While the world celebrates early rollouts of various COVID-19 vaccines, vulnerable refugee groups continue to face exclusion, in fear of further viral outbreaks, with many left outside of national vaccination programs.
Case numbers inside refugee and migrant groups have been continually underreported throughout the pandemic, with limited access to healthcare services exacerbating the situation.
The UN Refugee Agency (UNHCR) spokesperson for the Middle East and North Africa, Rula Amin, described the refugee situation as a “poverty pandemic”, with poor access to basic services, and restricted avenues for physical distancing.
Officially, only around 5,000 cases have been reported to UNHCR, but that number is on the rise in Iraq, Syria, Lebanon, Jordan and Palestine, according to the organization's November brief.
These countries collectively host at least 2.9 million Syrian refugees and 3.3 million Palestinian refugees, according to the latest UNHCR statistics.
In Lebanon, 26 percent of registered refugees were unable to buy medication by week 12 of the crisis, 61 percent lost their job, 74 percent were unable to pay rent, and 77 percent had difficulty buying food, according to a UNHCR survey from July 2020.
“Access to health services including vaccination is a fundamental right,” Amin told Al Arabiya English.
Excluded from national vaccination plans
Refugee host-countries in the Middle East struggle to get vaccines for their own populations, adding uncertainty about when refugees will get inoculated, if at all.
Globally, the situation remains similar.
In Latin America, Venezuelan refugees in Colombia are explicitly excluded from the COVID-19 vaccination campaign, as per President Ivan Duque’s statement to a local radio station on December 22.
Positive cases are being reported in refugee and migrant accommodation centers in the United Kingdom, Germany and Greece, according to reports.
In September, more than 240 refugees on the Greek island of Lesbos tested positive for COVID-19 after 7,000 tests conducted in camps. Since April, Greece is the only European country to periodically report positive cases among refugees.
Germany is the only European country to include collective accommodation centers in the second round of vaccination, covering at least 170,000 asylum seekers, according to national statistics.
Access to basic healthcare facilities and medicines in migrant camps is also proving problematic during the pandemic.
“One of the major impacts [of the pandemic] people reported is the lack of access to basic services, lack of ability to afford basic goods because of the economic effects of lockdown,” Bram Frouws, Head of the Mixed Migrant Center said. The Mixed Migration Centre serves people in 17 countries.
While it is often politically untenable to argue refugees be given priority in COVID-19 vaccination campaigns, the International Organization for Migration issued an urgent call last month for governments to include vulnerable populations.
With no alternative health protection mechanism, vaccinating is a way of potentially alleviating the factors that make these groups more vulnerable.
“Literature on migration in the context of COVID-19 has identified asylum seekers, refugees and migrants as a most-at-risk population owing to their existing vulnerabilities,” Ferdinand C. Mukumbang, Senior Scientist at the South African Medical Research Council wrote in an article published by MBJ Global Health Journal.
No consensus on humanitarian vaccine rollout
While public health experts agree that refugees should get vaccinated, there is no consensus about who takes responsibility for the rollout.
“Countries that get COVAX vaccines should also explicitly include asylum seekers and refugees in their ‘at-risk populations’, to get the vaccines,” Mukumbang argued.
Sidney Wong, the Executive Co-Director of the Medicines Sans Frontieres (MSF) Access Campaign, said that the quantities of vaccines needed didn’t measure up to the pandemic. This is the crux of the problem. “In the short-term in 2021 there will be a limited supply,” Wong explained.
Amin agreed with this. “In some countries the national services capacity is not equipped to serve all eligible people,” she said.
“Governments, like Lebanon, expect that vaccines for non-nationals should be financed by international agencies,” she added.
Building on the humanitarian vaccine mechanism, the World Health Organization (WHO) is attempting to integrate a global framework for the COVID-19 vaccine for vulnerable populations into its COVAX facility.
“WHO is leading an interagency group that is trying to set up what we call a humanitarian buffer,” Wong said.
“They are now negotiating with GAVI [international vaccine alliance] so that some of the supplies from the COVAX facility are allocated towards this humanitarian mechanism,” he added.
In December, COVAX secured at least 1.3 billion doses of the COVID-19 vaccines for distribution in 2021.
Under its statute, the COVAX facility has designated 5 percent of its vaccine capacity to those in need of humanitarian assistance, independent from the COVID-19 pandemic.
Given that most vaccines require two doses, applying the humanitarian buffer principle accounts for only 3.25 million out of 26 million refugees potentially included in this year’s vaccine rollout.
While almost one-third of this number include refugees in the Middle East, regional distribution has yet to be decided.
“We are in active discussions with partners, and global health experts to determine if a targeted donation program for a COVID-19 vaccine will be needed for vulnerable populations,” Lisa O’Neill, Pfizer’s Global Media Relations Director told Al Arabiya English in an emailed statement.
Now in 2021, a concrete decision has yet to be announced.
The uncertainty of a COVID-19 vaccine for the vulnerable lies in whether it comes too late, and whether its humanitarian distribution is enough to include all those in need.
“No one is safe until everyone is safe,” Frouws concluded.