Removing Barriers to Accessing COVID-19 Vaccination for Undocumented Migrants

Excerpt from Regularise’s briefing (published on 1/03/2021):

The fundamental rights of migrants to access health (and other public provisions) are protected under international law, yet these rights are often obstructed through exclusionary policies and data-sharing practices that exist between public institutions and immigration enforcement, with tragic consequences. For example, in the UK at the start of the pandemic, a Filipino man, known only as Elvis, died from COVID-19 as he feared accessing healthcare services in the event that this would lead to immigration enforcement. In Spain, the mortality rate of undocumented migrants rose by 15% after restrictions to accessing healthcare were introduced, with access restored in 2018, after which deaths then decreased.

The introduction of ‘Firewalling’ — preventing the sharing of information— between public service provision and immigration enforcement, allows undocumented migrants to feel safer in accessing their basic rights and improves the capacity of public services to achieve community-wide success. Common examples of how firewalling may assist the broader aims in communities include encouraging cooperation from migrants when they may have witnessed a crime; or encouraging migrants to feel confident in following public health guidance such as accessing tests, emergency care and vaccines in response to public health threats, like a pandemic. Firewalling allows all individuals to participate in civic society regardless of their immigration status, thus making the whole community safer.

This rationale has informed the introduction of firewalling in other countries. In Sweden, a robust firewall has meant that emergency healthcare is free for all without any need to provide documents. Rules of confidentiality for citizens have been extended to include non-citizens, therefore ensuring that undocumented migrants can access emergency healthcare without fear. During the COVID-19 pandemic, Ireland has recognised the need for the inclusion of undocumented migrants in relation to social, welfare and health care – demonstrated by the elimination of data sharing between service providers and immigration officers.

GP Surgeries Registration

Registration at a GP surgery is a necessary requirement in order to access a COVID-19 vaccine. With significant numbers of undocumented migrants disencouraged from registering with their local GP, registration remains a focal point for the direction of any meaningful efforts towards vaccine equity for those who are undocumented or have insecure status. Barriers to registration are often located within the surgeries themselves, with evidence of undocumented registrants being turned away for a variety of inconsistent reasons, such as not having photo identification or proof of address.

The unpredictable nature of GP registration processes are indicative of inaccurate information amongst primary healthcare staff and their management regarding the health entitlements of undocumented migrants. While some doctors’ might have a strong commitment to the health and confidentiality of their patients, without clear and widely-distributed guidance for GP surgeries, this potentially life-threatening obstacle will remain for undocumented migrants. Whilst the NHSEI’s ‘Everyone is welcome in general practice’ initiative is a step in the right direction, undocumented migrants are not specifically named.

Building Bridges: It’s About Trust

The Government’s recently-published plan clearly accepts that it is necessary to build bridges with vulnerable groups who may not access information easily. Migrants are often unaware of the healthcare they are entitled to due to a lack of information and some migrant communities, including those who are undocumented or with insecure status, have been reported as having a lack of trust in NHS services during the COVID-19 pandemic due to historical, present and perceived data sharing practices for immigration enforcement purposes —such as enforced removals or deportations. In order for information from healthcare providers to be trusted, the dissemination of essential communication through charities, voluntary organisations, friends, family, and local communities has been recommended as an effective approach.

While the Government itself are to run a public information campaign concerning access to vaccines, many undocumented migrants and their communities do not trust the Home Office and other public bodies due to justifiable fears resulting from Government policies introduced in the last decade.

An example of a partnership recommended by the NHS can be seen in the Primary Care Network (PCN) ‘Safe Hubs’ established in the London Borough of Lewisham by community primary care group One Health Lewisham, in collaboration with Doctors of the World and Lewisham Food Banks. The hubs allow GP practice managers and reception staff to overcome the undocumented migrants’ fear of being traced by the Home Office by registering them at a hub address.

Funding has been recently allocated to Community Champions, but with no reference to migrants, let alone undocumented migrants and those with insecure status.

Whilst it is a positive step that the government is supporting front line charities like Doctors of the World to translate COVID-19 resources into over 60 languages, it is vital that the government use all possible channels of communication to ensure that both NHS staff and undocumented migrants are informed in order to accelerate GP registration for those who aren’t registered and vaccine uptake for those who are.

For a population of people that continue to live in fear and on the margins of society, it will take a concerted effort and fundamental shift in how both Government and civil society view and interact with undocumented migrants in order to make people feel safe, and included, building trust both in the short-term and long-term.

Beyond COVID-19

The COVID-19 pandemic has highlighted the pre-existing inequities in the UK, especially of those living on the margins of society. Without support, undocumented migrants and migrants with insecure status—including those seeking asylum—will continue to experience multiple risks even as the rest of society recovers from this crisis.

Providing people with tools for survival works better when people are confident to access these tools in the first place and in an equal manner to the rest of society. The risks to lives and livelihoods will continue as long as there is an at-risk population of people living in the UK who, despite being part of British society with many having lived here for many years, have limited rights and barriers in accessing support when needed.

Looking to the future, the risk of further pandemics remains significant. As the UK looks to manage this risk, it is important to recognise the impact that underlying conditions and health inequities have had on hospitalisation and death during the COVID-19 pandemic. Pandemic-proof public health policy of the future will focus on the long term management and prevention of conditions throughout every community.

With the structural barriers faced by undocumented migrants having been highlighted even more during this pandemic, lessons can be learned from COVID-19 to ensure that all members of every community are taken into account in public health planning. Overall public health can improve by removing the structural barriers faced by undocumented migrants.

Download the full briefing from the link below.