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.
