistically the largest cohort of foreign-born nationals resident in the country, is statistically little different from the take-up by Irish-born nationals.

Meanwhile, the vaccination record of immigrants from other parts of the world is 79-89 per cent – lower than the native population, but far, far higher than those from eastern European countries.

However, there is a qualifier here. Official figures for the number of foreign-born nationals living in Ireland are out of date because last year’s census was cancelled due to the virus.

The most up-to-date figures come from the 2016 Census, but this does not take account of immigrants who may have returned home if they lost jobs during the height of the pandemic, or because of a desire to be close to family.

However, the Central Statistics Office (CSO) estimates there are a total of 645,500 foreign-born nationals living in Ireland, accounting for about 13 per cent of the total population.

If confirmed by next April’s census, this would represent, despite Covid and any collateral effects of Brexit, an increase from the 535,475 figure of foreign-born nationals recorded as living here in the 2016 Census.

Previous experience

The figures for what is presumed to be vaccine hesitancy among eastern European reflects the experience in their home countries, where vaccination rates are poor.

Just 29 per cent of people in Bulgaria are fully vaccinated, the lowest figure in a survey conducted by the EU's European Centre for Disease Control and Prevention (ECDC).

"There's a vaccine programme in Bulgaria but I cannot explain why people are not vaccinated," says a Sofia diplomat in Dublin. "Maybe it's communication? Bulgaria encourages vaccination."

And the figures are poor across the region.

Death figures are directly linked to poor vaccination rates: 325 people per million are now dying with Covid in Bulgaria, 267 for Romania, 266 for Latvia, 168 for Croatia, 135 for Hungary, down to 29 for Slovakia.

The best performers in the ECDC set of countries are Ireland and Portugal where, respectively, vaccine take up is 93 and 92 per cent and deaths per one million are 15 and 10.

The effects of vaccine hesitancy are clear, with HSE director Paul Reid pointing out this week that about 50 per cent of hospitalised Covid patients are unvaccinated, both Irish-born and foreign-born.

Mistrust

The attitude of some eastern European immigrants reflects a profound mistrust of authority, stemming from both the legacy of communist rule and the corrosive effects of social media-fuelled conspiracy theories.

The decline in the belief notion that "most people can be trusted" has been most pronounced in post-communist countries, according to the Taking Stock of Shock study conducted by Kristen Ghodsee and Mitchell Orenstein.

"The low level of public trust that distinguishes eastern Europe is a legacy of the collapse of communism, the deep transitional recession in many countries, and the failure of post-communist governments to mitigate effects," they write.

Elsewhere, Cosmin Toth, a sociologist at the University of Bucharest, capital of Romania, cites “hatred against the political system” as a reason for low vaccine take-up there.

Here, Lunn suggests two paths to counter vaccine hesitancy. Firstly, the way in which vaccines work must be properly explained, while misinformation must be tackled head on.

For instance, some hesitancy relates to the speed with which the Covid vaccine was engineered, and tested prior to use, relative to other vaccines. Worries are expressed that corners were cut that have compromised safety.

The truth, says Lunn, is that medical research and vaccine development teams ran multiple checks in parallel, rather than one after another, thereby cutting down development time, leading to rapid approval by oversight authorities.

However, Lunn says such research as exists on the non-take-up of vaccination among resident foreign nationals suggests that only a minority actually hold anti-vax views.

“What comes back is that there is a problem of trust of people in authority, of government and doctors. A lot of people who are not taking the vaccine are not following the domestic [Irish] news. Our evidence suggests that,” he says.

Leach agrees: "It's a bit like the Irish in the UK or Australia – they don't necessarily consume local news but turn to home sources and their own circles," he says.

Domestic media

The second front of action by the HSE is to work on getting migrant communities more plugged into domestic media, thereby digesting more consistently the same messaging that is reaching the bulk of society.

Vaccine promotion campaigns among migrant communities do work but progress is slow. In recent months, there has been a one percentage point vaccine take-up in those living in Monaghan, Donegal and Laois.

“We are seeing inroads, but it’s slow and painstaking,” Leech tells The Irish Times, adding that the level of mistrust among some east European-born nationals is deep.

“It is rooted in their history, their lived history. These things are ingrained in their psyches. They have a huge resistance to vaccines because governments forced it in the past and used it as a tool.

“This is what communities tell us. Migrant communities tend to be poorer and less integrated. We have to remove those barriers of literary, geography and of information,” he says.