Migrants are in danger of becoming an afterthought in the international effort to vaccinate against Covid, with UN agencies fearing many will be too scared of authorities to accept a shot.
There are also concerns around compiling data on refugees and migrants, many of whom are reluctant to engage with officials due to a lack of trust, the agencies said.
Dr Jaime Calderon, the senior migration health adviser at the International Organisation for Migration’s regional office in Vienna, says governments must take steps to ensure refugees and migrants are not left behind, and go beyond simply procuring adequate vaccine doses.
Governments should “reduce the number of administrative hurdles for migrants to access health care and vaccines by making sure it is affordable, if not free, and that no particular proof of residence, work or identity is required in order to get the shot,” he said.
"One of the concerns we have is that even if offered access to the vaccine, many migrants may not even attempt to get the shots for fear of arrest or deportation. There needs to be tangible efforts in policy, communication and implementation to build trust with all migrant communities," he told The National.
“In addition to offering guarantees that vaccination will not lead to arrest or deportation, communications need to go through channels that are adequate for reaching all migrants, with key information on how to access the vaccine and what the conditions are.”
On the EU’s eastern border, malnourished refugees languish in bitterly cold makeshift camps, where conditions are often far from sanitary.
Many live in remote areas and distrust local authorities, a fear entrenched because of the brutality security forces in their homelands inflicted on them in the past.
Ensuring fair distribution of Covid-19 vaccines has been a priority for the global community during the pandemic, but rich countries have nonetheless led the way in inoculations. New data suggests only 0.1 per cent of doses have been administered in the world’s 50 poorest nations.
But arguably further away from the spotlight is how to ensure that vaccines are distributed equitably within countries. UN agencies have been clear that migrants and refugees, regardless of their legal status, must be included in vaccination programmes – not only from an equity standpoint, but also to limit the spread of the virus.
Another concern is the lack of data on the impact of Covid-19 on refugee and migrant populations, said Dr Siddhartha Datta, a regional adviser in the vaccine-preventable diseases and immunisation division at the World Health Organisation’s European office.
Dr Datta raised the importance of ensuring refugees and migrants are informed about the vaccine.
He also pointed to a lack of trust in the system that both documented and undocumented migrants may have. Basic matters, such as finding out where to be vaccinated and who to speak to if they develop Covid symptoms must also be established, Dr Datta said.
“One thing which we can see in this population group is about communication, communicating to them what this vaccine does and what this vaccine doesn’t do. This is extremely important.
“This is much more complex because of the fact that there is always a language barrier between the host country that is providing this information or services to the people who are coming. We have seen that in the routine vaccination programme as well. So, the communication campaign has to be tailored to these particular population groups.
“The other factor is if they don’t see the disease happening in their own population ... the perception of the population will be low to the receipt of the vaccine.”
The Pfizer-BioNTech shot must be stored at −70°C, adding another layer of complexity, particularly when migrants and refugees live in hard-to-reach areas that lack suitable facilities or even basic sanitation.
Dr Datta says vaccines must be handled with care to ensure they do not become tainted.
“If the −70°C or −80°C fridge is not there, then what is the mechanism that [the WHO’s] member states or the ministries of health will put in place?” he said.
Some progress is being made, with Unicef agreeing to deliver eight refrigerators to Bosnia and Herzegovina for storing vaccines in ultra-cold conditions – but there is still a long way to go.
Jagan Chapagain, the secretary general of the International Federation of Red Cross and Red Crescent Societies, said any sense of health security that countries obtain through inoculation would be false if marginalised communities are not included.
In Europe, where hostility towards immigration is high, some countries have publicly stated they plan to include migrants and refugees in vaccination programmes. While the EU is in charge of procuring vaccines, it is the individual member states who deliver and develop the campaigns to inoculate their populations.
Countries bordering the bloc such as Bosnia and Serbia, which have large migrant populations, will receive some vaccines from the EU and the Covax initiative, but have also set about buying their own.
The UN has underlined the human element of ensuring migrants and refugees be vaccinated – but it is also the smart thing to do, Dr Calderon said.
“If this pandemic has demonstrated something, it’s that no one is protected unless everyone is protected. Vaccines offer the opportunity we have been waiting for to have a chance at restarting our economies in full gear.
“But we have to use them wisely and strategically: we must vaccinate the most vulnerable first, no matter their nationality or their migration status, or we will all continue to pay a higher price than is necessary,” he said.
Dr Datta says it is a “universal truth” that infectious diseases “know no borders,” but the issue becomes even more critical for vulnerable population groups.
“These refugees or migrants, they’re moving around, they’re living in not so good conditions, the stress level is high there. The chances of getting an infection is quite high. You and I can wash our hands and have access to running water or using a mask or ensuring that you and I be separated with at least the physical distancing that we can maintain. Those conditions may not be there,” he said, referring to the informal camps many migrants live in.
“But then also, the mobility of these people in itself poses several problems,” he said.
Supplying the global community remains a pressing problem, but without including everyone in the immunisation push, pockets of unvaccinated people will be a major barrier to overcoming the virus.
“The equitable distribution of Covid-19 vaccines between and within countries is more than a moral imperative. It is the only way to solve the most pressing public health emergency of our time,” Mr Chapagain said.
“Without equal distribution, even those who are vaccinated will not be safe.”