Central argument

With the number of COVID-19-related deaths reaching the 1 million mark and affecting every geographical region globally, the COVID-19 vaccine must be treated as a global public good.10 Nevertheless, as the world struggles to contain COVID-19, different countries are increasingly focused on the protection of their citizens and are neglecting their obligations and commitments to protect asylum seekers, refugees and foreign-born migrants living within their borders. For instance, although countries like England considered accommodating unsuccessful asylum seekers at the start of the COVID-19 pandemic, these unsuccessful asylum seekers where being evicted from their Home Office provided accommodations during the second wave of the COVID-19 pandemic, an act which makes no sense in either humanitarian or public health terms.11 Also, despite international maritime laws dictating a ‘duty to rescue’ refugees and asylum seekers in distress at sea, search-rescue-disembarkation operations in the Mediterranean have been brought to a halt.12 These structural xenophobic tendencies, and more, are further manifested in the lack of engagement and consideration of this population in countries’ economic, poverty and hunger alleviation schemes during the national lockdown measures.7

Although COVID-19, disproportionately, has a greater impact on certain populations, asylum seekers, refugees and foreign-born migrants usually find themselves in comparatively worse positions of vulnerability.7 The COVID-19 vulnerabilities are usually an extrapolation of already existing vulnerabilities: weakened social support structures, bleak socioeconomic prospects, unequal access to healthcare and social services, precarious housing conditions, tenuous living and working conditions, and higher risks of exploitation and abuse.8 13 14 These vulnerabilities have exacerbated in the context of the COVID-19 pandemic as they are living in crowded refugee camps and deportation centres with little or no resources and opportunities to practise personal hygiene and social (physical) distancing, in addition to diminished access to food and healthcare services.7 15 16 Those among the general population live in informal/illegal situations in urban slums having issues with access to basic health facilities owing to insecurity and crime that prevail in these informal settlements.

A few countries have taken steps to accommodate asylum seekers and refugees at the start of the COVID-19 pandemic. For instance, Portugal temporarily granted all asylum seekers and foreign-born migrants full citizenship rights to remove the structural barriers to access to healthcare services.17 In Germany, the COVID-19 pandemic acted as a catalyst to mobilise solidarity and support for the plight of refugees.18 In England, the thousands of asylum seekers who were refused were provided with accommodation by the Home Office at the start of the COVID-19 outbreak.11 Nevertheless, many other countries have persisted with policies that exclude asylum seekers, refugees and foreign-born migrants from critical services while also continuing with deportations during the worldwide travel bans.7 17

Based on the way asylum seekers, refugees and foreign-born migrants were treated during the national lockdown implemented to curb the spread of the pandemic, there is little chance that this population will be considered for immunisation when the vaccine reaches the borders of various countries. Reflecting on this in light of ongoing discourse on the political stakes of migration governance, in South Africa for instance, we observe that the COVID-19 response revealed little change in the government’s agenda to deal with asylum seekers, refugees and other migrants.19 This reticence to include asylum seekers, refugees and foreign migrants in policies and mechanisms to address the COVID-19 pandemic is further fuelled by xenophobic tendencies.7 19 According to Reidy,17 some governments are likely to take advantage of the COVID-19 crisis to push through legally dubious, hardline migration policies that cannot be justified by public health concerns. The glaring absence of migration-aware and mobility-competent policies is likely going to reduce the level of engagement of asylum seekers, refugees and foreign migrants in the national fight against the COVID-19 pandemic and thus reducing their consideration for a COVID-19 vaccine.

At the global level, currently, COVAX envisages setting aside a small buffer of about 5% of the total number of available doses that will be reserved to build a stockpile to help with acute outbreaks and to support humanitarian organisations, for example, to vaccinate refugees who may not otherwise have access.20 The WHO EURO outlines current best practice, evidence and knowledge to support policy and programme development for the vaccination of refugees and migrants,21 which could be used to guarantee COVID-19 vaccine coverage in this population group. Unfortunately, these bestpractices and policies have not been dependably considered. We, therefore, concur with Severoni and Bartovic22 that future efforts need to build on existing structures and resources to bolster coordination and prepare a blueprint for future emergency vaccine distribution in a manner that considers asylum seekers, refugees and migrants equitably.

The International Organization for Migration and civil society organisations (CSO) are strategically placed to contribute to discussions and decisions around the scale-up and equitable access to COVID-19 vaccines especially representing the interests of asylum seekers, refugees and foreign migrants. Nevertheless, it appears their representation and engagement in the structure and processes of Gavi—the Coalition for Epidemic Preparedness Innovations—is based on Gavi’s inadequate appreciation and distrust of what CSOs do and can bring to Gavi’s operations.23 Owing to pressure from CSOs, Gavi and WHO are seeking representative CSOs to participate in COVAX.24 If CSOs are better represented in the COVAX governance mechanism, there is a chance that they will be better placed to represent the interests of asylum seekers, refugees and foreign migrants efficiently.

Although governments will be the initial recipients of the COVID-19 vaccines, fair distribution within each country must reflect a moral concern for the ultimate recipients and should be guided by the following three principles: (1) benefiting people and limiting harm, (2) prioritising the disadvantaged, and (3) equal moral concern.25 This ‘fair priority model’, proposed by Emanuel et al,25 accommodates asylum seekers, refugees and foreign migrants more explicitly as it prioritises the disadvantaged. In this approach, Emanuel et al25 propose that a fair allocation of the COVID-19 vaccine requires distributing the first doses to those population segments where it is possible to save the greatest number of life years, then considering also the disability that can be prevented by the vaccine and the amount of poverty and aggregate economic damage the vaccine can prevent, and finally distributing the vaccine to reduce transmission rates as far as possible. A truly ethical proposal toward the COVID-19 vaccine distribution should accommodate asylum seekers, refugees and foreign migrants, treating all people equally and helping them get vaccines when they cannot do so on their own. This position is contrary to the notion of accepting inequality in access as an unchangeable fact; bypassing the poor to help the rich, the vulnerable to help the strong.4

At this stage, there is the recognition that the first useful vaccines to emerge may be in short supply, and approved vaccines will initially be made available to a tightly targeted 3% of the population of COVAX participating countries, then building over time to 20% of each country’s most vulnerable population.26 While decisions on the distribution of vaccines initially supplied under the COVAX scheme will remain at each nation’s discretion, countries are advised that they should use the initial 3% of their vaccines to focus initially on reducing mortality and protecting the health system—vaccinating healthcare and social workers.26 In the same way, the other 20% of the vaccines allocated for the country’s most vulnerable population will be at the discretion of the country to manage. After everybody has received the 20%, the vaccine would be distributed according to other criteria, such as country vulnerability and the immediate threat of COVID-19.20 Although it is often politically untenable to consider refugees and asylum seekers when it comes to the planning of vaccination campaigns of this nature,22 following this proposed distribution protocol, we argue that asylum seekers, refugees and foreign migrants should be considered during the 20% distribution point as they fit the bill of a vulnerable population. The point is that there is a need to include and prioritise refugees, asylum seekers and foreign migrants in all COVID-19 vaccination programmes, regardless the source of the vaccine, to successfully eliminate the pandemic within the national borders and indeed globally.