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COVID-19 immunization in refugees and migrants: Principles and key considerations - Interim guidance (31 August 2021)

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Introduction

Although everyone is affected by the COVID-19 pandemic, the impact is not shared equally. This document, which draws on a recent WHO global review of national deployment and vaccination plans and experience from their implementation and the vaccine rollout worldwide plus literature reviews and existing WHO guidance and tools, provides key principles and policy consideration on equitable prioritization and access to COVID-19 vaccines for refugees and migrants.

The document provides information on key challenges and barriers to accessing vaccination services and key considerations in addressing them, as well as good practices. It highlights principles such as global equity for vaccine distribution, national equity and equal respect. It also emphasizes the importance of community engagement and communication to build trust and counter misinformation, fake news and misconceptions, as well as the importance of developing innovative approaches for vaccine delivery. The document is derived from rights and policy and practices and does not offer evidence-based recommendations.

Background

The COVID-19 pandemic has exposed vulnerabilities and exacerbated existing inequalities within and between low- and high-income countries. These inequalities have had the biggest impact on the poorest and most vulnerable people, which may include refugees and migrants (particularly those in irregular situations). These groups often have vulnerabilities that are heightened by this pandemic.

Social, political and economic exclusion can result in poverty, homelessness and exploitation, which can create a higher risk of infection with SARS-CoV-2, the virus that causes COVID-19. Refugees and migrants may have to live in close quarters or work in conditions with inadequate protection (such as in overcrowded informal settlements, workers' dormitories, reception and detention centres or insecure housing arrangements), with limited ability to physically distance or self-isolate. Many refugees and migrants work in essential sectors with more exposure to the virus and, consequently, are more vulnerable to infection. They may also be more vulnerable because of being outside the dominant population group through factors such as ethnicity, culture, language or race. They may experience poor access to quality health care or have suboptimal health-seeking behaviours, distrust of governments or fear of detention and deportation if seeking health care.

In these contexts, refugees and migrants are more likely to experience a higher burden of COVID-19 infection and be disproportionately represented in cases, hospitalizations and deaths. They may also have a high prevalence of underlying health conditions that increase their risk of severe COVID-19.

Studies in several member countries of the Organisation for Economic Co-operation and Development found an infection risk in these groups that was at least twice as high as that for native-born individuals, with a disproportionately negative toll on refugees and migrants (both regular and irregular) in most countries for which data are currently available.

Hence, it is vital to ensure equitable prioritization and access to health care and COVID-19 vaccines for all groups including refugees and migrants. While States bear the primary responsibility for protecting and promoting the well-being and human rights of those living within their borders, the global community also has an obligation to address the human rights claim to vaccines for all those living in countries who cannot, without assistance, meet their needs. Such actions include reducing the obstacles to obtaining vaccines that confront countries with fewer resources and less geopolitical power. Transmission of COVID-19 knows no borders, and as long as there is active transmission anywhere there will be a risk of transmission everywhere.

The COVID-19 Strategic Preparedness and Response Plan and the Global Humanitarian Response Plan emphasize the need to protect the vulnerable, including those in low-resource, hard-to-reach and humanitarian settings. United Nations resolution 2565 (2021) calls for strengthened international cooperation to facilitate equitable and affordable access to COVID-19 vaccines in armed conflict and post-conflict situations and during complex humanitarian emergencies.

This document builds on existing COVID-19 immunization guidance documents endorsed by the WHO Strategic Advisory Group of Experts on Immunization (SAGE); the WHO guidance on developing a national deployment vaccination plan (NDVP); WHO plans to promote the health of refugees and migrants; and the Global Immunization Agenda 2030. It also draws on evidence and experiences from COVID-19 vaccination programmes in refugee and migrant populations from January to June 2021.

The document targets national authorities, governmental and nongovernmental organizations, health cluster teams, WHO country offices and United Nations country teams that are responsible for managing and supporting deployment, implementation and monitoring of COVID-19 vaccines in refugees and migrants; and partners who provide support.