When privilege and injustice collide

Since the end of December 2020, most European Member states have started carrying out vaccination campaigns following specific orders of priority. European countries have defined targeted groups who should get priority in these vaccination campaigns. For instance, apart from health care and frontline workers, older persons over 80 years of age or essential staff working in schools and universities were identified as categories that should have priority access to vaccines.

Some controversies surrounding vaccination plans and strategies highlight the need to clarify where migrants, refugees and asylum seekers stand. It is urgent to reflect on the dynamics behind the prioritization of some categories over others and to foster inclusive approaches in our health-related thinking and practices. The so-called vulnerable populations – including migrants, refugees, asylum seekers, internally displaced persons and other people on the move – are often involved as frontline workers to address the Covid-19 crisis. Furthermore, in many countries, migrants do not only represent a large part of the health-care labour force, but they also take on essential roles, that of students, entrepreneurs, inventors, scientists, investors, consumers and taxpayers.

In December 2020, the European Centre for Disease Prevention and Control (ECDC) published a detailed report outlining the Covid-19 vaccination strategies and vaccine deployment plans in the EU/EEA and the UK. Despite the validity of this document and the outlined need to protect health care workers along with the elderly and individuals with certain comorbidities, it is surprising that migrants, refugees, asylum seekers and other categories at risk are not mentioned at all. The risk is that individuals with transnational stories, foreign-born backgrounds and diverse nationalities are not and will not be sufficiently included in the Covid-19 vaccine discourse. It is essential to guarantee that migrants, refugees and asylum seekers are not left out of our global efforts to fight back against Covid-19 and other diseases.

The status quo and the challenges

At the beginning of the Covid-19 pandemic, a few countries took measures to accommodate asylum seekers and refugees. For example, to eliminate institutional obstacles to healthcare access, Portugal temporarily granted full citizenship to all asylum seekers and foreign-born migrants. In Germany, the vaccination strategy and prioritization included asylum seekers living in accommodation centres, who were identified as part of the second group to receive the vaccine. The second group also comprises people from the age of 70 and those with a very high or high risk to be infected with Covid-19. Countries like Greece have also claimed that asylum seekers living in refugee camps will receive vaccinations in May 2021. Even though this represents an important step to guarantee more inclusion and accessibility to the vaccination campaigns, the procedures in place in countries like Germany and Greece only cover a partial group of foreign-born individuals. These interventions solve the problem temporarily by providing vaccination to those who are the most at risk, who are living in harsh conditions and complex contexts. However, there is a large part of individuals associated with the broad category of migrants and refugees, who were not sufficiently taken into consideration and may risk being excluded from the vaccination campaigns for now.

The discrimination around asylum seekers, refugees and foreign-born migrants still persists during the current crisis and it has reinforced enduring inequalities. There are several challenges to consider which lead to impediments for these categories to access the vaccines. For instance, difficulties associated with an individual’s visa status can create problems when accessing health insurance, care services and, in turn, vaccines in the host country. Most European countries seem to have included undocumented migrants within their vaccination strategies. However, as Gianluca Cesaro from the Platform for the International Cooperation on Undocumented Migrants (PICUM) claimed: “It is one thing to include undocumented people in the vaccination strategies on paper. It is another to actually grant them meaningful, practical access to the vaccines. This means governments and authorities need to enact effective outreach strategies to get to these communities”.

In addition, these vaccination strategies imply the need to collect targeted and accurate data from individuals, such as information about one’s name, birth date, address and other relevant details. This represents a risk when it comes to individuals’ privacy and safeguarding. Some experts outlined that the prerequisite to collect such data could limit the access to vaccines for those workers who are in the country illegally and who, by sharing this kind of information, could be thrown out. This results in a large piece of the population who lives in the shadow and, during such a crisis, desists from lining up for vaccination.

Moreover, the absence of targeted and clear guidelines impedes coordination within European Member States and it can hinder the success of vaccine administrations for the immunization of displaced and foreign-born people. For instance, it is not always clear whether health-care professionals should immediately offer vaccination to refugees and migrants with unknown vaccination history, or they should rather conduct further testing to verify a patient’s medical history better and, as the report from WHO outlines, they can potentially offer vaccination to those found to have insufficient immunity to Covid-19.

These are just a few controversies, among many other issues, that can reduce immunization to Covid-19 for migrants, refugees and asylum seekers, by creating “clusters” of under-vaccinated communities. The amount of difficulties that migrants and forcibly displaced persons have to deal with across countries remains far too significant. These examples outline the need to clarify and define cohesive, coherent, and inclusive ways to guarantee vaccine administrations even among irregular migrants. To combat vaccine hesitancy and, in turn, move forward a broader immunization of individuals, it is essential to foster awareness among health care workers by developing training and detailed guidelines to follow and clarify which vaccinations should be given or readministered to refugees and migrants. This also implies the necessity to develop culturally sensitive procedures to avoid discriminatory approaches that might reinforce stigma and induce refugees and migrants to distance themselves from health care services and any other support they may need. Along with this, there is the need to make sure that displaced people, refugees, people in transit and migrants are informed about their health rights.

This lack of understanding and, in turn, the potential exclusion of certain groups from vaccination campaigns, can also lead to further discrimination and stigmatization against migrants or, in general, the so-called foreign-born population. Individuals may tend to exclude these groups even more, to exclude or move away from them as they can be perceived as more likely to be infected and carry Covid-19. This may diminish the efforts that are being made to include migrants and integrate them into the population.

It has been proved that the current pandemic is exacerbating racism and xenophobia. For instance, populist groups are often increasing prejudice against migrants and they are blaming them for the spread of the virus. Stigmatic suspicions of migrants and refugees as potential disease-carriers may result in poor access to health care services, stirring up a vicious circle of exclusion, health inequalities and stigmatization. Thus, it is important for governments, institutions and media to act on unfair public representation, raise awareness and decrease discrimination.

We have been witnessing a lack of clarity in existing national policies along with the shortage of consistent guidelines between countries when it comes to access to vaccines for migrants, refugees and asylum seekers. A switch is needed, and European countries should work cohesively to promote inclusive strategies along with coherent actions to involve both irregular and regular migrants within the Covid-19 vaccination campaigns. These approaches would allow moving the first steps towards fairer and more equal health systems where justice and equity are prioritized over privilege and mere nationalistic strategies. In the past year, we learned that this virus is not restricted within borders nor it makes distinctions based on privilege and individuals’ nationality. This shows that tackle the current crisis, at least from a medical point of view, there is the need to guarantee collective immunity and protection against Covid-19 for every individual despite his or her origins, background and personal story.