The invasion of Ukraine has unleashed a humanitarian crisis and the impact is devastating for millions displaced in Ukraine and for those fleeing the country. Receiving countries in Europe are reeling with shock and disbelief and trying at the same time to grapple with the reality of providing for a large, unplanned, unprecedented number of refugees mainly women and children on the move. Several calls for actions, comments and statements express outrage, the risks, and the impending consequences to life and health. There is a need to constantly assess the situation on the ground, identify priorities for health and provide guidance regarding how these needs could be addressed. Therefore, the Lancet Migration European Regional Hub conducted rapid interviews with key informants to identify these needs, and in collaboration with the World Health Organization Health and Migration Programme, summarized how these could be addressed. This viewpoint provides a summary of the situation in receiving countries and the technical guidance required that could be useful for providing assistance in the current refugee crisis.

This paper addresses the SARS-CoV-2 vaccination progress in Australia. Globally, Australia was initially praised for its national COVID-19 response, reflecting well with regard to case numbers and mortality rates. However, Australia’s progress with its vaccine rollout has come under scrutiny. When compared globally, it fares very low in terms of the number of vaccine doses administered. This paper discusses the first three months of the vaccination process, and the challenges Australia faced during that time. Through an extensive literature review, data was collected on relevant topics concerning all aspects of the Australian COVID-19 situation. The following key points are discussed: the specific COVID-19 organisation at the federal vs. the state government levels, the Australian economy, the vaccine supply strategy, and the vaccine priority roll out. In conclusion, we highlight the impact of Australia initially relying heavily on the AstraZeneca vaccine, which subsequently came under fire regarding safety issues likely linking the vaccine to thrombosis with thrombocytopenia syndrome (TTS).

Background: The COVID-19 pandemic has widened inequities, affecting migrant and refugee populations in vulnerable situations, who may face elevated risks of infection, constrained healthcare access and discrimination. Inclusive vaccination campaigns are recommended, but barriers persist. This study aimed to identify barriers and facilitators and estimate vaccination coverage among refugees and migrants in low- and middle-income countries, emphasising inclusive policies for effective rollout. Methods: A mixed-method study was conducted in two phases in Ecuador, Nepal, Pakistan, the Philippines and Rwanda. Phase 1 (March–May 2022) included policy analysis, in-depth interviews and focus-group discussions with 52 key informants analysed with thematic and grounded theory approaches using hybrid coding. Phase 2 (June–August 2022) included a cross-sectional study among refugees and migrants in regular (MIRS) and irregular situations (MIIS) and used descriptive analysis and a COVID-19 Vaccine Equity Index (CVEI). Results: A total of 1378 individuals responded to the survey (43.8% MIRS, 31.2% MIIS and 25% refugees). 87% reported receiving at least one dose of the COVID-19 vaccine. The CVEI at the global level (0.824) suggested differences in complete vaccination between migrants and other residents in most of the study countries (refugees reported more access to vaccines than MIRS and MIIS). However, the qualitative phase reported delays and inequities in the early stage of the vaccination process in all countries. Overall, 64.2% of respondents perceived that government’ campaigns were successful. Both the qualitative and quantitative phases identified several barriers and facilitators. The main barriers included a lack of trust in authorities, extended waiting times and distance to vaccination centres, discrimination and xenophobia, lack of identity documentation, and adverse reaction concerns. On the other hand, the primary facilitators were the widespread distribution of vaccination centres, sources and provision of information, specific campaigns for refugees and migrants, free vaccination and the motivation to protect others’ health. Conclusions: Despite the high coverage of COVID-19 vaccines among refugees and migrants in the study countries, the process had significant barriers. Simple vaccination registration procedures, targeted campaigns, mobile vaccination teams for hard-to-reach and vulnerable groups, and building trust in the host country authorities are pivotal for future and inclusive vaccine deployments.

Migrants and refugees are among the most disadvantaged populations, with limited evidence on the access and uptake of COVID-19 vaccination among them. Therefore this qualitative study explores the behavioral and social drivers of the COVID-19 vaccine among the refugee and migrant population in Pakistan through in-depth interviews and focus group discussions with regular and irregular migrants and refugees residing in Pakistan. Key informant interviews were conducted with stakeholders responsible for overlooking the COVID-19 vaccination process. A total of 18 participants were interviewed to gather insights on COVID-19 vaccine access, uptake, and behaviours among migrants and refugees. Data was collection from June to July 2022, in Karachi, Hyderabad, and Quetta. All the interviews were audio recorded, transcribed, translated, and thematically analysed on Nvivo software. The study found that refugee and migrant communities in Pakistan faced significant challenges to COVID-19 vaccination uptake, with barriers including misconceptions about vaccine safety and efficacy, fears of side effects, and mistrust spread by religious leaders. Participants were refused vaccinations at many centers despite government directives allowing vaccines for those without Computerized National Identity Cards (CNIC). Limited outreach and awareness efforts from the government, fears of identification and deportation, long wait times at vaccination centers, and the absence of female vaccinators in communities with strict gender norms further hindered access. Many participants also reported being charged for vaccination leading to lower vaccine coverage. Despite these challenges, some individuals were motivated to vaccinate due to workplace requirements, peer influence, or personal health concerns. Facilitators included door-to-door vaccination campaigns and school vaccination mandates. Vaccination camps set up by NGOs and government agencies at border areas and migrant-rich districts facilitated access. The study suggests targeted strategies to improve vaccination coverage, including provision of identification documents to migrants, inclusion in policy, and enforcement of multilingual communication to improve healthcare access.

Introduction: Since 2000, the number and role of global health initiatives has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and inefficiencies linked to the GHIs and attempts to improve their alignment with country health systems. There is a growing momentum to adjust GHIs to the current broader range of global health threats, such as non-communicable diseases, humanitarian crises and climate change. However, these reform attempts hit up against political economy realities of the current structures. Methods: In this article, we draw on research conducted as part of the Future of Global Health Initiatives process. The study adopted a cross-sectional, mixed-methods approach, drawing from a range of data sources and data collection methods, including a global and regional level analysis as well as three embedded country case studies in Pakistan, South Africa and Senegal. All data was collected from February to July 2023. 271 documents were analysed in the course of the study, along with data from 335 key informants and meeting participants in 66 countries and across a range of constituencies. For this paper, data were analysed using a political economy framework which focused on actors, context (especially governance and financing) and framing. Findings: In relation to actors, the GHIs themselves have become increasingly complex (internally and in their interrelations with other global health actors and one another). They have a large range of clients (including at national level and amongst multilateral agencies) which function as collaborators as well as competitors. Historically there have been few incentives within any of the actors to maximise collaboration given the competitive funding landscape. Power to exert pressure for reforms sits ultimately with bilateral and private funders, though single-issue northern NGOs are also cited as important influencers. Funders have not collaborated to enable reforms, despite concerns amongst a number of them, because of the helpful functional role of GHIs, which serves funder interests. Some key global boards are reported to be engineered for stasis, and there are widespread concerns about lack of transparency and over-claiming (by some GHIs) of their results. Narratives about achievements and challenges are important to enable or block reforms and are vigorously contested, with stakeholders often selecting different outcomes to emphasise in justifying positions. Conclusion: GHIs have played an important role in the global health ecosystem but despite formal accountability structures to include recipient governments, substantive accountability has been focused upwards to funders, with risk management strategies which prioritise tracking resources more than improved national health system performance. Achieving consensus on reforms will be challenging but funding pressures and new threats are creating a sense of urgency, which may shift positions. Political economy analysis can model and influence these debates.