Immigrant Access to COVID-19 Vaccines: Key Issues to Consider

introduction

As the spread of COVID-19 vaccines continues and spreads to larger segments of the population, it is important to consider how to prevent inequalities and ensure equitable access to the vaccine. It is important to ensure that all people have access to the vaccine and that a high vaccination rate is achieved in the communities in order to mitigate the disproportionate impact of the pandemic on underserved populations, to prevent increasing differences in the future and to achieve broad immunity among the population. The nearly 22 million immigrants living in the United States today face increased risks and challenges related to the pandemic. Many non-citizenship immigrants work in important jobs that are likely to be among the first priority groups for COVID-19 vaccination, but they face a number of potential barriers to obtaining the vaccine. Therefore, targeted efforts to reach out to non-citizenship immigrants as part of the vaccination effort will be central to preventing vaccination differences. This letter provides an overview of key issues to consider in achieving COVID-19 vaccination efforts to reach out to non-citizenship immigrants.

Immunization schedules and immigrants

Immigrants make up a significant proportion of workers in certain categories that are likely to be among the priority vaccination groups. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) makes federal recommendations for the allocation of vaccines. ACIP has issued initial recommendations to give certain groups access to the vaccine. The first group recommended for Phase 1a vaccination included health workers and residents and long-term care facility workers. Subsequently, it was recommended that people aged 75 and over and (non-healthcare) frontline workers should be included in Phase 1b, and people aged 65 to 74, those aged 16 to 64, should be included in Phase 1c with high-risk diseases and essential labor not included in phase 1b. States are free to determine their own prioritization and distribution plans, and while some states follow ACIP recommendations, others make alternative prioritization decisions. In total, there are nearly 13 million non-citizens immigrants who make up 8% of the workforce. They make up a significant proportion of workers in categories that are likely to be considered essential and prioritized for vaccination. For example, they make up 5% of healthcare workers who have direct patient contact and 8% of long-term care workers who are in the first Phase 1a priority group for vaccinations. They also make up over a fifth (22%) of all those employed in food production, including over a third of those employed in crop production.

Possible obstacles to vaccinating immigrants

Non-citizenship immigrants face a number of potential barriers to accessing COVID-19 vaccination. Non-citizenship immigrants are more likely than citizens to be uninsured (Figure 1) and are therefore less likely to have a usual source of care and more likely to delay or forego it and to worry about its cost. The federal government has allocated funds to make the COVID-19 vaccine available free of charge to people who are uninsured regardless of immigration status. However, uninsured individuals may be more concerned about the potential costs associated with obtaining the vaccine. Immigrants who are not citizens may also have difficulty accessing the vaccine due to limited transportation, lack of flexibility in work and childcare requirements, and / or language and literacy issues.

Figure 1: Uninsured rates among non-elderly people by immigration status, 2019

Even though expected side effects The COVID-19 vaccines are generally mild immigrants who are not citizens and may have increased concerns about possible side effects. Among the general public, concerns about side effects and safety are a major reason people are reluctant to get a vaccine. Although data are not currently available to assess concerns about vaccine-related adverse reactions in migrant populations, they may be of particular concern for a number of reasons. Non-citizenship immigrants are more likely to be employed in low-wage jobs that offer less paid sick leave. As a result, they may have heightened concerns that side effects could affect their ability to work and lead to lost wages. They may also have increased concerns about the health care costs associated with possible side effects, as they are more likely to be uninsured.

Non-citizenship immigrants may not know whether they are eligible to receive the vaccine and / or fear that receiving the vaccine could have negative consequences for immigration. Immigrant families may not know if they are eligible for the vaccine, especially as they face restrictions on eligibility for health insurance programs and federal COVID-19 aid. They may also fear that receiving the vaccine could negatively affect the immigrant status of their or a family member. Immigrant families have experienced increasing levels of fear and insecurity in recent years. During this time, the federal government has implemented a number of measures to curb immigration, improve enforcement of immigration rules, and limit the use of public support for migrant families. Research shows that in this political climate, migrant families are increasingly reluctant to access programs and services for themselves and / or their children, including health insurance and health care. These fears can also contribute to reluctance to access the vaccine.

Collecting and sharing data related to COVID-19 vaccinations can further increase immigrant fears. Providers and vaccination centers collect certain information from people receiving the vaccine in order to monitor uptake, ensure dose adjustment and timing for the second dose, and to evaluate the effectiveness and safety of the vaccine. All states have existing state vaccination registers or databases to keep track of this data. Additionally, the CDC urges states to submit COVID-19 vaccination data in support of federal surveillance, including certain personal data such as name, address, state of birth, and a unique recipient ID. As set out in the Data Use and Sharing Agreement, the Department of Health and Human Services and CDC are committed to maintaining the confidentiality of identifiable or potentially identifiable data, and will only use the data to “promote the public health response to COVID-19 ". An appendix to the Data Usage Agreement states that data may not be used for any civil or criminal prosecution or enforcement, including, but not limited to, immigration enforcement. The Data Use and Sharing Agreement further advises that jurisdictions that (due to legal or regulatory restrictions) cannot provide identifiable information to CDC will be given the alternative option to transfer data. According to media reports, some states are still working on details of their data usage and sharing agreements. In addition to these specifications related to data sharing, U.S. Citizens and Immigration Services have made it clear that testing, treatment, or preventive measures, including vaccines, related to COVID-19 will not be considered as part of a public illicit investigation. Despite these limitations on how the data is used, the collection of personal data and its disclosure to the federal government is likely to make some immigrant families reluctant to access the vaccine.

Remove barriers to vaccination for immigrants

Minimizing entry barriers, targeted contact and education, and eliminating fears about possible negative effects on immigration will be important to avoid vaccine gaps in migrant families:

• Ensuring that vaccination sites are available in locations that are easily accessible via multiple modes (e.g. driving or walking) over several hours (including evening and weekend) that take into account different work schedules can help to break down barriers to entry. In addition, the involvement of providers serving large numbers of immigrant families as vaccine administration sites can facilitate access and reduce potential language barriers.
• Through targeted public outreach and education, individuals can understand that they are eligible to receive the vaccine and that it is available free of charge. Past experience with public health messaging, public outreach and registration efforts under the Affordable Care Act (ACA) shows the importance of providing public outreach and information about trusted ambassadors within the community and of making culturally appropriate material available in multiple languages do. Even with these interventions, some people may be afraid or reluctant to access the vaccine, especially if they fear that side effects could result in lost work time and / or health care costs.
• Minimizing the collection of personal data, clearly explaining how it is used and making it clear that it cannot be used for immigration-related purposes can help reduce fears about vaccine access. While the federal government has indicated that COVID-19 vaccination data cannot be used to enforce immigration regulations and receiving the vaccine is not considered part of public billing, delivering this information directly to families via trusted messengers is key to alleviation of immigration. related fears.

As of early January 2021, some states have put in place plans or measures to target potential obstacles to vaccinating immigrant families. Some states have indicated that immigrants are a priority as part of vaccination efforts. For example, the state health director in Arizona named the undocumented population a high priority for vaccination, Virginia includes people living in migrant labor camps in Phase 1b of its vaccination schedule, and New Jersey includes migrant workers as a high-risk population in Phase 1c. Some states have taken steps to clarify whether immigrants are eligible for the vaccine and to reduce fears about the potential negative impact on immigration. For example, in Connecticut, Governor Lamont noted that receiving a COVID-19 vaccine is confidential and the information will not be shared with other authorities, including immigration and customs control. In the FAQs, Illinois states that everyone, including undocumented immigrants, is eligible for the vaccine, and Utah clarifies that personal information is confidential and immigration status does not affect the ability to receive the vaccine. In early December 2020, New York Governor Cuomo sent a letter to the Secretary of State for Health and Human Services highlighting concerns that states are required to provide certain vaccination data to the federal government in order to prevent undocumented immigrants from searching for it To get vaccinations. Several states, including Arizona, Oregon, and Washington, announced plans to develop targeted messaging and contacting immigrant communities. Oregon and Washington also made explicit reference to the involvement of immigrant and refugee communities in planning and advising on information about the spread of vaccines. In contrast to these efforts, Nebraska state officials made comments that undocumented immigrants could be expelled or prioritized behind citizens for vaccination.

Conclusion

Overall, the COVID-19 pandemic poses increased risks and challenges for immigrants without citizenship. Many non-citizenship immigrants work in important jobs that are likely to be among the first priority groups for COVID-19 vaccination. However, they face a number of potential barriers to obtaining the vaccine, including access restrictions, confusion about eligibility and potential costs, and concerns about the health and economic effects of side effects and immigration fears. In view of these obstacles, efforts to minimize barriers to entry, as well as targeted contact and information, will be important to facilitate access to vaccination by migrant families. To date, few states have put in place plans or measures to specifically address potential obstacles facing migrant families. Looking ahead, it will be important to assess immigrant access and willingness to receive the vaccine in order to mitigate the impact of COVID-19 on immigrant communities, avoid major health disparities for immigrants and avoid gaps in the future avoid vaccination that could put communities at risk for the further spread of COVID-19 infections.