Excluding migrants undermines the success of Covid-19 vaccine rollouts
- Rebecca Walker, Jo Vearey and Nicholas Maple
Failure to ensure access for all to prevention and treatment, including vaccines, undermines national responses to Covid-19.
Migration is increasingly recognised as a . Research that, in many cases, cross-border migrants arriving in new countries are healthier than the host population. But the advantage often falls away as non-nationals encounter discrimination and challenges in accessing documentation, support services and employment.
The of all individuals within a countrys borders must be addressed. But African states have failed to design and implement health systems and responses. Many non-citizens, asylum-seekers and refugees are excluded from public health programmes.
The impact of such exclusions is now playing out. COVID-19 illustrates how , asylum seekers, internally displaced people and migrants are being left out of , including national vaccination programmes.
shows that the vast majority of migrants are currently excluded from state-based COVID-19 vaccine rollout programmes. These forms of exclusion are likely to have far-reaching public health implications. To effectively of COVID-19, everyone must be vaccinated. Otherwise the virus will continue to spread while new variants emerge.
The African continent has the lowest COVID-19 vaccination coverage globally. Just of the population has received at least one vaccine dose. But beyond this is the issue of how countries implement their own programmes and who they leave behind.
Some countries do migrant populations. But the International Rescue Committee (IRC) reported in May 2021 that receiving their vaccines through had excluded refugees or internally displaced populations from their national plans.
We have been conducting exploring access to COVID-19 vaccines across the continent. Our findings and a case study of South Africa highlight the issues of vaccine nationalism, vaccine exclusion and hesitancy and their likely effect at the population level.
Exclusion and violation of rights
Restricted access to vaccines is one clear example of discrimination against migrants. Not all migrants are undocumented and not all who are undocumented are vulnerable. But the exclusion of specific groups on the basis of citizenship, immigration or documentation status , and affects the success of any vaccination programme.
Our highlighted how migrants and refugees are being excluded.
First, migrant populations have simply in vaccination rollout plans of many states. Few make it explicit whether and how various migrant groups will fit into the rollout. For example, in May 2021 noted that in Nigeria, there are concerns that over 2.7 million internally displaced people are at risk of being completely ignored in the current vaccine plans.
Second, even where non-nationals are explicitly included in plans, , they may face barriers. For example, in Kenya, refugees are fearful of coming forward and accessing state services such as public healthcare. noted that Kenya might exclude hundreds of thousands of refugees through a disconnect between policy and practice.
The risks of are significant in many states. If people dont feel safe, COVID-19 vaccination programmes will be less effective.
There are nonetheless notable exceptions on the continent Rwanda, Cameroon and Senegal being three. For example, Senegal and Cameroon are allowing refugees to register in . Rwanda was one of the first 20 countries worldwide . The national response plan prirotises asylum-seekers and refugees alongside healthcare workers and key civil society and community members.
The case of South Africa
Exclusion, barriers to access and discrimination can be seen clearly in southern Africa, and specifically South Africa. The region has diverse historical and contemporary migration patterns. South Africa . Only of the South African population is estimated to have been born in another country.
Due to an increasingly restrictive immigration regime and a seriously Home Affairs Department, many migrants in South Africa struggle to regularise their stay. As a result, those who start off with work permits or asylum-seeker permits often find themselves through no fault of their own .
For refugees and migrants in South Africa with no papers, the consequences of being undocumented are far-reaching. They are unable to access formal employment and bank accounts, and have . Undocumented migrants live with the .
Where the vaccination rollout requires an identity number, passport number or refugee permit to register there is no option for those who do not have these. Furthermore there is no clear directive of how people who are undocumented including South African citizens can register for vaccination.
The South African government has included refugees and asylum-seekers with documentation in the countrys vaccination rollout.
Vaccine hesitancy
Finally, a response to vaccine hesitancy within local communities and migrant groups on the continent demands collective action between states, international humanitarian organisations and civil society. In addition to a mistrust of vaccinations themselves, hesitancy can take the form of a fear of being treated badly due to anti-foreigner attitudes, or fear of arrest or deportation.
For example, in the Central African Republic, rumours have been circulating about foreigners spreading the virus and even fears that international aid agencies are . In Rwanda, rumours and the spread of misinformation have .
More strategic thinking is needed to raise awareness, build trust and outline measures of protection for those who fear coming forward for the vaccine. As the International Organisation for Migration has to migrant communities, in tailored languages and through relevant communication channels, is central to creating vaccine demand.
One approach would be to civil society organisations, community groups and religious leaders in vaccine rollout programmes.
A clear way of improving the safety of everyone is through firewalls. These for undocumented people, ensuring they face no penalties when accessing state health services. Any information collected is used by the health system only.
Looking ahead
According to Dr Matshidiso Moeti, WHO Regional Director for Africa, thus far .
Not only does the continent need more vaccine doses, but countries must also include all migrant populations. Failure to ensure access for all undermines national responses to COVID-19. The consequences spread far beyond those nations.
There is no place for hypocrisy. The international community cannot be called out on if states do not plan for an inclusive national response themselves. Without vaccinating everyone, nobody is safe.
, Research Associate at the African Centre for Migration & Society, ; , Associate Professor, , and , Post Doctoral Research Fellow at the African Centre for Migration & Society (ACMS), . This article is republished from under a Creative Commons license. Read the .