The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination

Abstract

Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as “essential workers”, including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.

Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women

“…According to the Turkey Demographic and Health Survey (TNSA) 2018, 81.0% of Turkish pregnant women were vaccinated against tetanus for their last live birth in the last 5 years [ 24 ]. Only 30.0% of pregnant Syrian women were vaccinated against tetanus for their last birth [ 25 ]. There is a need to increase tetanus vaccination coverage in pregnant Syrian women.…”

“…However, Turkey deserves to be a big focus of this topic. A large number of immigrants have come to Turkey in recent years [ 25 ]. Syrian immigrants are also among these groups.…”

The determinants of COVID-19 vaccine uptake among migrants from 109 countries residing in China: A cross-sectional study

“…These determinants (the 5 “A's”) include (1) access, which refers to the ability to access vaccines, such as native language proficiency and confidence in policy-makers or government; (2) affordability, which refers to the ability of individuals to afford vaccination, both in terms of financial and non-financial costs, such as direct vaccine costs and time costs; (3) awareness, which refers to the degree to which individuals have knowledge of the need for vaccines and risks and entitlement to knowledge about vaccination and risks; (4) acceptance, which refers to the degree to which individuals accept, question, or refuse vaccination, such as perceived vaccine safety, side effects, and benefits; and (5) activation, the degree to which individuals are encouraged to be vaccinated, such as vaccination incentives and health education ( 8 ). Regarding access, inequalities in access to COVID-19 vaccination by undocumented migrants ( 16 ) and historical experiences of migrants influence COVID-19 vaccine uptake ( 17 ). Language barriers and lack of interpreting services were common barriers to measles and hepatitis B vaccine uptake ( 18 , 19 ).…”

COVID-19 Vaccination Program for Undocumented Migrants: Notes from the Field of a Regional Center of General Medicine and Public Health, Canton of Vaud, Switzerland

“…Among them, undocumented migrants – people living in a country without legal documents and permits 1 – are particularly at risk of health inequities. Indeed, their living and social conditions (high population density, belonging to a minority ethnic group, cultural and language barriers, social deprivation, and being “essential workers”) increase their exposure to COVID-19 [ 2 , 5 – 8 ]. Moreover, they have limited healthcare access, especially if they are uninsured.…”

“…Moreover, they have limited healthcare access, especially if they are uninsured. In this context, ensuring equitable access to vaccination for undocumented migrants is not only an ethical priority but also a significant public health issue to prevent new outbreaks [ 8 – 11 ]. A recent review highlighted the numerous barriers faced by undocumented migrants to access COVID-19 vaccination, including systemic restrictions and practical barriers both on the supply- and demand-side [ 8 ].…”