Introduction From The CDC
Refugees, unlike most immigrant populations, are not required to have any vaccinations before arrival in the United States. In addition, many vaccines have limited or no availability in some developing countries or in specific refugee settings. Therefore, most refugees, including adults, will not have had complete Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations when they arrive in the United States. However, depending on health-care access, organized vaccination programs and initiatives, and availability of vaccines, refugees may have some documented vaccinations. During the medical screening visit for new arrivals, the provider must review any written vaccination records presented by the refugee, assess reported vaccinations for adherence to acceptable U.S. recommendations, and subsequently, initiate necessary immunizations. Each of these tasks presents challenges to the clinical practitioner.
Scope of the Problem factual statements on the extent of the problem in the past, current, or future
Health Disparities
The rate of racial and ethnic minorities, comprising over 33 percent, 100.7 million people, of the US population in 2007, is rising.[i] Despite their growing presence, minorities still lag behind other groups in terms of access to necessary services, such as health care. “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” the 1999 federally-funded report on health disparities, found that in contrast with the general population, racial and ethnic minorities within the US experience a lower quality of health care and are less able to utilize routine medical services.[ii] Accessing adequate and appropriate health care is one of the greatest challenges facing ethnic minorities in America due to the exorbitant cost of health care and health insurance as well as the language and cultural barriers often associated with minority status.
Immigrants and refugees encounter their own set of health risks as a result of exposure to infectious diseases in their country of origin in addition to the terms of their migration. Many refugees arrive in the US with vitamin deficiencies, intestinal parasites, stress-related trauma and tuberculosis among other infectious diseases.[iii]
The health risks facing refugees pose a health threat to much of the US, including Maine.[iv] Maine currently hosts between 8,000 and 12,000 refugees.[v] Since 2001, over 4,000 refugees from Somalia and elsewhere have moved to Lewiston, alone.
Examining risk factors for infectious diseases confirms that the national burden of disease is directly related to race and ethnicity. Immunization coverage among minorities nationwide is much lower than the surrounding population despite an increased risk of infectious disease. Rates of influenza, pneumococcal and Hepatitis B immunizations are significantly lower for African American and Hispanic adults than for white adults.[vii]54.6 percent of non-Hispanic Black women and 44.9 percent of Hispanic women as opposed to 62.6 percent of non-Hispanic White women received the Hepatitis B vaccine in 2004, for instance.
While the spread of infectious diseases and the neglect of pressing health conditions is detrimental not only to the health status of minorities and refugees but to Maine’s total population, state-wide budgetary choices have not acknowledged the importance of adult immunizations among the refugee population.
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Just out of curiosity where is the Wonderful Vaccination, Test or Poke for active TB, they seem to have no problem letting them drag into the USA? Oh, I forgot it’s against their Religion!
Cost of Vaccinating Refugees Overseas Versus After Arrival in the United States, 2005
Since 2000, approximately 50,000 refugees have entered the United States each year from various regions of the world (1). Although persons with immigrant status are legally required to be vaccinated before entering the United States, this requirement does not extend to U.S.-bound persons with refugee status.* After 1 year in the United States, refugees can apply for a change of status to that of legal permanent resident, at which time they are required to be fully vaccinated in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP) (2,3). A potentially less costly alternative might be to vaccinate U.S.-bound refugees overseas routinely, before they depart from refugee camps. To compare the cost of vaccinating refugees overseas versus after their arrival in the United States, CDC analyzed 2005 data on the number of refugees, cost of vaccine, and cost of vaccine administration. This report summarizes the results of that analysis, which suggested that, in 2005, vaccinating 50,787 refugees overseas would have cost an estimated $7.7 million, less than one third of the estimated $26.0 million cost of vaccinating in the United States. Costs were calculated from the perspective of the U.S. health-care system. To achieve public health cost savings, routine overseas vaccination of U.S.-bound refugees should be considered.
To facilitate the cost analysis, refugees who were U.S. bound in 2005 were divided into age groups, using the CDC Information on Migrant Populations (IMP) database.† For 2005, IMP contained demographic information on 50,787 refugees.§ Two assumptions were made in the cost analysis: 1) that 100% of refugees would receive vaccinations and 2) that all refugees would be vaccinated in accordance with the ACIP schedule¶ within either 180 days of departure or 180 days of their arrival in the United States. All costs were estimated in 2005 dollars; because all costs were incurred in less than 1 year, no future costs or discounts to current values were calculated. The following equation was used to calculate the cost of vaccinations overseas and in the United States:
Cost of vaccination = (cost of vaccine/dose × doses/person × persons) + (cost of administration/dose × doses/person × persons).
The cost of purchasing each of the 10 vaccines recommended by ACIP in 2005** in the United States was assumed to be in accordance with the CDC vaccine contract price list (4). The cost of administering vaccines in the United States for persons aged <18 years was established as $14.95 per child vaccination††; this assumption was based on the average of maximum allowable regional charges in the federal Vaccines for Children program (5). The cost of administering vaccine to adults was established at $18.81 per adult vaccination; this assumption was based on the average of maximum allowable state charges in the 2005–2006 Medicare Administration and Vaccine Reimbursement Rates (6). MORE
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