Vaccine hesitancy among migrant populations in Europe: A mixed-methods systematic review

Objectives: Among migrants, vaccine uptake is influenced by various factors including interrupted vaccination in origin countries, divergent schedules, and marginalization within host systems. Vaccine hesitancy is shaped by cultural, structural, and experiential factors that differ from native-born populations. This systematic review aims to synthesize qualitative and quantitative evidence on vaccine hesitancy among migrant populations in Europe. Method(s): Eight databases (PubMed/MEDLINE, PsycINFO, EMBASE, Scopus, CINAHL, Web of Science, ERIC, and Cochrane Library) were searched for primary studies published in English or French between January 2000 and December 2024. References from relevant non-primary studies were hand-searched. This review followed the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Eligible studies explored vaccine attitudes among migrant populations in Europe. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data extraction used JBI's Mixed Methods Data Extraction Form, and synthesis followed a convergent integrated approach. Result(s): Forty-six studies were included (20 qualitative and 26 quantitative), most conducted in Western or Northern Europe and examining diverse migrant populations including legal and undocumented individuals. Evidence was synthesized under seven integrated findings: (1) acculturation, (2) distrust in authorities, (3) health literacy, (4) informal information networks, (5) sociocultural determinants, (6) sociodemographic characteristics and (7) vaccine-specific perceptions. No studies were excluded based on quality, but MMAT scores informed interpretation. Conclusion(s): Vaccine hesitancy among migrants in Europe reflects the interplay of origin-country beliefs, host-society norms, and migration-related vulnerabilities, reinforced by gendered constraints, limited health literacy, informal information networks, and persistent institutional mistrust. Addressing these determinants requires culturally responsive, participatory interventions co-designed with migrant communities, tailored to health literacy needs, and attentive to institutional mistrust and gendered constraints. Further research should examine underrepresented groups, the interaction of gender, migration, and trust, and evolving attitudes across generations to guide sustainable confidence-building strategies. Copyright © 2025 The Authors