COVID-19 Vaccines for Undocumented Migrants: Achieving Equitable Access

“No one is safe until everyone is safe”

On 10 July, Commission President Ursula von der Leyen announced in a statement that the EU had received enough vaccine doses to vaccinate 70% of its adult population. She also acknowledged that the virus “is not yet defeated” and that now “member states must do everything to increase vaccinations”, adding “nly then will we be safe.”

This echoes the mantra of the World Health Organisation (WHO) and other international bodies over the last several months that “none of us will be safe until everyone is safe” – a simple statement of the need for solidarity and equity to be at the heart of our collective response to the pandemic, at both the global and national levels.

What about people with irregular residence status?

International and regional public health and human rights bodies have, since the end of 2020, been vocal about the need for inclusive and equitable vaccination schemes, as a matter of public health, fairness and human rights; and have published guidelines about how to achieve this for people with irregular migration status, who have long faced major barriers to accessing health care. Click here for a more detailed picture of existing recommendations.

In Europe, vaccine strategies vary considerably, with wide variation in governments’ approaches to inclusion of undocumented people. Despite important gaps, promising practices have emerged in several countries to promote access by undocumented people and others facing various forms of systemic exclusion to COVID-19 vaccines. Below is an overview of some of those promising practices.

1. Proactive measures to address legal, practical barriers to access. The United Kingdom announced in February that all UK residents could access the vaccine for free, regardless of their migration status, with only a requirement (for those without a national health number) to register with a general practitioner. This was reflected in official national guidelines. Access has, however, been hampered by fears linked to the “hostile environment” and the fact that most GPs refuse to register undocumented patients because they cannot provide documentation, such as a valid residence permit, even if this is not required by law.
2. NGOs, community-based organisations actively involved by governments in the definition of strategies. In Belgium, the federal government was receptive to the concerns of non-governmental and community-based organisations and collaborated with them from early on in the development of its strategy and approach; and the Brussels region has worked proactively with local organisations to craft practical solutions for ensuring that undocumented people and others facing exclusion can get the vaccinated, including through mobilisation of mobile clinics.
3. Clear instructions from governments and health authorities about entitlements and how to ensure undocumented people get COVID-related care. In Spain, the federal vaccination strategy explicitly mentions undocumented migrants and other marginalised populations as groups to be vaccinated. It doesn’t, however, detail how to reach them. While there are examples of inclusive approaches in some regions, non-governmental organisations have been pushing for clear guidelines from the Ministry of Health to the regions to address inconsistencies in practices that lead to exclusion.
4. Clear commitment and communications that personal data will not be shared with immigration authorities or otherwise used for purposes not related to public health. In Ireland, the Minister of Health stated clearly that there would be no immigration consequences for people coming forward to be vaccinated, and encouraged undocumented people to do so. During the lockdowns in 2020, Ireland had already announced that undocumented people could access COVID19-related care without risk of data sharing with immigration authorities – and that they would be included in the country’s Pandemic Protection Program for workers who lost their jobs. In Germany, the Munich municipality confirmed in writing that there would be no immigration checks on undocumented people who would try to access the vaccines.
5. Straightforward and flexible procedures, with limited documentation requirements. Portugal published a COVID-19 vaccination registration website where undocumented people can book their vaccinations, and which is adapted to be less burdensome in terms of the information that must be provided (address, birth date, phone number and nationality). According to official figures from June, more than 19000 undocumented migrants had registered via the website, often with assistance from local NGOs.
6. Communications campaigns tailored to the needs of diverse groups. Because undocumented people generally do not have access to mainstream health systems, they often also do not have ready access to health-related information. They may also have limited access to online sources of information. So it’s essential that information about the pandemic and about the COVID-19 vaccine – its safety and efficacy, who is eligible to receive it and how – is tailored to address these barriers, and made available and accessible in multiple languages to promote awareness and understanding, address vaccine hesitancy.

The COVID-19 vaccination strategies are spotlighting pre-existing gaps and inequities in national health systems across countries in Europe, and at least in some cases tensions between immigration control and public health and equity imperatives. Some countries have been proactive in trying to fill gaps in the context of the pandemic and vaccination programs, in particular. This is a key moment to think not only about a more equitable pandemic response, but sustained and systematic efforts to repair the cracks in our health systems, and to prioritise need over status in defining and implementing rights to care.

Cover: Adobe Stock – bernardbodo