The world has witnessed major strides in the battle against COVID-19 within the past month. As of mid-December 2020, several countries have authorized and begun to administer vaccines, including the United Kingdom, United States, and European Union. However, as governments undertake the challenge of vaccinating their populations, they must not forget about the more than 80 million people who are displaced around the world. Refugees International has urged governments and the international community to account for the needs and circumstances of displaced populations in their COVID-19 responses—including by ensuring equitable access to a vaccine. Now that vaccines are available, these issues are no longer hypothetical. A review of a few of the challenges in light of recent developments underscores the urgent action that must be taken to ensure that truly everyone is protected against the coronavirus.
How will vaccines reach everyone in need?
Conscious that vulnerable populations could be left behind in COVID-19 vaccine response plans, the World Health Organization (WHO) and GAVI, the international Vaccine Alliance, established COVAX, a global collaborative effort to promote the development and equitable distribution of COVID-19 vaccines throughout the world. It includes the COVAX Advance Market Commitment (AMC), a financing mechanism to provide donor-funded vaccine doses to 92 low- and middle-income countries that might not otherwise be able to afford them.
This is critical in light of vast global wealth inequalities and the rise of “vaccine nationalism”—of the approximately 9.8 billion doses that had been reserved by November 30, 2020, the overwhelming majority were secured by high-income countries, sometimes in amounts greatly exceeding those required for their own populations. As of December 18, COVAX had made agreements to access almost 2 billion doses of vaccines, including 1.3 billion for the COVAX AMC. However, while a recent surge in funding pledges helped the AMC meet its 2020 fundraising target of $2 billion, the WHO estimates it needs at least $4.6 billion more in 2021.
Further, although the vast majority of refugees reside in low-income countries, providing those host governments with vaccines does not guarantee access for displaced people or others in need of humanitarian aid. To protect those whom government programs cannot or will not cover, the COVAX allocation plan establishes a small “humanitarian buffer” containing about 5 percent of total available doses. It will “help with acute outbreaks and to support humanitarian organisations, for example to vaccinate refugees who may not otherwise have access.” But governments should not treat this stockpile as a substitute for their vaccination efforts—they should incorporate displaced populations into their own plans and preserve it as a tool of last resort, tapped only to respond to true emergencies.
Indeed, the obstacles to ensuring access, affordability, and equitable distribution of COVID-19 vaccines—particularly to communities in need of humanitarian assistance—remain significant. COVAX plans to begin administering vaccines in 2021, though this will likely be a protracted endeavor extending beyond the next year. High-income countries must build on recent momentum and continue to contribute to international efforts promoting the equitable distribution of COVID-19 vaccines.
Will national vaccine distribution plans include refugees and other forced migrants?
The international community’s intervention becomes necessary if national governments neglect their responsibility to care for displaced people they host. Some governments, such as Tanzania and Bangladesh, have been proactive in incorporating refugees in their COVID-19 response plans, providing access to testing, quarantine, and treatment in government facilities. However, immunization policies for refugees and migrants vary vastly—in the European Union, for example, some member states grant broad access to vaccinations while others offer only restricted services. Furthermore, although Colombia initially developed a COVID-19 action plan specifically for the approximately 1.7 million displaced Venezuelans living there, President Iván Duque announced in December 2020 that hundreds of thousands of them would not be eligible to receive COVID-19 vaccines.
It is therefore essential that international organizations collaborate with national health authorities to ensure displaced people are included in their COVID-19 vaccination plans. Drawing from their lessons learned in the past year, governments should remember that whole populations benefited when authorities took extraordinary measures to expand protections for displaced people and were left vulnerable when they did not.
What healthcare documentation challenges exist?
Even if enough vaccines are developed and plans are in place to vaccinate displaced people, there are many obstacles to delivering health care to this population because of their unique circumstances. One of the challenges is that asylum seekers, refugees, and IDPs may remain on the move or at risk of repeated displacement. This, as well as the limited health care services available in many refugee camps and refugee-hosting communities, means they often lack consistent access to health care services. As a result of an interruption in care, they may not be able to receive the second dose needed for the COVID-19 vaccine to be effective.
Health care providers must find a method of record-keeping to document patients’ immunization history even in displacement. For example, they might rely on electronic/mobile health data collection tools such as the District Health Information System II Software (DHIS2)— a software already used in many lower-income countries’ national health systems—to track the health and immunity of displaced people. Governments could also learn from initiatives like the regional vaccination card created for displaced Venezuelans in Latin America. Ultimately, expanding access to healthcare and seeking innovative technological solutions to improve documentation and cross-border coordination are critical so that individuals receive the care they need.
How can healthcare and humanitarian workers reduce vaccine hesitancy?
Improving displaced communities’ access to accurate and credible information is critical to promoting vaccine acceptance and distribution. Often, asylum seekers, refugees, and other forced migrants who have access to healthcare in their host communities do not know they have this right. Some might fear deportation or other negative consequences if they try to seek healthcare. Distrust of authorities is also common among some displaced communities as a result of past vaccination campaigns that disregarded local communities’ autonomy. For example, the success of the smallpox eradication campaign in the 1960s and 1970s came at the expense of respecting local laws and customs, a mistake that jeopardized the rights of locals and compromised their trust in foreign health care workers.
To avoid repeating this failure, the administration of COVID-19 vaccines must be done in a culturally appropriate manner. Authorities must also ensure displaced people are informed about the COVID-19 vaccine itself. They can learn from the community-led information campaigns that played an instrumental role in promoting preventive measures against Ebola in Liberian refugee camps. By mobilizing local community members to raise awareness about the effectiveness of vaccination, organizations can work to reduce wariness of COVID-19 vaccines among displaced populations.
Ultimately, the development and authorization of COVID-19 vaccines is only the beginning. As humanitarian actors have expressed throughout the pandemic, nobody is truly safe until everybody is safe—and that means making sure vaccines are available to all. Ensuring that vaccines reach displaced populations will require international organizations, government officials, and civil society actors to work together to address these—and many other—complex challenges. By properly doing so, they will not only help address the current global health emergency, but leave the world better prepared for future disease outbreaks.
Editor’s note: This piece was updated on January 5, 2021