Since December 2020, the world’s wealthiest nations have procured millions of doses of various COVID-19 vaccines and initiated its inoculation to their most vulnerable. As people around the world await their turn to receive their first dose, the fate of the world’s 80 million refugees and internally displaced people remains uncertain. The UNHCR estimates that nearly 26 million of these people are refugees, with 85% of them being hosted by low- and middle-income countries. In addition to the barriers they already face within their individual nations, refugees may now also fall victim to the broader issue of international global vaccine inequity based on the income status of their host countries.
Why should refugees be a priority group for vaccination?
Though each nation with access to the vaccine is developing an extensive vaccination plan, many of them are not explicitly incorporating refugees into the equation, despite the disproportionate impact the pandemic has had on refugee and migrant populations. Amidst the global pandemic, migrant families, refugees and internally displaced people have become even more vulnerable to poverty during the pandemic, and are less likely to be included in the economic recovery plans of the nations in which they now reside.
Refugee camps are usually isolated from urban areas where the virus spreads more rapidly, and statistics show that there have been significantly fewer reported COVID-19 cases in these areas. However, this can be attributed to the underreporting of cases and the lack of adequate testing available in most camps. Refugee camps are also extremely densely populated and have inadequate access to latrines, water supplies, and protective equipment like masks. Failing to prioritise refugees and migrants living in such conditions could be catastrophic.
Refugees are also an integral part of the communities in which they reside. In Jordan, France, Peru, and the United States many refugees with backgrounds in healthcare have joined frontline workers in the pandemic response. According to the 2018 American Community Survey, 15.6% of refugees in the United States work in the healthcare industry, making it the second most common field for refugees in the U.S. Aside from healthcare, many refugees and migrants also work in agriculture, food service, retail, and many other essential jobs, often at significant personal risk since the onset of the COVID-19 pandemic.
A Global Response: UNHCR, World Bank, and COVAX
Since the vaccine rollout began in December 2020, the UNHCR and World Bank have been urging countries that including refugees in vaccination programs is “key to ending the pandemic”, appealing to them through a platform of mutual success through ensuring refugees’ access to public health, education, and labor markets. The UNHCR has also warned countries on the detrimental effects of not having their refugee populations vaccinated. It is estimated that between 70 and 95 percent of the general population must be vaccinated to achieve herd immunity against COVID-19, so exclusion of refugees and other displaced people from vaccination would further exacerbate the risk of ongoing transmission within these populations, as well as the broader national population. It is therefore in the best interest of refugees, individual states, and the world to ensure that no one is unprotected against the virus.
Of the low- to middle-income countries who have pledged to include refugees in their vaccination plans, many face financial barriers to vaccine procurement. Already, the richest countries have acquired 60% of the world’s total supply, though they only make up 16% of the global population. Low income countries can get vaccines through COVAX, one of the three pillars of the WHO’s Access to COVID-19 Tools (ACT) Accelerator launched in April 2020, which aims to ensure equitable access to COVID-19 diagnostics and vaccines. COVAX has enough funding to provide these free vaccines to 20% of the world’s poorest countries by the end of 2021, as well as an “emergency buffer” which would set aside 5% of available doses for humanitarian and emergency use. According to Kathryn Mahoney, a UNHCR spokeswoman,
“The principle is that buffer will supply vaccine to countries where humanitarian affected populations, including refugees, asylum seekers, stateless, remain excluded from national rollouts to ensure they are reached.”
Despite these efforts, however, the UNHCR estimates that 9 out of 10 people living in the poorest states in the world may not receive the vaccine this year, widening the global vaccination gap and further limiting access to refugees and asylum seekers.
Are host countries doing enough?
Of the 90 countries that have developed national COVID-19 vaccination strategies, 51-57 percent have included refugees in their vaccination plans. Turkey, the country with the largest refugee population, has yet to release a statement about whether refugees will be included in their vaccine rollout. Colombia, which hosts 2 million Venezuelan refugees and migrants, has further politicised vaccine rollout, announcing that they will prioritise vaccination of their own citizens and will not make vaccines available to other groups. Even among the 54 nations who have explicitly committed to vaccinating refugee populations, plans for practical access remain uncertain.
In most nations, an individual’s access to the vaccine is dependent on their age, occupation, or preexisting conditions. Because many refugees are not always documented under these specific categories, it could make many unsure whether they qualify for inoculation in their host countries. Misinformation and a lack of cultural competence in health communication efforts has also led many refugees to fear the vaccine. Procuring the vaccine for refugees, migrants, and asylum seekers is only half the battle; it is equally as important to ensure that there is sufficient community outreach and engagement. A prime example of ensuring cultural competency, community engagement, and health literacy among refugee populations can be seen in Jordan, a nation that began vaccinating refugees in January.
Jordan: The “Gold Standard”
In January 2021, Jordan announced that anyone living on Jordanian soil, including refugees and asylum seekers, is eligible to receive the vaccine at no personal cost. Home to an estimated 1.3 million Syrian refugees, as well as large Iraqi and Palestinian communities, Jordan has consistently enforced preventative measures and provided adequate resources to refugees since the start of the pandemic. As a result, the proportion of refugees with COVID-19 has remained at 1.6%, lower than even the general population of Jordan. Jordan began vaccinating the most vulnerable populations regardless of their country of origin, insisting that the health of the nation is dependent on the health of refugees, who are at a higher level of medical vulnerability. The Jordanian government initially purchased 3 million doses of the Pfizer-BioNTech and Sinopharm vaccines. The population of Jordan is 10 million, with 2.5 million being refugees, but there has not yet been an issue of undersupply, as only 300,000 people have registered for the shot.
Jordan’s vaccination plan extends beyond simple procurement of the vaccine, conducting social media information campaigns through WhatsApp and other community networks to let refugees know when they are eligible for the vaccine, to answer any questions they may have about receiving the vaccine, and to help people overcome potential hesitations towards getting the vaccine. After completing the on-line sign up, patients receive a text message with the details of their appointment, and the UNHCR facilitates their transport to a clinic. Patients will also receive a second text when it’s time for their second dose. Though this system has proved mostly effective, the online sign-up and administration of the shots makes it difficult to reach refugee populations in urban areas, limiting vaccination to those living in camps.
Mohsen Ibrahim, a 65-year old Syrian farmer living in the Zaatari refugee camp in northern Jordan, was among one of the first to receive the vaccine. Even while waiting for his shot in the health clinic, he expressed that he still could not believe he would be getting the vaccine so soon:
“I expect a country to vaccinate its own citizens first. It’s their right, but I am so glad Jordan sees it differently”Mohsen Ibrahim
For refugees like him, who shares 2 crowded trailers between his 7 children and 5 grandchildren in the Zaatari camp, the vaccine could truly be life-saving.
What can we do?
In a world plagued by health inequality, where the wealthiest nations have had access to better treatment and health care for centuries, it is difficult to see hope for change. There is hope in the way Jordan prioritises the health of its refugees, and other nations committed must develop plans using a similar humanitarian framework to ensure vaccine access for their refugee populations. As we begin to receive the vaccine ourselves and try to return to some sense of normalcy, it is also imperative for us to remember that for the world’s 80 million forcibly displaced people, there was never a sense of normalcy.
UNHCR and the International Rescue Committee (IRC) have been bringing medical supplies, personal protective equipment, and other essential resources to refugees through their COVID-19 response campaigns since March 2020. Even a small donation can help to protect those who are most vulnerable during this pandemic.