The misery of the refugee at the end of the vaccine queue

“We are human, but we do not have any rights," said an Afghan refugee in New Delhi, speaking of her community’s vulnerability to covid while awaiting a vaccine shot. As the pandemic accelerated, such communities grew particularly vulnerable to loss of livelihood, reduced aid and stagnation in documentation processes. Adding to the world’s estimated 82.4 million forcibly-displaced people, recent conflicts in Afghanistan, Yemen, Ethiopia, South Sudan, Palestine, Syria, Iraq and Congo displaced 11.2 million more during the pandemic. Displaced persons now account for a significant proportion of the world population and at least 70% of them live with economic, social and legal vulnerabilities. Refugee children are often unimmunized. Pre-existing medical conditions and poor access to healthcare could raise their risk of severe covid to twice that of the better-placed. Combined with circumstantial difficulties in adherence to social-distancing, hand-washing and mask protocols, lack of access to testing and quarantine facilities has meant frequent covid outbreaks in refugee camps across the world. They need vaccines, but have the least access to them.

Globally, 70% of 104 vaccination plans reviewed by the World Health Organization (WHO) in 2021 excluded migrants, including refugees and asylum seekers. Most plans omitted the 11.8 million counted as internally displaced people. Unfortunately, all this has not alarmed global leaders who can influence policies. Countries continue to close borders and adopt harsh policies to keep out asylum seekers in pandemic times. As healthcare demand increased, countries like Denmark adopted policies that would reduce asylum applications from 21,000 to 1,500 in 2021. Some nations have sought to isolate refugees in detention centres or on islands with very poor basic facilities. While the 1951 Refugee Convention states that refugees should have access to similar healthcare as host populations, policies and international treaties have paid little attention to this in recent times.

Vaccine inequity has resulted in 79% of global doses being administered in high-income countries, with only 2.3% given in low-income countries. Rich countries have hoarded doses, while Big Pharma has little financial incentive to do business in poor countries.

Bangladesh, Congo, Jordan, Kenya, Lebanon, Pakistan, Sudan, Uganda and Venezuela, which host a majority of the world’s refugees, have not been able to cover their populations even with first doses so far. Africa, sadly, has got only 2% of the global vaccines administered. It is clear that countries with the highest refugee and asylum populations are among the least vaccine-covered countries.

Refugees are constantly asked to prove their identity, although they have typically fled war, violence or persecution and often lack identification papers. Failure to prove their existence on paper should not result in denial of vaccination, a basic right in today’s context, but that is what has happened.

Most vaccination programmes use digital systems linked to some proof of identity. By design, they exclude people without documents. For example, the UK allows refugees to access vaccines through its National Health Service, but excludes those who fail to provide identification. Unfortunately, health service providers in many countries appear unaware of refugee rights.

There is also a demand problem. Even in countries with inclusive vaccination programmes, many undocumented migrants are hesitant to register for jabs in fear of penalties, deportation or separation from their families. In the Maldives, the government agreed (with Red Crescent) not to use vaccine-registry data for any other purpose. Still, many refugees fear their names being recorded more than getting infected.

A World Vision survey suggests that 47% of global refugees thought they were ineligible or were unaware of vaccine programmes. Though Lebanon and Jordon have inclusive vaccine policies, The United Nations High Commissioner for Refugees has highlighted that vaccine hesitancy persists on account of misinformation on adverse effects, while cultural and language barriers add to it.

Despite challenging economic conditions, some Latin American countries’ immunization schemes cover refugees as well. Colombia, for example, has offered Venezuelan refugees 10-year temporary protection status. Portugal temporarily granted asylum seekers full citizenship rights to give them access to healthcare, including vaccines.

Yet, the outlook is grim. As G7 nations fail to keep their vaccine diplomacy promises and block an intellectual property waiver that would increase dose supply, hopes of vaccine equity have faded. Millions of doses that will expire by 2021-end are expected to be wasted if not redistributed immediately.

Vaccine inequity is a result of structural inequalities that go beyond the health sector. Ensuring vaccine access cannot be done by national vaccination programmes or issuing statements on global platforms. We need pragmatic political solutions that prioritize human rights over power. Else, refugees and vulnerable communities would have a long way to go before they can feel covid-safe.

Meenuka Mathew is a teaching and research fellow at Jindal School of Government & Public Policy.