World Refugee Day - A Hope for Solidarity: Asylum Seekers and Vaccination Campaigns in the EU
Since World Health Day on April 7th, equitable access to COVID-19 vaccines has been a cornerstone of the UNHCR’s call for solidarity with refugees and migrants. Ensuring the rights of all people regardless of their circumstance or country of origin, especially in the midst of a global pandemic, means ensuring equitable access to essential healthcare as a public good.
Right now, that solidarity means access to COVID-19 vaccines, as no one is safe until we can ensure that everyone is safe. Herd immunity is an essential medical strategy to overcoming this deadly pandemic, although this cannot be achieved if vulnerable and marginalized parts of the population living in countries are not prioritized in vaccine administration. Access to vaccines is crucial for not only individual health, but collective health.
In the European Union (EU), policy action to ensure the availability of vaccines for refugees and migrants has been sporadic and inconsistent since vaccines first became widely available at the start of 2021. Many countries have already adopted vaccination plans that include refugees, but implementation faces many challenges. Other countries within the EU have thus far failed to prioritize, or even explicitly exclude refugees and asylum seekers even as they experience high-infection-risk settings.
Germany has set the precedent for a comprehensive vaccination strategy to offer access to asylum seekers living in (often high density and thus high risk) government accommodation centers, by making those living in these centers part of the second priority group to receive the vaccine back in April. Unfortunately, the program has faced setbacks as reportedly only one in five people living in these facilities are willing to receive the inoculation. This situation highlights the oft-overlooked barrier to vaccine access for many people, especially refugees, asylum-seekers, and migrants, which is a lack of accessible information about vaccinations or vaccine programs. Equitable healthcare for these communities means not only access to services, but access to information about healthcare which allows the provision of informed consent. Germany has thus again set a positive precedent by embarking on a publicity campaign to address the lack of trust in vaccines by providing information videos in 15 languages. The Berlin Office of Refugee Affairs (LAF) has already reported that people seeking asylum in accommodation centers throughout Germany have responded positively to the initiative.
France, UK, Netherlands
France, the United Kingdom, and the Netherlands have also successfully included refugees and even undocumented persons in their national vaccination strategies, but similarly faced the issue of people of these communities being unwilling to receive the vaccine. In the UK and France especially, this has prompted a widespread campaign to dispel mistrust in public authorities and ease the fears of undocumented people or asylum seekers that receiving the vaccine will lead to their information being shared. In these cases, where availability of the vaccine to refugees and migrants is not the issue but rather trust in the vaccine, campaigns by health authorities with explanatory documents in a variety of languages are essential to ensure true equity of vaccine distribution.
While Italy initially made strides by including asylum seekers in their national vaccination strategy, developments reveal how practical barriers in healthcare system access can limit the efficacy of even the most well-thought out plan. Healthcare officials have revealed that over 700,000 foreign citizens are effectively ‘invisible’ as they do not have access to COVID vaccination campaigns because they lack health insurance cards or fiscal codes. This inequality of vaccine accessibility affects immigrants from both non-EU countries and EU countries, as well as irregular migrants currently living in Italy, who are unable to book a COVID vaccination on regional platforms because they lack the necessary documentation. Many of those affected by this loophole have an Stp (foreigners present temporarily) card, which is released to irregular migrants after being present in Italy for more than three months and guarantees access to urgent or essential health services including vaccinations. This demonstrates the complications of policies ensuring vaccine access, because while Italy technically gives these regular and irregular migrants a right to vaccination, in practice the policies and extensive requirements implemented by the government regionally mean that people slip through institutional cracks.
In the early months of vaccine rollout in Slovakia, certain migrants experienced a similar problem of denied vaccine access because of their type of health insurance. As a result, the Slovakian government has proposed a new law that explicitly grants access to COVID-19 vaccines for all persons without public health insurance – including migrants and refugees of all types of legal status.
Portugal has also made valiant efforts for inclusive vaccine access, recognizing the vulnerability of people living in refugee camps to COVID-19, and granting temporarily all asylum seekers and foreign-born migrants full citizenship to eliminate institutional obstacles to healthcare access.
Conversely, countries like Poland have passed legislation that explicitly includes some while excluding others by way of purposely placing obstructive healthcare barriers. The Polish government guaranteed all foreigners residing in Poland (including refugees and persons who have applied for international protection) the legally-recognized right to be vaccinated against COVID-19 free of charge. But this ‘right’ only applies to those who can prove evidence for their legal residence in Poland, explicitly excluding irregular migrants and refugees or those who have struggled to secure sufficient documentation or temporary residence cards because of bureaucratic obstacles. Nonetheless, asylum seekers who stay in reception facilities receive vaccination based on age group and occupation according to the national plan, but Polish efforts highlight how even if ‘included’, migrants and refugees still face significant barriers to vaccine access.
Greece in particular faced criticism from international rights groups since January for failing to prioritize migrants and refugees in its national vaccination strategy, but now represents a tentative hope for solidarity as they begin a large scale COVID vaccination drive for asylum seekers. This ‘long-awaited’ program prioritizes tens of thousands of asylum seekers living in Greek government-run facilities on the Aegean Islands of Lesbos, Chios, and Samos. The push for this campaign is especially necessary, given that the asylum seekers who live in these government facilities are in close-quarter camps which make social distancing and other COVID-mitigation practices difficult. The vaccination program for asylum seekers is also being rolled out on other Greek islands and the mainland, buoying hope from the UNHCR that the over 91,000 refugees in Greece will become inoculated against COVID-19 within the coming months. Greece in essence serves as a positive precedent for countries, which initially prioritized their own populations in vaccination strategies, taking the positive step of solidarity to extend vaccination strategies to those seeking asylum in their countries.
In Greece, like Germany, France, and other EU member states, there is hesitancy from asylum seekers to receive the vaccine, although officials are confident the amount of vaccine interest will increase from 15% once the campaign gets thoroughly underway. Additionally, concern is minimal given that 30% of the population of asylum seekers are under 18 and thus ineligible for vaccination, while 30% have already been infected with COVID-19, it is believed this vaccine reluctance will have minimal impact on the path to immunity among asylum seekers.
Overall, when it comes to ensuring equitable access for refugees and migrants to COVID-19 vaccines, states in the European Union still face numerous of barriers. These primary challenges are twofold. Firstly, national vaccination strategies must include asylum seekers by explicitly enabling access to vaccines by addressing the issue of those who fall through the cracks of national healthcare systems because they lack residency cards or other documentation. Unfortunately, even strategies intended to target vulnerable communities (such as those in government centers) often still fail to address the inequalities of access entrenched in national healthcare systems inhibiting access for those who are not residing in government accommodation. As Gianluca Cesaro from the Platform for the International Cooperation on Undocumented Migrants (PICUM) claimed: “It is one thing to include undocumented people in the vaccination strategies on paper. It is another to actually grant them meaningful, practical access to the vaccines. This means governments and authorities need to enact effective outreach strategies to get to these communities”. Thus, policy of inclusion is not as cut and dry as allowing access to vaccines on paper, all the practical exceptions to the rule must be accounted for to ensure legitimate equal access for all people regardless of their migration status.
Finally, an equally essential element in vaccine equity is the provision of information about COVID-19 vaccines to refugee and migrant communities. As the situation in Germany and many other countries demonstrate, part of ensuring people have equitable access to healthcare is also ensuring that healthcare information is accessible and understandable. Health-related misinformation on vaccines is notable in asylum seeking and migrant communities throughout Europe, which impacts the willingness to be vaccinated even if they have access. Furthermore, a lack of understanding of healthcare rights and benefits as well as mistrust in administration services can lead to further discrimination and inaccessibility. Therefore, beyond pushing for the inclusion of all stateless people in national vaccination campaigns, a key policy to achieve the UNHCR goal of essential healthcare access in the time of COVID-19 must also be the availability of vaccine and healthcare information in different languages.
The way forward for ensuring true equitable access to COVID-19 vaccines for all refugees and migrants – regular and irregular – is not only availability of the vaccine, but also access to information and education on the vaccine. Through nuanced policy, inclusion, outreach and communication, there is hope that the member states of the EU can act in solidarity to heal and provide essential healthcare for all people residing in the borders of the EU.
Institute of Public Affairs
MA Candidate at the Munk School of Global Affairs, University of Toronto