This developmental research grant award (R21) requests funds to characterize the social and transmission networks of migrant workers in Greece as part of pandemic preparedness, to mitigate ongoing and future coronavirus epidemics among vulnerable populations in diverse contexts. We aim to better understand COVID-19 prevention, testing, treatment, vaccination, seroprevalence and immunogenicity in order to address facilitators and barriers to COVID-19 prevention. Migrant workers comprise one of the foremost essential worker categories, are at increased risk of COVID-19 transmission and at the same time have some of the lowest rates of testing and vaccination. Critical to public health is improving COVID-19 prevention among these populations and their larger social networks. Network analysis can better illuminate ongoing transmission dynamics and the potential for future epidemics. Contact tracing and other strategies do not fully include the larger social network and data are often limited due to the stigma associated with providing named contacts, as well as mistrust in government, particularly for migrant workers subject to harsh immigration policies. Social network analysis, following traditional egocentric network approaches that this team has expertise in, can illuminate multiple networks (family, workplace, acquaintance) and develop metrics tied to disease transmission such as density, bridging and transitivity. In addition, network analysis can better explain transmission potential phenomena such as sharing of resources across household units, workplace networks and other transmission potentials. Understanding the potential transmission dynamics would help develop tailored interventions to limit the explosive transmission documented in the US and Europe. The study context and team are ideal for this proposal. Athens Greece is the entry point to the largest migrant population in the EU and Bangladeshi migrants are the second largest constituency. Although the target population is very specific, it represents an extremely important stream of global migration that connects two populous world regions, with salient epidemiological consequences for the entire globe. The PI has a track record of collaborative work implementing participant recruitment protocols in Athens among vulnerable populations through street based and community focused engagement. The PI and site-PI are joined by additional experts in virology, demography and South Asian and migrant health. Accordingly, we aim to: 1) Characterize the social networks of Bangladeshi migrant workers in Athens and measure features of their network structures - degree, density and bridging – most relevant to COVID-19 transmission potential; 2) Determine individual (ie. age, gender), contextual (ie employment type), network and structural (stigma, health care access) factors associated temporally with SARS-CoV-2 infection, seroprevalence and immunogenicity status. We will collect survey data and biologic samples to model COVID-19 transmission; and 3) Determine individual and network level factors associated with prevention behaviors: social distancing, masking, testing and vaccination.

This proposal requests funds to characterize the social and transmission networks of migrant workers in Greece to mitigate ongoing and future coronavirus epidemics among vulnerable populations in diverse contexts. We aim to better understand COVID-19 prevention, testing, treatment, vaccination, seroprevalence and immunogenicity in order to address facilitators and barriers to COVID-19 transmission mitigation. Critical to public health is improving COVID-19 prevention among these populations and their larger social networks.