General discussion 9 273 (including access to and uptake of vaccination). Below, I discuss context-specific interventions initiated in the Netherlands and consequently describe global programmes to reduce inequity in COVID-19 burden. In the Netherlands, official announcements of new public health regulations were made exclusively in the Dutch language via press conferences on Dutch national television. Although the RIVM offered summaries of public health advice in different languages, these sources of information are only effective for those actively seeking information. Official routes of information provision were therefore insufficiently accessible to communities facing language barriers or with limited health literacy. To counter these barriers, numerous COVID-19 prevention strategies were initiated by the Public Health Service of Amsterdam (PHSA). Efforts were made to provide information in multiple languages and via accessible routes such as local media channels, specifically aiming to address culture-specific concerns around the virus, public health regulations and (at a later stage) vaccination. In addition, dedicated COVID-19 prevention teams co-created strategies for behavioural changes together with community leaders[27, 28]. Despite these efforts, ethnic disparities in COVID-19 burden persisted: a nationwide study reported that the incidence rate ratio (IRR) of COVID-19 deaths among populations with a LMIC migration background (as compared with populations with a Dutch background) was higher in the second wave than the first wave[4]. Surveillance data of COVID-19 hospitalisation also demonstrated that differences in hospitalisation rates between ethnic-Dutch individuals and those with a non-Western/European migration background persisted throughout the second wave of COVID-19 (this thesis, Chapter 3). Concerningly, decreased vaccination uptake among individuals with a migration background compared to ethnic-Dutch person further widened these gaps beyond 2021[29]. Lower vaccination intention was associated with distrust of the government, fear of stigmatisation and language barriers[30], whilst socio-demographic determinants included being female and aged under 45 years[31]. Moving forward, continuing to involve communities in designing appropriate interventions and leveraging existing knowledge on behaviour change and health communication (for instance, utilising centres of expertise such as Pharos[32]) may help to reduce the impact of current inequalities. An example of such an approach is highlighted by the Pandemic and Disaster Preparedness Centre (PDPC), which used semi-structured interviews with key stakeholders to identify key barriers and drivers of adverse health outcomes among different underserved groups, building a knowledge base for the development of tailored recommendations[33]. To ensure the success of any intervention, however, commitment from the government is required to
RkJQdWJsaXNoZXIy MTk4NDMw