Ensuring global access to COVID-19 vaccines: deployment strategies for refugees and migrants must not be forgotten

Abstract

World Health Organization (WHO) estimated 1 billion migrants in the world today of whom 258 million are international and 763 million internal migrants [1]. Migrants, refugees, and asylum seekers may be both more affected by and vulnerable to the spread of COVID-19. In the context of the COVID-19 pandemic, vulnerabilities of this group have exacerbated since many of them are living in crowded refugee camps or difficult housing conditions with limited means and opportunities to implement personal hygiene and social distancing. Consequently, COVID-19 outbreaks among this population can have devastating impact and have already been reported [2]. Recently, authors discussed in an important paper development and production, affordability, allocation and deployment of COVID-19 vaccines [3], highlighting important barriers and outlining necessary steps to implement in order to achieve global vaccine immunity. However, we feel that an important aspect relating to deployment of vaccines needs to be specifically highlighted: access to COVID-19 vaccination campaigns for migrants, refugees and asylum seekers. Although sustainable health is universally considered a basic human right, access to healthcare systems varies and depends on several factors. Most countries have developed online platforms for booking appointments to rule out COVID-19 vaccination campaigns. This requires both the technical means and a regular registration status of the candidate booking the appointments. However, access to healthcare greatly varies across the globe. In general, legal status is the most important determining factor [4], with those considered “undocumented” having “a priori” limited access to basic services. The International Organization for Migration has estimated that 10–15% of the world’s 214 million international migrants were undocumented [5], suggesting that millions of people worldwide may have difficulty in accessing the vaccine. To make things more complicated, refugees’ and migrants’ access to basic health services may be further impacted by their employment status [4]. Undocumented labor migrants may choose not to present to health care institutions because of fear of deportation [4]. Even with documented legal and employment status, other barriers may further limit access, such as language barriers, lack of accessible information channels, unawareness of entitlements by health care providers and beneficiaries, limitations of health staff expertise, and economic limitations [4]. These points highlight potential difficulties for providing equal access to SARS-CoV-2 vaccines for migrants and refugees. They need to be proactively addressed by institutions and policy-makers with dedicated plans, since most standard administrative procedures would not allow easy access to vaccination programs for migrants and refugees. The first attempt to provide equity in SARS-CoV-2 vaccines access was represented by the COVAX program, one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, launched in April 2020 by the WHO, the European Commission and France in response to this pandemic (https:// www. who. int/ initi atives/ actaccel erator/ covax). The ACT aims to bring together governments, global health organizations, manufacturers, scientists, the private sector, * Danilo Buonsenso [email protected]