Social value case study: Vaccinations in asylum hotels
This project delivers targeted vaccination outreach within asylum hotels across Cambridge and Peterborough. Led by the Off The Grid (OTG) Project in partnership with Cambridgeshire and Peterborough CSAIS, it provides monthly on‑site vaccination clinics that bring preventative healthcare directly to vulnerable refugee populations who face significant barriers to accessing mainstream services.
The outreach model aims to reduce health inequalities, mitigate the risk of infectious disease outbreaks in high‑density accommodation, and strengthen protection for both residents and the wider community.
Central to the approach is a focus on trust, continuity, and informed choice, recognising the complex needs and lived experiences of displaced populations.
The challenge
Residents living in asylum hotels face a heightened risk of infectious disease transmission. This risk arises from a combination of factors, including unknown or incomplete immunisation histories, communal living arrangements, and a higher prevalence of underlying health needs. The transient nature of the population, with frequent arrivals and relocations, further complicates continuity of care and follow‑up.
Access to primary care is often limited, and language and cultural barriers can make engagement with healthcare services challenging. In addition, post‑COVID vaccine hesitancy and trauma‑related mistrust of authorities and healthcare systems can significantly affect willingness to engage. Collectively, these issues present a clear public health risk, including the potential for rapid outbreaks within hotel settings and onward transmission to staff and the wider community.
Project description
The project expanded in September 2024 from delivery in a single Cambridge hotel to three sites across Cambridge and Peterborough, supported through collaboration with the Integrated Care Board.
Monthly on‑site clinics are delivered by a small, consistent team, typically comprising one registered nurse and one administrator. Vaccines are transported safely using mobile vaccine porters, enabling delivery within accommodation settings.
The following vaccines are offered, subject to age eligibility:
- MMR (Measles, Mumps and Rubella)
- DTP (Diphtheria, Tetanus and Polio)
- HPV
- Meningitis ACWY
Trust‑building with residents
Trust with residents is fostered through continuity of staff, calm and culturally sensitive consultations, and respect for all decisions, including refusals. Residents are encouraged to ask questions and engage in shared decision‑making, with reassurance that they can return at future sessions if they wish. The visible, repeat presence of the team helps demonstrate reliability and commitment over time.
Trust‑building with hotel management
Strong relationships with hotel management are also essential to delivery. This is supported through early engagement, regular communication, and shared understanding of the public health rationale for the clinics. Collaborative planning helps maximise attendance while allowing flexibility to reduce operational disruption.
Innovative features
The project is characterised by several innovative features, including delivery of preventative healthcare directly within accommodation settings and a relationship‑led, rather than target‑driven, approach. Opportunistic vaccination is combined with a longer‑term engagement strategy that prioritises trust and sustainability.
Outcomes and impact
Over a 12‑month period, a total of 552 vaccines were administered through the outreach programme. Given the fluctuating and transient nature of the population, percentage uptake metrics are not considered appropriate or meaningful. Frequent resident turnover, new arrivals, relocations, and the voluntary participation framework mean that traditional performance measures do not accurately reflect impact.
Instead, impact has been demonstrated through qualitative and observational outcomes, including reduced outbreak risk within high‑density settings and increased protection for hotel staff and the wider community. As trust developed, repeat declines became less common, with many residents choosing to return for vaccination after taking time to review information and build confidence in the service.
The service ethos is clear throughout delivery:
- Vaccination is offered, never imposed
- Consultations are education‑led
- Informed choice is central to the model
- Trust is prioritised over short‑term numerical targets
Our project demonstrates that sustained, relationship-based outreach improves engagement and strengthens population-level protection.
Lessons learned
Delivery has highlighted a number of challenges, including variable engagement from hotel management, fluctuating clinic attendance, and persistent vaccine hesitancy rooted in cultural and historical mistrust of healthcare systems. These challenges underline the importance of flexibility and persistence when working within asylum accommodation settings.
Key factors that have worked well include the consistency and visibility of staff, a relationship‑led approach, and the provision of clear written information to support informed decision‑making. Respecting autonomy has been essential in building long‑term credibility and engagement.
To further increase uptake, the project will focus on:
- earlier and more structured engagement with hotel management
- enhanced pre‑clinic promotion, including posters and advance reminders
- exploration of group health education sessions
- identification of peer advocates or resident champions
- continued emphasis on staff continuity to maintain trust.
Next steps
The project will continue to deliver monthly outreach clinics across all sites and strengthen partnership working with accommodation providers. There will be ongoing exploration of opportunities to integrate wider health promotion interventions, alongside continued monitoring of engagement trends and repeat uptake. The strategic focus remains on reducing health inequalities and preventing outbreaks.
Key takeaways
Trust, continuity, and informed choice are critical to improving vaccine engagement within displaced and vulnerable populations. Outreach models that prioritise relationships over targets can deliver sustainable public health impact and meaningful protection for individuals, services, and communities.
Contact information
Kathy Law, Off The Grid Lead Cambridgeshire and Peterborough CSAIS kathy.law1@nhs.net
