How do you reach refugee communities and encourage uptake of the Covid-19 vaccine, when some don’t even believe the virus is real? Dr Abela Mahimbo found out.

An illegal gathering

 

At the height of the COVID-19 lockdown emergency in August 2021, 60 people, including children, travelled to The Christ Embassy at Blacktown for worship.

 

They came from all over western and south-western Sydney, then the epicentre of the burgeoning pandemic.

 

The service violated almost every health order then in force, and resulted in fines totalling almost $50,000 for the pastor and the worshippers.

 

Pastor Martin Osaghae reportedly told the congregation:

 

"In the name of Jesus, we refuse every lockdown in our cities, in the name of Jesus go ahead and pray."

 

The event was a perfect example of the need to communicate the urgency of health orders and explore ways of promoting vaccine uptake in migrant and refugee communities.

Reaching refugees

Dr Abela Mahimbo

Dr Abela Mahimbo

The NSW Refugee Health Service engaged Dr Abela Mahimbo, lecturer in the School of Public Health, to explore refugees' perceptions, attitudes, and concerns about the COVID-19 vaccines, their information needs as well as barriers and facilitators to accessing the vaccines.

The project ran from March to August.

“This was a period where there was a lot of hesitancy with concerns of vaccine safety,” Dr Mahimbo said.

“Refugees are hard to reach. They have language barriers and therefore have limited access to mainstream media.

“Much of their information was coming from social media, which wasn’t always accurate.”

Dr Mahimbo is a trained medical doctor from Tanzania who migrated to Australia in 2012 to undertake a Master of Public Health and Health Management and thereafter a PhD to examine policies and practices in immunisation service delivery for refugees.

Language barriers

The project targeted refugees aged over 18 years from four language-speaking groups: Arabic, Dari (Afghan), Dinka (South Sudan), and Karen (Myanmar) in southwest and western Sydney.

Because of the language barriers, she had to train bilingual community educators in the aims of the project and how to run a focus group.

What she found was both reassuring and concerning.

Freedom, calmness, peace of mind, and the ability to travel interstate and overseas to see family – ‘a return to normalcy' - were some of the key motivators that would drive the individuals to take up the vaccine.

“Despite the overall positive attitudes, there were concerns around the safety of vaccines which could potentially contribute to vaccine hesitancy and/or reluctance.”

The concerns of many Dari, Arabic and Karen participants mirrored those prevalent in the wider society at that time.

“These concerns were mainly attributed to vaccines being developed too quickly, the short time to test the vaccines, limited access to safety data, and side effects associated with the Astra Zeneca vaccine,” Dr Mahimbo said.

“While participants were well aware of the impacts of the COVID-19 disease, most were not eager to get the vaccine and preferred to ‘wait and see’ due to a low COVID-19 risk perception at the time that this study was undertaken.”

Disbelief

The attitudes of the Dinka-speaking refugees from South Sudan were markedly different.

They didn’t believe in COVID-19, they thought it was a manmade disease, and they couldn’t differentiate between a vaccine and drug. All Dinka participants said they would not get vaccines.

“They raised concerns about why there were different versions of the vaccines." Dr Mahimbo said.

“There were a lot of trust issues underpinning their hesitancy, a lack of health knowledge as well as religious beliefs.”

So the next challenge was to recommend the most effective sources of information most frequently used or trusted by refugees.

“The key issue for me was the need for ongoing community engagement strategies to address the information gaps,” Dr Mahimbo said.

“Participants wanted to know why people were still getting the disease if they were already vaccinated.”

Communication

The project found that leveraging social media channels was crucial to reaching these communities.

It was also important to recruit community and religious leaders who are trusted and can speak in their language.

“These might be imams or pastors, or they could also be doctors trained overseas but highly regarded in the communities,” Dr Mahimbo said.

She is just about to complete a follow-up study with the Dinka community for the NSW Department of Customer Service examining their stance on COVID-19 vaccines in the current climate. Preliminary results are positive.

Next year, she will undertake a quantitative study of vaccine uptake levels and communication of public health measures, and experiences with COVID-19 in refugee communities.

I am passionate in health equity and the barriers faced by migrant and refugee communities to accessing healthcare, because I have experienced those issues myself as a migrant.
– Dr Abela Mahimbo

  • Refugee participants by numbers

    37 participants from three language groups: Arabic, Dari, Karen and Dinka
    58% had lived in Australia for more than 10 years
    28% had lived in Australia for less than 5 years

  • Of the 37 participants who responded:

    36% were tertiary educated
    14% were high school leavers
    11% were primary school leavers
    14% were English language learners
    25% had no formal education
  • Dr Abela Mahimbo
    Dr Abela Mahimbo
    Lecturer, School of Public Health

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