Sight Unseen: A Vision for Effective Access to COVID-19 Vaccines for Migrants

"To beat COVID-19, we will need to focus both on the 'hardware' and the 'software' of successful vaccination. The hardware is about getting vaccines to every country and every community. The software is ensuring that everyone, including refugees and migrants, is informed and included." - Francesco Rocca, President of the International Federation of Red Cross and Red Crescent Societies (IFRC) [from an IFRC press release]

A range of international bodies have called for migrants to be included in COVID-19 vaccination plans. However, research conducted by the Red Cross Red Crescent (RCRC) Global Migration Lab reveals that existing vaccination policies and rollout strategies need to be strengthened to ensure effective access for everyone in society, including marginalised and hard-to-reach populations who may be at heightened risk of COVID-19.

The report takes stock of global trends in migrants' access to COVID-19 vaccines and offers recommendations for addressing the longstanding barriers, both formal and informal, that impede inclusion and access. "Spotlights" throughout the report share the experiences of National RCRC Societies in various countries, highlighting good practices and/or lessons learned.

Of the 52 National Societies surveyed around the world in June 2021 as part of this research, 49% reported COVID-19 vaccination policies in their country cover all migrants, irrespective of status, while 31% reported policies included only certain groups of migrants; 12% reported policies did not specify whether migrants were included.

The report asserts that inclusion of migrants in policy does not necessarily translate to access in practice. The main barriers for migrants to access COVID-19 vaccines, as identified and reported by National Societies, included:

• limited information about where and how to get the vaccine (90%)
• vaccine hesitancy (80%)
• language issues (67%)
• lack of required documentation (60%)
• fears of arrest, detention, or deportation (50%)
• limited vaccine supply (50%)
• distrust/uncertainly over eligibility (40%)
• complex registration processes (33%)

The report outlines the actions several National RCRC Societies are taking to address these barriers alongside governments and host communities. Among those surveyed:

• 87% are involved in information-sharing and awareness-raising activities for migrants on where and how to access COVID-19 vaccines. For example, the Bulgarian Red Cross adapted information resources developed by the IFRC and British Red Cross to the local context and translated them into the languages of migrant and refugee communities.
• 77% are supporting migrants in registering or attending vaccination appointments. For example, as part of its COVID-19 response, the Red Cross of Montenegro offers mediation and support to people, including migrants, facing challenges in completing the vaccine registration process or attending vaccine appointments.
• 70% are involved in direct advocacy with governments and policymakers for greater inclusion of migrants. For example, Australian Red Cross engaged with relevant authorities at the national and local levels to ensure everyone in Australia - in particular, people on temporary visas and people without visas - are aware of and able to access COVID-19 vaccinations without barriers.
• 60% are tackling vaccine hesitancy. For example, the British Red Cross' London emergency response team has carried out vaccine hesitancy conversations with people housed in emergency homeless shelters. The National Society also developed a bespoke e-learning on supporting migrants and vaccine hesitancy.

Common challenges shared by National Societies in promoting and ensuring vaccine equity for migrants (at the policy or operational level) have included:

• difficulty in identifying and reaching undocumented migrants;
• language barriers;
• vaccine misinformation;
• lack of recognition among authorities about the risks of COVID-19 faced by migrants living in shelters and centres due to inability to follow public health recommendations and the need to vaccinate all migrants living in these situations;
• varying approaches between local and national government systems and procedures with regards to vaccine registration and access;
• confusion among frontline healthcare workers about eligibility of migrants;
• low uptake of vaccines due to fears of side effects and perceptions the vaccine will require migrants to remain in one location (where a vaccine require two doses), preventing work opportunities;
• vaccine shortages and perceived competition between migrants and host communities; and
• limited funding to support vaccine awareness and sensitisation.

The report recommends that states work together with local partners to:

1. Provide safe and equitable access to COVID-19 vaccinations for all migrants, irrespective of status and without discrimination - ideally, free of charge for everyone.
2. Understand informal and formal access barriers at the local level, adopt measures to overcome these barriers, and establish procedures that facilitate equitable access to vaccination for migrants, including undocumented migrants.
3. Invest in and provide targeted outreach and public health messaging and information on COVID-19 vaccinations to migrants in accessible channels, languages, and formats, including through digital, online, and face-to-face and fixed and mobile initiatives.
4. Undertake further research on vaccine hesitancy among migrant communities to inform and design strategies to counter reservations and increase vaccine uptake.
5. Prioritise the most vulnerable, based on needs and levels of risk to COVID-19, not on migration or legal status.

According to the Global Migration Lab, states and civil society must work together in partnership with migrants and their communities, seeking and listening to their advice and guidance on how to address barriers, tailor approaches and rollout strategies and communicate effectively to promote and facilitate access to COVID-19 vaccines.