Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Figures & data

Figure 1. PRISMA diagram¹⁷.

Table 1. Themes addressing barriers and interventions from qualitative studies.

Theme	Definition	Example quote	N
Barriers
Lack of knowledge	Knowledge gaps about vaccine preventable disease and/or not knowing that a vaccine exists to prevent the disease	“The greatest barrier to receiving the vaccine was lack of knowledge about this resource.”^Citation52 (p5) (Q2, R2, P2)	7
Misinformation	Incorrect or misleading information resulting in vaccine hesitancy	“Lacking reliable and trustworthy information sources while having access to misinformation was common. Sources of misinformation contributed to the commonly held belief that people would get infected by going to testing sites.”^Citation74 (p9) (Q1, R2, P2)	5
Access	Physical or logistical barriers preventing use of vaccine services, including lack of insurance coverage, lack of primary care physician, or unable to time off work to get vaccinated	“Others were remarkably consistent in their reasons for not getting the vaccine… they experienced inflexible working conditions that did not allow time off to get vaccinated…”^Citation64 (p1114) (Q4, R5, P1)	4
Safety concerns	Concern for harmful, unintended side effects as a result of vaccination	“Personal barriers that were commonly discussed by HNs and CLs included: (1a) Fears related to the vaccine… rumors about the potential side effects of the vaccine were quite common and traveled quickly, saying ‘The bad news goes very fast that the vaccine will cause death or the vaccine will cause this symptom, the vaccine will make you sick, the vaccine will not cure the virus. So those kinds of things I often hear all the time in the community. So, it is challenging for us.’”^Citation33 (p1233) (Q10, R6, P2)	4
Distrust	Lack of confidence in government entities or public health authorities resulting in vaccine hesitancy	“Lack of confidence in government entities (e.g., the political administration, public health), due to the anti-immigrant political context, played a major role in the attitudes and beliefs held by community members.”^Citation74 (p9) (Q1, R4, P1)	4
Cultural bias	Negative attitudes based on cultural norms, practices or beliefs, pressure from family or peers, or fatalism	“Participants were influenced by the people around them, including mothers, physicians, and friends, when considering undergoing a Pap test or HPV vaccination. Others’ negative attitudes toward Pap tests and the HPV vaccine discouraged participants from undergoing the procedures.”^Citation71 (p356) (Q5, R4, P1)	4
Insecurity	Loss of autonomy and stability due the inability to make independent decisions, feeling pressured due to language barriers or immigration status	“Immigration and citizenship status create barriers to COVID-19 testing services and shape ideas around anticipated vaccination. Identification and being identified as undocumented are significant concerns.”^Citation55 (p10) (Q8, R4, P3)	2
Interventions
Receiving information from a trusted source	Where knowledge gaps or misinformation existed, participants sought a trusted source of information to overcome these barriers. Physicians (4), family members (1), and community leaders (1) were listed trusted sources of information in the studies	“The majority of participants reported that the most influential person on their health decisions is themselves, their family, and their doctor.”^Citation69 (p58) (Q6, R3, P2)	6
Providing culturally tailored education	Participants sought education that provides culturally sensitive, age appropriate, and language congruent content. Social media or trusted news outlets in the community were considered appropriate mediums for transmitting education	“Participants expressed a variety of ideas about the most effective methods to engage the Somali community and increase HPV immunization rates. Many mentioned advertisements in the form of flyers and pamphlets in both English and Somali … Participants suggested using community events and forums in community centers to provide information about HPV and HPV vaccination. Many felt that face-to-face outreach would be the most valuable. These interactions could be between a medical provider and patients; however, participants stressed the value of having someone from within their community, such as a Somali health care provider, involved in the communication effort.”^Citation36 (p2047) (Q9, R6, P1)	5
Facilitating access	Eliminating physical or logistical barriers to vaccination, such as offering vaccine clinics within communities, making appointments widely available, or having language congruent services on site. This may also involve providing incentive for participation	“Both HN [health navigators] and CL [community leaders] respondents offered a variety of potential interventions or suggestions for how to increase vaccine uptake among refugees. These included… (3c) offering a vaccine clinic in the community.”^Citation33 (p1235) (Q10, R7, P1)	3

The extracted themes address barriers and interventions to vaccination in the RIM population. The coding system was used by the reviewers through the extraction process and refers to the location of the quote within the original article (article number (Q), subheading within results section (R), and paragraph number below subheading (P)).

Figure 2. Summary of meta-analyses for rates of vaccination for Foreign-born participants compared to US-born.

The figure shows summary estimates for meta-analysis for rates of vaccination between US-born (control) and foreign-born. The summary estimate is odds ratio and reported with 95% confidence interval. The result shows that odds of vaccination was low in a range of 25% to 38% depending on the type of vaccination offered.

Table 2. Characteristics of studies included within meta-analysis.

	Study	Study Design	Study Time Period	Intervention Group	Comparison Group	N	Effect measure
HPV	Budhwani 2017	Cross sectional	2008–2013, except 2010 (data from National Health Interview Survey (NHIS))	Foreign-born adults across the US	US-born adults	20,040	Adjusted odds ratio=0.812, 95% CI: 0.571–1.155 Adjusted for demographics, health variables and economic variables
	Cofie 2018	Cross sectional	2013–2015 (NHIS)	Foreign-born women across the US	US-born women	15,890	Adjusted odds ratio=0.58, 95% CI: 0.49–0.70, p<.001 Adjusted for age, education, race/ethnicity, income level, marriage, region, self-rated health status, and OB/GYN visit/Pap test in the past 12months
	Cofie 2022	Cross sectional	2013–2017 (NHIS)	Foreign-born Black participants in the US originating from Mexico/Central America/Caribbean Islands/South America, or Africa	US-born Black participants	5,246	Adjusted odds ratio=0.73, 95% CI: 0.53–1.01 Adjusted for survey years, sex, age at HPV vaccination eligibility, degree, FPL (federal poverty level), and marital status, insurance stats, self-reported health status, and usual source of care
	De 2017	Cross sectional	2013 (NHIS)	Foreign-born adults nationally located throughout the US	US-born adults	34,557	Adjusted odds ratio=0.617, 95%: 0.390–0.975, p<.05 Adjusted for race, economic and healthcare access
	Lu 2014	Cross sectional	2012 (NHIS)	Foreign- born American adults originating from Mexico/Central America/Caribbean Islands, South America, Europe, or Asia nationally located throughout the US	US-born adults, aged 18-49	34,525	Adjusted prevalence ratio=0.6, 95% CI: 0.4–0.9 Adjusted for age, gender, race/ethnicity, marital status, education, employment status, poverty level, health insurance, number of doctor visits, self-reported health status, region of residence
	McElfish 2021	Cross sectional	2014 (NHIS)	Foreign-born Native Hawaiian and Pacific Islanders (NHPI) aged 18–26 in the US	White respondents	4,602	Prevalence ratio=0.67, 95% CI: 0.50–0.90, p=.007 Adjusted for race/ethnicity, nativity status, and age
	Perez 2018	Cross sectional	2011–2015 (NHIS)	Foreign- born adults nationally located throughout the US	US-born adults	39,761	Unadjusted odds ratio=0.57, 95% CI: 0.45–0.73, p<.05 Adjusted odds ratio: Male=0.63, 95% CI: 0.47–0.85 Female=0.57, 95% CI: 0.49–0.66 Adjusted for survey year, age at HPV vaccination eligibility, race/ethnicity, geographic region, and relationship status, educational attainment, employment status, insurance status and usual source of care
Influenza	Budhwani 2016	Cross sectional	2013 (NHIS)	Foreign-born Asian Indians, Blacks, Whites, and other Asians adults nationally located throughout the US	US-born adults	104,520	Adjusted odds ratio=0.812, 95% CI: 0.571–1.155, p>.05 Adjusted for interaction between economic and health variables
	Chuey 2022	Cross sectional	2012–2018 (NHIS)	Foreign-born adults from the 2012–2018 NHIS survey nationally located in the US	US-born adults	29,673	2012–2013 US- born=43.8, 95% CI: 42.6–44.9 Foreign- born=37.5, 95% CI: 35.0–40.0, p<.05 2013–2014 US-born=44.0, 95% CI: 42.8–45.3, p<.05 Foreign-born=38.1, 95% CI: 35.7–40.5, p<.05 2014–2015 US-born=45.9, 95% CI: 44.8–47.1 Foreign- born=38.8, 95% CI: 36.5–41.3, p<.05 2015–2016 US-born=44.8, 95% CI: 43.6–46.0 Foreign- born=37.5, 95% CI: 34.8–40.3, p<.05 2016–2017 US-born=45.6, 95% CI: 44.4–46.8 Foreign- born=43.5, 95% CI: 40.6–46.5 2017–2018 US-born=46.9, 95% CI: 45.7–48.1 Foreign- born=42.4, 95% CI: 39.6–45.3, p<.05 Vaccinated: Foreign-born= 39.6% avg (2,023/5,109) US-born = 45.2% avg (11,102/24,564)
	Dallo 2015 (men)	Cross sectional	2000–2011 (NHIS)	Non-Hispanic white, foreign-born American men from Arab and European nations	Non- Hispanic white US-born men	91,636	Adjusted odds ratio: Europe born = 0.47, 95% CI: 0.36–0.62) Arab = 0.38, 95% CI: 0.21–0.67 Adjusted for demographic, socioeconomic, health access, risk factor and acculturation effects
	Dallo 2015 (women)	Cross sectional	2000–2011 (NHIS)	Non-Hispanic white, foreign-born women originating from Arab and European nations and nationally located throughout the US	Non- Hispanic White US-born women	117,893	Adjusted odds ratio: Europe born = 0.48, 95% CI: 0.38–0.60 Arab born = 0.34, 95% CI: 0.21–0.58 Adjusted for demographic, socioeconomic, health access, risk factor and acculturation effects
	Lu 2014	Cross sectional	2012 (NHIS)	Foreign- born American adults originating from Mexico/Central America/Caribbean Islands, South America, Europe, or Asia nationally located throughout the US	US-born adults, aged 18-49	34,525	Adjusted Prevalence Ratio=1.0, 95% CI: 0.9–1.0 Adjusted for age, gender, race/ethnicity, marital status, education, employment status, poverty level, health insurance, number of doctor visits, self-reported health status, region of residence
	Tse 2018	Cross sectional	2009– 2012	Foreign-born non-Hispanic blacks, Hispanic, Chinese, Korean, Filipino, or Vietnamese American adults in New York City or Los Angeles and Orange counties in California	US-born adults in New York City or Los Angeles and Orange counties in California	14,139	Adjusted odds ratio NYC=1.0, 95% CI: 0.9–1.2, p=.87 LA/Orange County=1.2, 95% CI: 1.1–1.5, p=.01 Adjusted for sociodemographic and health-related factors
	Vashist 2018	Cross sectional	2018 (NHIS)	Foreign- born American adults from the 2018 NHIS survey	US-born adults	24,772	Adjusted odds ratio=0.91, 95% CI: 0.80–1.04 Adjusted for associations of COVID-19 priority grouping and socioeconomic and health-related factors
Hepatitis B	Kilmer 2019	Cross sectional	2013–2015 (NHIS)	Foreign-born American women of reproductive age (aged 18–44) originating from Mexico, Central America, Caribbean, Indian subcontinent, Southeast Asia, South America, Asia, Africa, or Europe nationally located throughout the US	US-born women (aged 18–44)	24,216	Odds ratio: 1.85, 95% CI: 1.67–2.04 (Foreign-born reference)
	Lee 2013	Cross sectional	2010	Foreign-born, self-identified Asian Pacific Islander college students (aged 18+) in Boston, Massachusetts	US-born college students (aged 18+)	208	Odds ratio: 1.4, 95% CI:0.7–2.6 (Foreign-born reference)
	Lu 2014	Cross sectional	2012 (NHIS)	Foreign- born American adults originating from Mexico/Central America/Caribbean Islands, South America, Europe, or Asia nationally located throughout the US	US-born adults, aged 18-49	34, 525	Adjusted Prevalence Ratio=0.9, 95% CI: 0.8–1.0 Adjusted for age, gender, race/ethnicity, marital status, education, employment status, poverty level, health insurance, number of doctor visits, self-reported health status, region of residence
	Tang 2018	Cross sectional	1997–2007	Foreign-born Asian American adults in NYC	US-born Asian American adults in NYC	19,816	Adjusted odds ratio: Birth China=0.22, 95% CI: 0.16–0.31 Birth other non-US=0.33, 95% CI: 0.22–0.48 Adjusted for age, sex, region of birth, language preference, insurances, reported family history of hepatitis B virus
Pneumococcal	Dallo 2015 (men)	Cross sectional	2000–2011 (NHIS)	Non-Hispanic white, foreign-born American men from Arab and European nations	Non- Hispanic white US-born men	91,636	Adjusted odds ratio: Europe born=0.42, 95% CI: 0.29–0.60 Arab=0.33, 95% CI: 0.16–0.70 Adjusted for demographic, socioeconomic, health access, risk factor and acculturation effects
	Dallo 2015 (women)	Cross sectional	2000–2011 (NHIS)	Non-Hispanic white, foreign-born women originating from Arab and European nations and nationally located throughout the US	Non- Hispanic White US-born women	117,893	Adjusted odds ratio: Europe born=0.43, 95% CI: 0.28–0.64 Arab born=0.14, 95% CI: 0.06–0.32 Adjusted for demographic, socioeconomic, health access, risk factor and acculturation effects
	Lu 2014	Cross sectional	2012 (NHIS)	Foreign-born adults (aged 18+) originating from Mexico/Central America/Caribbean Islands, South America, Europe, or Asia nationally located through the US	US-born adults (aged 18+)	34, 525	Adjusted prevalence ratio=0.8, 95% CI: 0.7–1.0 Adjusted for age, gender, race/ethnicity, marital status, education, employment status, poverty level, health insurance, number of doctor visits, self-reported health status, region of residence
	Tse 2018	Cross sectional	2009– 2012	Foreign-born non-Hispanic blacks, Hispanic, Chinese, Korean, Filipino, or Vietnamese American adults in New York City or Los Angeles and Orange counties in California	US-born adults in New York City or Los Angeles and Orange counties in California	14,139	Adjusted odds ratio: NYC=1.3, 95% CI: 1.0–1.6, p=.046 LA/Orange County=1.1, 95% CI: 0.7–1.6, p=.81 Adjusted for sociodemographic and health-related factors)

Table 3. Characteristics of studies excluded from meta-analysis.

	Study	Study Design	Study Time Period	Target population	Comparator	N	Results
HPV	Beltran 2016	Cross sectional	2015	Hmong Americans in Minnesota	None	192	HPV initiation: 46.3% HPV completion: 32.7%
	Lee 2015	Cross sectional	2012–2013	Asian American and Pacific Islander (AAPI) college students in the Midwest US	Non-Latino white students	2,270	HPV completion: 38.6% (which was significantly higher than non-Latino white students at 60.7%, p < .001)
	Lu 2015*	Cross sectional	2012	Foreign-born participants age 19–26 y responding to National Health Interview Survey (NHIS)	US-born	34,218	HPV initiation: Living in the US <10 y: aPR = 0.52, 95% CI: 0.28–0.98 Living in the US > 10 years: aPR = 0.71, 95% CI: 0.50–0.99
	Mohareb 2021	Retrospective cohort	2013–2015	Adult refugees in Connecticut	None	111	HPV initiation within 1 y of resettlement: 15%
Influenza	Lu 2015	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born	34,218	Influenza vaccination (past 12 months): Living in the US <10 y, 19–64 y: aPR = 1.09, 95% CI: 0.92–1.25 Living in the US <10 y, 65+ y: aPR = 0.84, 95% CI: 0.59–1.21 Living in the US > 10 y, 19–64 y: aPR = 1.00, 95% CI: 0.92–1.07 Living in the US > 10 y, 65+: aPR = 0.89, 95% CI: 0.80–0.98
	Morrison 2012	Cross sectional	2008	Somalian refugees in Minnesota	Non-Somalian clinic patients	91,557	Influenza vaccination: 41.45% for Somalian patients (vs. 53.73% for non-Somalian patients, p < .001)
	Vlahov 2012	Cross sectional	2010	Foreign-born individuals in an underserved community in New York	US-born individuals in an underserved community in New York	991	Interest in influenza vaccination: OR 4.11, 95% CI: 2.19, 7.72
Hepatitis B	Mitruka 2019	Cross sectional	2009–2011	Adult refugees in California, Massachusetts, Minnesota, and Washington	None	39,896	Of susceptible individuals (7,409), 38.3% completed the 3 dose series, 29% received 2 doses, 19.6% received 1 dose, and 13.1% received no doses
	Mohareb 2021	Retrospective cohort	2013–2015	Adult refugees in Connecticut	None	111	HBV initiation: 92% HBV completion of 3 doses 1 y following resettlement: 59%
	Ogunwobi 2019	Cross sectional	2016	African immigrants in New York	None	70	HBV initiation: 50.77%
	Raines-Milenkov 2021	Cross sectional	2014–2020	Refugee and immigrants in Texas	None	1,069	HBV initiation: 26% Uncertain of status: 53% No HBV doses: 21%
	Zhao 2015	Cross sectional	Not reported	Chinese American immigrants in California	None	179	HBV initiation: 26.4%
Pneumococcal	Lu 2015	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born population	34,218	Pneumococcal vaccination (ever received): Living in the US <10 y, 19–64 y: aPR = 0.86, 95% CI: 0.53–1.38 Living in the US <10 y, 65+ y: aPR = 1.00, 95% CI: 0.72–1.39 Living in the US > 10 y, 19–64 y: aPR = 0.87, 95% CI: 0.7–1.09 Living in the US > 10 y, 65+: aPR = 0.74, 95% CI: 0.66–0.83
	Morrison 2012	Cross sectional	2008	Somalian refugees in Minnesota	Non-Somalian clinic patients	91,557	Pneumococcal vaccination: 83.8% for Somalian patients (vs. 86.3% for non-Somalian patients, p = .4546)
TDaP/Td	Chai 2013	Cross sectional	2003–2007	Asylees and refugees in District of Columbia	US-born population	781	Need for TDaP or TD: 79.9% of asylees or refugees compared to 48.4% of general US population
	Lu 2014	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born population	34,525	Tetanus vaccination containing pertussis (past 7 y): aPR 0.8, 95% CI: 0.7–0.9
	Lu 2015	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born population	34,218	Tetanus vaccination (past 10 y): Living in the US <10 y, 19–64 y: aPR = 0.96, 95% CI: 0.90–1.03 Living in the US <10 y, 65+ y: aPR = 1.13, 95% CI: 0.86–1.48 Living in the US > 10 y, 19–64 y: aPR = 0.89, 95% CI: 0.84–0.93 Living in the US > 10 y, 65+: aPR = 0.81, 95% CI: 0.72–0.91
	Mohareb 2021	Retrospective cohort	2013–2015	Adult refugees in Connecticut	None	111	TDaP (1 dose):96% initiated and completed within 1 y of resettlement
	Morrison 2012	Cross sectional	2008	Somalian refugees in Minnesota	Non-Somalian clinic patients	91,557	Tetanus vaccination Somali patients: 84.6% vs. 83.1% for non-Somali patients (p = .2758)
	Sanchez-Gonzalez 2017	Cross sectional	2012–2013	Foreign-born participants responding to National Health Interview Survey (NHIS)	None	13,154	Tdap vaccination: 9.1% Td vaccination: 49.8%
Hepatitis A	Lu 2014	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born population	34,525	Hepatitis A (among those endorsing travel): aPR = 1.0, 95% CI: 0.8–1.2)
	Mohareb 2021	Retrospective cohort	2013–2015	Adult refugees in Connecticut	None	111	Hepatitis A within 1 y of resettlement: 89% initiated, 83% completed 2 dose series
MMR	Chai 2013	Cross sectional	2003–2007	Asylees and refugees in District of Columbia	US-born population	781	Need for MMR: Asylee adults: 66.6% Refugee adults: 64%
	Mohareb 2021	Retrospective cohort	2013–2015	Adult refugees in Connecticut	None	111	MMR within 1 y of resettlement (among non-susceptible): 93% initiated, 71% completed
Shingles	Lu 2015	Cross sectional	2012	Foreign-born participants responding to National Health Interview Survey (NHIS)	US-born population	34,218	Shingles vaccination (ever received): Living in the US <10 y: aPR = 0.88, 95% CI: 0.39–1.97 Living in the US > 10 y: aPR = 0.74, 95% CI: 0.57–0.97
COVID-19	Abouhala 2021	Cross sectional	2020	Arab Americans	None	638	COVID-19 vaccine intent: Yes: 56.7% No: 7.5% Uncertain: 35.7% aOR vaccine intent by nativity: aOR 1.70, 95% CI 1.05–2.77 (comparator foreign-born Arab Americans to US-born)
	Kheil 2022	Cross sectional	2021	Arab American immigrants across the US	None	1,746	COVID-19 vaccination: 92% by November 2021
	Shaw 2022	Cohort	2020–2021	Refugees in New York	None	244	COVID-19 vaccine intent before widespread availability: Yes: 57.3% No: 8.3% Uncertain: 34.4% COVID-19 vaccine intent before widespread availability: Yes: 57.4% No: 25% Uncertain: 17.6% COVID-19 vaccination after widespread availability: 44.7%
	Sudhinaraset 2022	Cross sectional	2020–2021	Undocumented immigrants in California	None	326	COVID-19 vaccine intent: 65%
	Zhang 2021	Cross sectional	2020–2021	Refugees across the US	None	435	COVID-19 vaccine intent: Yes: 70.3% No: 7.6% Uncertain: 22.1% Country of origin comparison to Afghan refugees: Somalia (aOR = 0.28; 95% CI, 0.11–0.71) Burma/Myanmar (aOR = 0.29; 95% CI, 0.09–0.97) South Sudan (aOR = 0.19; 95% CI, 0.06–0.57)

*Footnotes: Lu 2015 was excluded from the meta-analysis to avoid duplication of data from Lu 2014 (same dataset utilized).

Table 4. Barriers to vaccination in the RIM population from quantitative studies.

	Study	Study Design	Study Time Period	Population	Location within the US	N	Barriers & Facilitators
HPV	Ashing 2017	Cross sectional	2009–2011	Black/African descended or Hispanic/Latinx immigrants	California	393	Black immigrants Barrier: Lack of awareness where to receive HPV (OR 0.36, p = .007 compared to US-born) Latinx immigrants Barrier: Perceived cost (OR 4.75, p = .044 compared to US-born) Barrier: Lack of awareness of HPV vaccine (Latinx: OR 0.37, p = .033 compared to US-born) Barrier: Lack of awareness where to receive HPV (OR 0.21, p = .001 compared to US-born)
	Barnack-Tavlaris 2016	Cross sectional	2007–2008	Foreign and US-born women in California	California	1,672	Barrier: Lack of awareness of HPV vaccine (OR = 1.89, CI 95%: 1.42–2.52, p < .005 compared to US-born) Barrier: Lack of interest in HPV vaccine in non-US-born Latinas (OR = 0.38, CI 95%: .18–.79, p = .009 compared to US-born Latinas)
	Bhattacharya 2021	Cross sectional	2017–2018	Foreign and US-born adults nationally in the US	National	2,415	Barrier: Lack of awareness of HPV infection (aOR 0.39, 95% CI = 0.26–0.61)
	Budhwani 2017	Cross sectional	2008– 2013 (except 2010 NHIS)	Asian Indian and Asian subpopulations	National	234	Facilitator: Private insurance (aOR 1.91, 95% CI: 1.542–2.367) Facilitator: Higher education (aOR = 1.157, 95% CI: 1.107–1.210)
	Cofie 2018	Cross sectional	2013–2015 (NHIS)	Immigrants originating from Mexico, Central America, Caribbean Islands; South America; Europe; Africa; Indian subcontinent; Asia; Southeast Asia	National	32,917	Facilitator: US citizenship (OR = 1.60, 95% CI: 1.16–2.20 Foreign-born US citizens compared to non-citizens) Potential barrier: Country of origin (European women 28.19%, 95% CI: 19.02, 37.35; Indian women 4.28%, 95% CI: 1.09–7.46)
	Cofie 2022	Cross sectional	2013–2017 (NHIS)	Black immigrants originating from Mexico/Central America/Caribbean Islands/South America, or Africa	National	40,646	Facilitator: Female gender (aOR = 3.65 95% CI: 2.95, 4.50) Facilitator: Younger age at time of eligibility (aOR = 3.44, 95% CI: 2.90, 4.07) Facilitator: Marital status as single male (aOR = 2.30, 95% CI: 1.32, 4.01) Facilitator: Higher education, some college attendance (aOR = 1.75, 95% CI: 1.33–2.31)
	Escobar 2021	Cross sectional	2017–2018	Mexican, Puerto Rican, Cuban, other Hispanic immigrants in the US, US-born Hispanics, and US-born non-Hispanic whites	National	4,523	Barrier: Lack of knowledge on HPV vaccine (non-Hispanic whites aOR = 1.95 (95% CI 1.19–3.21 compared to Foreign-born Hispanic) Facilitator: Female gender (aOR = 4.53, 95% 3.48–5.88) Facilitator: Higher education, some college (aOR = 3.77,95% CI 2.04–6.96) Facilitator: Having a family member aged 9–27 (aOR = 1.48, 95% CI: 1.07–2.04)
	Lee 2015	Cross sectional	2012–2013	Asian American Pacific Islander (AAPI) immigrant college students	Midwest	2,270	Barrier: Lack of knowledge of HPV vaccine (AAPI compared to non-Latina White) 73.6% vs 90.6%, p < .01
	Lee 2018	Cross sectional	N/A	Korean American women immigrants	Georgia	243	Barrier: Age was inversely related to HPV literacy (B = −0.21, SE = 0.124, p < .05) Barrier: Low English proficiency (B =  = 0.146, SE = 0.227, p < .05) Barrier: Education (B =  = 0.145, SE = 0.333, p < .05) Barrier: Poor health status (B =  = 0.145, SE = 0.382, p < .05)
	Mehta 2021	Cross sectional	2018	Undocumented and documented Hispanic immigrant women	Rhode Island	159	Barrier: Lack of knowledge of HPV and vaccine (45% aware of HPV vaccine, but only 20% received vaccine)
	Nguyen 2012	Cross sectional	2012	Mandarin- speaking American immigrants	Northeast	71	Barrier: Lack of Knowledge on HPV and vaccine (20.3% heard of HPV, 35.7% heard of HPV vaccine) Facilitator: Insurance coverage (OR = 9.4, 95% CI: 1.5–60.6, p = .019) Facilitator: English speaking (OR = 10.7, 95% CI: 1.8–62.3, p = .008)
Influenza	Budhwani 2016	Cross sectional	2013 (NHIS)	US-born and foreign- born Asian Indians, Blacks, Whites, and other Asians adults	National	104,520	Facilitator: Insurance coverage – After controlling for insurance coverage, there was no statistical difference in vaccine coverage between foreign and US-born (OR = 0.812, 95% CI: 0.571–1.155)
	Jih 2015	Cross sectional	2007, 2009	Latino and Asian immigrants with low English proficiency (LEP)	California	4,821	Language discordance did not result in significant differences in vaccination rates among immigrants with LEP
	Moran 2017	Cross sectional	2012–2013	Hispanic female immigrants from Central and South America	California	1,565	Facilitator: Higher religiosity (aOR = 1.12, p < .007) Facilitator: Higher vaccine safety confidence (aOR = 2.38, p < .001)
	Morrison 2012	Cross sectional	2008	Somalian refugees	Minnesota	91,557	Facilitator: Increased number of primary care visits (2.3 visits for unvaccinated vs. 6.27 visits for vaccinated, p < .0001)
	Ogunwobi 2019	Cross sectional	2016	African immigrants	New York	70	Facilitator: Health insurance (Œ≤ = 2.37, p < .01)
	Strong 2012	Cross sectional	2009–2010	Chinese, Korean, and Vietnamese immigrants	Maryland	877	Facilitator: Knowledge of HBV (OR = 1.20, 95% CI: 1.12–1.29) Facilitator: Physician recommendations (OR = 2.09, 95% CI: 1.30–3.37) Facilitator: HBV screening suggested by friends and family (OR = 2.01, 95% CI: 1.28–3.15)
	Zhao 2015	Cross sectional	NR	Chinese immigrants	California	179	Barrier: Lack of medical problems necessitating visits (60% of sample endorsed this) Barrier: Absence of a physician recommendation (49% of sample endorsed this)
Pneumococcal	Morrison 2012	Cross sectional	2008	Somalian refugees	Minnesota	91,557	Facilitator: Increased healthcare visits (average number of primary care visits: 2.06 for no vaccine vs. 5.04 for vaccinated, p = .004)
Tetanus	Morrison 2012	Cross sectional	2008	Somalian refugees	Minnesota	91,557	Facilitator: Increased healthcare visits (average number of primary care visits: 0.7 for no vaccine vs. 2.61 for vaccinated, p < .001) Facilitator: Access to medical interpreters
	Lu 2014	Cross sectional	2012	Foreign-born individuals residing in the US	National	34,525	Barrier: English speaking (4.6% in non-English speaking vs. 11.5% in English speaking foreign-born, p < .05)
	Sanchez-Gonzalez 2017	Cross sectional	2012–2013	Foreign-born individuals residing in the US	National	13,154	Barrier: Low socio-economic status Barrier: No or public health insurance Facilitator: College education Facilitator: Access to medical care (more visits to PCP)
COVID-19	Abouhala 2021	Cross sectional	2020	Arab Immigrants	National	638	Barrier: Female sex (aOR = 5.00, 95% CI: 1.95, 12.83, higher odds of being unlikely to receive vaccine) Barrier: Younger age (aOR: 3.36; 95% CI: 1.34, 8.39, higher odds of being unlikely to receive the vaccine) Facilitator: Smaller households (aOR = 0.50, 95% CI = 0.25–0.99) Facilitator: Lower religiosity (OR = 0.35; 95% CI: 0.16–0.78) Facilitator: Previous COVID infection (OR = 0.40; 95% CI: 0.19–0.83)
	Kheil 2022	Cross sectional	2021	Arab Immigrants	National	1,603	Barrier: Safety concerns (86%) Barrier: Distrust in healthcare system, vaccines, and government (70%) Barrier: Religious or personal beliefs (31%) Barrier: Previous infection with COVID-19 (7%)
	Page 2022	Cross sectional	2021	Migrants	International (extracted data from Maryland)	142	Barrier: Lack of health insurance (56%) Barrier: Not knowing where to get vaccinated (36%) Barrier: Perceived high cost (8%) Barrier: Perceived lack of eligibility to enroll (4%)
	Shaw 2022	Cohort	2020–2021	Refugees	New York	244	Barrier: Previous decline of vaccinations (42.1% for history of decline vs 24% for those without history of decline, p = .001) No significant association between sociodemographic factors and COVID-19 intent
	Sudhinaraset 2022	Cross sectional	2020–2021	Undocumented immigrants	California	326	Barrier: Increase in immigration enforcement exposure (vaccine acceptance aOR = 0.88, 95% CI: 0.78–0.99) Barrier: Health insurance (aOR = 0.46, 95% CI: 0.24–0.88) Facilitator: Female gender (aOR = 3.11, 95% CI: 1.79–5.35) Facilitator: Enrollment in school (aOR = 2.65, 95% CI: 1.10–6.35)
	Zhang 2021	Cross sectional	2020–2021	Refugees	National	435	Barrier: Concern for side effects (71.3%) Barrier: Concern for effectiveness (12.4%) Barrier: Fear of needles (8.5%) Facilitator: Being an essential worker (aOR = 2.37; 95% CI, 1.44–3.90) Facilitator: Male sex (aOR = 1.87; 95% CI, 1.12–3.12) Facilitators: Among those intending to get the COVID-19 vaccine, their main reasons were wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%)

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