Refugees’ plight when vaccine queue ends

“We are human beings, but we have no rights,” said an Afghan refugee in New Delhi, while waiting for a vaccine shot, of his community’s vulnerability to Covid. As the pandemic intensified, such communities were particularly vulnerable to loss of livelihoods, less support and pauses in documentation processes. Recent conflicts in Afghanistan, Yemen, Ethiopia, South Sudan, Palestine, Syria, Iraq and Congo displaced 11.2 million more during the pandemic, adding to the world’s estimated 82.4 million forcibly displaced people. Displaced persons now constitute a significant proportion of the world’s population and at least 70% of them live with economic, social and legal vulnerabilities. Refugee children are often unimmunised. Pre-existing medical conditions and poor access to health care can double their risk of severe covid. Lack of access to testing and quarantine facilities, along with circumstantial difficulties in following social distancing, hand-washing and mask protocols, have meant frequent Covid outbreaks in refugee camps around the world. They need vaccines, but have the least access to them.

Globally, 70% of the 104 vaccination plans reviewed by the World Health Organization (WHO) in 2021 excluded migrants, including refugees and asylum seekers. Most of the plans left out 11.8 million to be counted as internally displaced people. Unfortunately, not all of this has worried global leaders who could influence policies. Countries continue to close borders and adopt harsh policies to keep asylum seekers out in times of pandemic. As demand for health care grew, countries such as Denmark adopted policies that would reduce asylum applications from 21,000 to 1,500 in 2021. Some countries have sought to isolate refugees in detention centers or on islands with very poor infrastructure. While the 1951 Refugee Convention states that refugees should have access to equitable healthcare as the host population, policies and international treaties have received little attention in recent times.

Vaccine inequality has resulted in 79% of the global dose administered in high-income countries, with only 2.3% given in low-income countries. Rich countries hoard food, 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 most of the world’s refugees, have so far not been able to cover their populations even with the first dose. Tragically, only 2% of global vaccines have been administered to Africa. It is clear that the 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 usually fled war, violence or persecution and often lack identity cards. Failure to prove their existence on paper should not result in denial of vaccination, which is a basic right in today’s context, but that is what happened.

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

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

A survey by World Vision shows that 47% of global refugees thought they were ineligible or were unaware of vaccine programs. Although Lebanon and Jordan have inclusive vaccine policies, the United Nations High Commissioner for Refugees has highlighted that misinformation on adverse effects continues to cause vaccine hesitancy, while cultural and language barriers add to it.

Despite challenging economic conditions, some Latin American countries also include refugees in their vaccination plans. For example, Colombia has offered 10 years of temporary security status to Venezuelan refugees. Portugal temporarily granted full citizenship rights to asylum seekers providing access to healthcare, including vaccines.

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

Vaccine inequality is the result of structural inequalities that extend beyond the health sector. Vaccine access cannot be ensured by issuing statements on national immunization programs or on global forums. We need pragmatic political solutions that prioritize human rights over power. Otherwise, refugees and vulnerable communities will have a long way to go before they feel COVID-safe.

Meenuka Mathew is a Teaching and Research Fellow at the Jindal School of Government and Public Policy.