In less than three months, over 360 million COVID-19 vaccine doses have been administered across more than 100 countries. The pace of inoculation is picking up day by day and the world is hopeful that the light at the end of the COVID-19 tunnel is within sight.
The success of national vaccination campaigns depends on how inclusive and equitable they are.
But as public health experts, policy advisors and government decision makers continue to draft and implement their respective national vaccination plans, there are serious concerns that some members of vulnerable communities may be excluded from vaccination drives, even if they are mentioned on paper.
The fabric of our communities
Some of the hardest to reach and most at risk of being left out are migrants living, working and meaningfully contributing to our societies, particularly those who have irregular residence status. They are our delivery drivers, construction workers, carers, cleaners, nannies, cooks and street vendors, that knit the fabric of our communities. Many once had visas or permits but fell between the cracks of our immigration systems. They may be adults, children, or older people, and many have lived for years in the country where they may be unable to get official authorisation to reside.
For migrants in irregular situations, the pandemic and related lockdown measures have made life infinitely harder and exposed them to new risks, especially if they are homeless or living in cramped, precarious conditions where physical distancing is challenging and access to running water is limited. Some lost their jobs because of the socioeconomic repercussions of the pandemic; others had to keep working – either because they work in essential sectors or because they could not afford to miss a day of income – without adequate protection.
There is strong evidence now that poor families and ethnic and other minorities have been disproportionately affected by the pandemic and are more likely to have poorer health outcomes. Added to this, living with irregular migration status often means restricted access to health services and information, and poor trust in authorities because of immigration control measures.
Encouraging policy developments
In the European Union and elsewhere, several countries have already made clear their intention to include migrants with irregular status in their vaccine roll-outs. The Dutch and Spanish vaccination strategies mention them explicitly. In France, it has been announced that vaccines are to be free for all and no health insurance card will be required. In Italy, it was announced that the vaccines will be available to anyone living in the country, regardless of their residence status. The United Kingdom’s guidance states that the vaccines are available for free including for anyone living in the country “without permission,” and that “no immigration checks are needed”for people seeking COVID-19-related health services.
Other countries across the world have sought to create enabling environments, for example, by temporarily granting all migrants equal status to nationals for social and health benefits, by regularising large groups, or by preventing health authorities from sharing patients’ data with immigration enforcement during the pandemic response to protect against the risk of deportation.
With these encouraging policy developments, many questions remain about the details of implementation. What is already clear is that for migrants with irregular status who are part of the groups prioritised due to higher vulnerability to infection – such as frontline workers, people with comorbidities or experiencing homelessness – proactive outreach to make them aware of their rights and how to access the vaccine is critical.
Lifting the barriers in practice and building trust
In February, the United Nations Security Council adopted a resolution calling “for COVID-19 national vaccination plans to include those at a higher risk of developing severe COVID-19 symptoms and the most vulnerable, including… refugees, internally displaced people, stateless people, indigenous people, migrants” and other groups.
Yet, in daily life, migrants, especially those in irregular situations, tend to contend with a long list of barriers that hamper their ability to access health services. They may be required to pay out-of-pocket fees, or to be registered in a social security mechanism, or to present documents they do not have. Language is another major factor that raises apprehension and limits comprehension between migrants and health service providers.
What is more, COVID-19 vaccination plans need to consider that widespread discrimination and criminalising policies may have eroded the trust of migrants in irregular situations in public authorities: too often, they avoid seeking health care for fear – and actual risk – of facing immigration enforcement instead.
Consequently, it is critical that the deployment of any COVID-19 vaccine to migrants with irregular status be done in close cooperation and consultation with trusted community-based organisations that have a history of working with and providing services to them, and with the collaboration and direct involvement of individuals and representatives from these communities. This would also help ensure that vaccine hesitancy within these groups is understood and addressed adequately.
Reliable firewalls must also be put in place between health and immigration authorities, with clear assurances that any information informally or formally obtained about a person’s residence status while providing the vaccine will not be used against them to trigger immigration proceedings. Importantly, missing official documents cannot be a barrier to getting a vaccine.
There is still time to get this right by learning from the national and local authorities that have taken steps towards equitability and by working with migrants and local communities themselves.
The success of national vaccination campaigns depends on how inclusive and equitable they are. And our collective ability to save as many lives as possible, and re-ignite our economies, depends on how well we ensure that everyone who needs the vaccine actually has access to it.