Blocking Undocumented Immigrants From Vaccination Is Self-Sabotage
A crucial and vulnerable population needs rapid access to the COVID-19 vaccine.
Zackary Berger, one of the authors of this article, works part-time as a primary care physician at Esperanza Center Health Clinic, which serves undocumented Spanish-speaking immigrants in Baltimore. On a recent afternoon, he asked one of his patients (a man in his forties, in work boots and jacket, wondering why his shoulder hurt so much) whether he was suffering from pandemic-related stressors, like so many in the practice. Did he have problems with food, rent, medications? Yes, yes, and yes. Then the man looked up and said, “This pandemic has destroyed so many. We are all hoping for the vaccine.”
Eillen Martinez (a co-author of this article) also worked for some time as a patient services coordinator at that clinic. Motivated by our work there, we are about to launch a research project to understand the experiences of Baltimore Latinx people during COVID-19. We see ever more clearly that at every turn in the pandemic, undocumented immigrants have borne a significant burden without relief. As vaccination distribution plans roll out, it is crucial to center the care of the undocumented community. Failing to do so would deny undocumented immigrants protection against the virus, and undermine herd immunity through vaccination, compromising the ability of the United States to recover from the COVID-19 pandemic.
Undocumented immigrants are often wary of public services, and this was exacerbated when in January 2020, the public charge rule dictated that undocumented immigrants who sought certain government services could be denied authorized residency status. Yet when cities first implemented stay-at-home orders in March, it was this community that were forced to buoy the system. Hundreds of thousands in the undocumented community continued to labor in the full spectrum of essential work: health care, meatpacking, grocery, farm work.
In August, undocumented farmworkers in the Californian Salinas Valley picked strawberries as the air was choked with ash from nearby wildfires. Yet when the Coronavirus Aid, Relief, and Economic Security (CARES) Act was implemented, and stimulus checks were released, undocumented immigrants, many of whom are entrenched in poverty, were excluded. In Baltimore City, where our work is situated, an undocumented patient facing anxieties about unstable work, eviction, food scarcity, and providing for his six children asked about the vaccine. His question called the country to account: “What is next for the undocumented community?” Cities and state governments must implement explicit plans to vaccinate, inform, and build trust with the undocumented community in what could be a crucial turning point in the U.S. fight against the pandemic.
It is true that the COVID-19 vaccine should be available at no cost regardless of insurance or immigration status, according to the federal government. U.S. Surgeon General Jerome Adams affirmed in December, “No one in this country should be denied a vaccine because of their documentation status, because it’s not ethically right to deny those individuals.” President Joe Biden has also said that his administration will not discriminate against immigration status in its $1.9 trillion stimulus plan to get people vaccinated at no cost.
However inclusive these statements, they are empty gestures if barriers to accessing the vaccine are not specifically addressed. The current lack of specific actions by federal, state, and city governments to target undocumented immigrants for vaccination distribution plans means the community slips through the cracks. To ensure the undocumented community is not neglected, at least three concerted actions must be prioritized: quelling fear of deportation; establishing trusted vaccination sites with accessible hours for the undocumented community; and disseminating culturally and linguistically conscious information to build trust and ease concerns.
The Centers for Disease Control and Prevention (CD) Advisory Committee on Immunization Practices has released guidelines recommending phased distribution of the vaccine by priority groups. Vaccine distribution methods are, however, ultimately at the discretion of state governments. Many states are in the midst of rolling out “Phase 1b” in accordance with CDC guidelines, which includes vaccinating essential workers, 6 million of whom are undocumented according to the Migration Policy Institute. Indeed, undocumented immigrants span every single priority group stipulated by the CDC. Nowhere, however, does it explicitly state that these priority guidelines apply to everyone, regardless of immigration status.
This omission set the stage for anti-immigrant rhetoric in Nebraska, where Governor Pete Ricketts falsely claimed that undocumented immigrants would be last in line to receive the vaccine. However untrue, impractical, and potentially unlawful his suggestion, his statements reflect a nativism that generates fear and mistrust on the part of the undocumented. This fear has reportedly deterred many from getting vaccinated. It is therefore crucial to provide unambiguous information about the inclusion of undocumented individuals and to clarify that any personal data collected for dosage monitoring will not be shared with government agencies.
This protection of data was confirmed by the CDC, after New York Governor Andrew Cuomo’s objected to the Trump administration’s requirement of collecting personal data points that could be possible indicators of citizenship. According to the CDC, data may not be used “for any civil or criminal prosecution or enforcement, including, but not limited to, immigration enforcement.” It is vital to highlight, in multiple languages, the protection of data in any information disseminated by local governments to dispel any associated reluctance.
Because every city’s immigrant community is different, it is critical for local governments to partner with trusted community organizations to disseminate linguistically and culturally conscious information and establish accessible vaccination sites that meet the needs of local undocumented communities. Public health authorities can draw from the approaches during the 1918 influenza pandemic which coincided with an influx of immigration to the United States. Community groups disseminated public health information in culturally sensitive ways and in the languages of newcomers in order to combat that era’s pandemic. Similar models are being implemented by the Chicago Public Health Department, and Baltimore City. In Boston, an initiative modeled after its “Stop the Spread” program is being suggested. While these are prudent steps, plans must be further developed and implemented nationwide to combat access barriers.
One particularly devastated subgroup of undocumented immigrants is held in ICE detention centers, where infection rates are 13.4 times higher than the general population. This group needs urgent attention. If releasing the detainees is not possible, vaccinating detained individuals is a basic human right and paramount to preventing transmission to other communities. While the CDC encourages jurisdictions to “vaccinate staff and incarcerated/detained persons at the same time because of their shared increased risk of disease,” most states have only included correctional officers in their top priority vaccination groups and only Louisiana has explicitly expressed intent to vaccinate its detained population. ICE must vaccinate detained persons as a priority to repair its substantial history of substandard medical care, prevent further human-rights transgressions, and protect against COVID-19 community transmission.
The pandemic can be beaten with sustained attention to the most vulnerable and at-risk, not by releasing vague statements that effectively lead to their exclusion. It is vitally important for states and cities to make explicit plans to outreach to the undocumented community and establish accessible vaccination sites. It would not only be inhumane to exclude undocumented immigrants, but would also perforate public health strategies, jeopardizing the country’s ability to counter the COVID-19 pandemic.
Zackary Berger is an internist, clinical epidemiologist, and bioethicist at Johns Hopkins School of Medicine. He is also Staff Physician at the Esperanza Center Health Clinic in Baltimore.