I. KEY MESSAGES
1 Access to vaccination is part of the human right to health. Equity and the availability of and access to vaccines, medicines, health technologies and therapies are an essential dimension of the right to health, which engages the immediate responsibility of States.
2 Access to vaccination for all is part of the 2030 Agenda for Sustainable Development and Immunization Agenda 2030.3 Ensuring healthy lives and promoting well-being at all ages was acknowledged as essential to sustainable development. Leaving no one behind as the overarching principle, Sustainable Development Goal 3 aims at achieving universal health coverage, including access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
3 Vaccination should be allocated in line with the equal respect principle, requiring that the interests of all individuals and groups, including refugees and migrants, are treated with equal consideration. While the supply of vaccine is limited, countries will set up prioritization plans which should consider the vulnerabilities, risks, and needs of groups who, because of underlying societal, geographic, or biomedical factors, are at risk of experiencing greater burdens from the COVID-19 pandemic. Such groups include refugees, IDPs, asylum-seekers, populations in conflict setting or those affected by humanitarian emergencies, low-income migrant workers, and vulnerable migrants in irregular situations.
4 No one is safe until everybody is safe. As the virus does not discriminate, responses cannot leave any one behind, including refugees and migrants. The benefits of the currently approved vaccines by WHO should reach all populations irrespective of nationality, legal status, location, or income-level. The inclusion of refugees and migrants is also key to social cohesion and stability. Reports of xenophobia, racism and discrimination against refugees and migrants have increased during the pandemic.
5 Exclusion from national vaccine programmes would not only pose a health risk to the society as a whole, but it could also lead to further marginalization and exclusion of refugees and migrants from other essential services. 5Firewalls should be established to separate immigration enforcement activities from the delivery of health and other essential services. Without such assurance, persons seeking vaccination may fear to get arrested and penalized by immigration services.
6 Inclusive communication and information capaigns are a crucial part of any vaccination strategy to counter vaccine misinformation and hesitancy. Refugees and migrants often lack access to information crucial to their safety and rights due to language barriers or lack of reputable signposting services. Immunization decisions could be influenced by a number of factors including language and cultural barriers, poor understanding of the national health system and personal beliefs. All populations should have access to accurate, up-to-date, and multilingual information on the importance of the vaccine, national vaccination plans, avenues to access services and other relevant information during the vaccination procedure. Targeted outreach to specific groups, taking into consideration age, gender, disability, and other factors, is also essential. Such information campaigns should make clear that firewalls between health information systems and immigration authorities have been established and persons seeking vaccination will not be penalized or targeted by immigration services.
7 Inclusivity requires removing barriers. Refugees and migrants may not have the relevant and/or upto-date documentation, or, in some cases, including for stateless people, any documentation, required to register for vaccination. Some countries have widened the criteria for documentation, accepting any document showing the identity of the person seeking vaccination.
In others, an oral declaration is accepted in the absence of documentation. Online registration systems can also lead to the exclusion of refugees and migrants who may lack digital literacy skills or access to internet. Alternatives of face-to-face interactions should be considered to address such challenges, as feasible.
8 Civil society actors, National Human Rights Institutions and refugee and migrant communities are well-placed to support COVID-19 vaccination plans.
They may be able to support the mapping of formal and informal settlements, including those hosting refugees and migrants with the view to help identify those to be prioritized for the vaccine. They may also assist with vaccine delivery and counter misinformation in locations where they are trusted by the local population.