The Impact of Policy and Policy Communication on COVID-19 Vaccination Inequalities Among Venezuelan Refugees and Migrants in Colombia: A Comparative Cross-Sectional Interrupted Time-Series Analysis

Background: Public health policies require regulatory frameworks and communication to effect uptake among the target population. Colombia’s National COVID-19 Vaccination Plan implicitly included Venezuelan refugees and migrants; however, initial communication restricted availability to people with regular migration status. We estimated the impact of a public announcement, which clarified access for refugees and migrants, on vaccination coverage among Venezuelans living in Colombia.Methods: Between July 30, 2021 and February 5, 2022, 6,221 adult Venezuelans participated in a cross-sectional health survey. We used a comparative cross-sectional time-series analysis to estimate the effect of the October 2021 announcement on the average bi-weekly change in COVID-19 vaccine coverage of Venezuelans with regular and irregular migration status.Findings: 71% of Venezuelans had an irregular status. The baseline (pre-announcement) vaccine coverage was lower among people with an irregular status but increased at similar rates as those with a regular status. After the announcement, there was a level change of 14·49% (95%CI: 1·57%-27·42%, p=0·03) in vaccination rates among individuals with irregular migration status with a 4·61% increase in vaccination rate per bi-weekly period (95%CI: 1·71%-7·51%, p=0·004). By February 2022, there was a 26·2% relative increase in vaccinations among individuals with irregular migration status compared to what was expected without the announcement.Interpretation: While there was no policy change, communication clarifying the policy drastically reduced vaccination inequalities across migration status. Lessons can be translated from the COVID-19 pandemic to into more effective global, regional and local public health emergency preparedness and response to displacement.Funding: This work was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement number NU2GGH002000-03-01.Declaration of Interest: The authors declare no conflicts of interest.Ethical Approval: Institutional and ethical review of the study was conducted by the Ethical Review Committee at the Universidad El Bosque in Bogotá, Colombia, and the Institutional Review Board at Johns Hopkins School of Public Health, USA. The protocol was also reviewed in accordance with CDC human research protection procedures. Participants were provided with referrals as needed for health and humanitarian services. To mitigate risks associated with the ongoing pandemic, study implementation followed approved biosecurity protocols and local COVID-19 policies.