Countries Are Ramping Up Vaccinations. What About Refugees?

With millions stranded in camps with limited access to shots, there’s a big problem looming in the world’s quest to quash COVID-19.

A Palestinian man and his wife ride a donkey cart past street art showing doctors wearing masks due to the COVID-19  pandemic in the Nuseirat refugee camp in Gaza Strip, on Nov. 16, 2020.
A Palestinian man and his wife ride a donkey cart past street art showing doctors wearing masks due to the COVID-19 pandemic in the Nuseirat refugee camp in Gaza Strip, on Nov. 16, 2020. MOHAMMED ABED/AFP via Getty Images

As countries around the world scramble to vaccinate their populations against the coronavirus and its deadlier variants, one group has been largely left out of the conversation: 26 million refugees.

In the quest for herd immunity, experts say including refugees in national immunization efforts is critical to ending the pandemic. Yet refugees, most of whom have fled conflict or persecution in their home countries, are missing from more than one-third of countries’ national vaccine plans. Turkey hosts the largest refugee population with 3.6 million people but has not said if they will be included in its national rollout. Neither has Pakistan, which is home to 1.4 million refugees.

At first blush, the coronavirus may not seem that big of a problem with refugee populations. Roughly a year into the pandemic, case numbers among refugees appear to be lower than experts originally predicted. One possible explanation? Demographically, refugees are relatively young—approximately half are under age 18, according to the United Nations High Commissioner for Refugees (UNHCR). Camps also tend to be fairly isolated from urban areas where the virus may spread more freely.

But data is also scarce, and it’s possible that cases are underreported: Since refugees aren’t being regularly tested because of capacity and supply limitations, it’s unclear how the virus is spreading among their populations. “We’re shooting in the dark right now in terms of how are refugees being affected,” said Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health. “We just don’t know.” 

More broadly, refugee populations face several big hurdles that could complicate the world’s efforts to tame the virus. 

Many of the practices commonly used to mitigate the virus’s transmission, like social distancing and wearing face masks, are difficult—even impossible—to implement among refugees, especially in crowded camps and settlements. With these conditions, they are “like sitting ducks for the spread of COVID,” said Annie Sparrow, special advisor to the director-general at the World Health Organization.

Many of the practices commonly used to mitigate the virus’s transmission are difficult—even impossible—to implement among refugees.

Refugees might also refrain from reporting cases to avoid facing discrimination or potential stigmas, especially after being falsely blamed for transmitting the coronavirus at the start of the pandemic. “There’s a possibility that we’re actually missing either hospitalizations and/or deaths, because they don’t want us to know about them,” Spiegel said.

There’s also the problem of variants, which emerged in South Africa, the United Kingdom, and Brazil. The absence of information among refugees has fueled concerns about how the spread of these deadlier and more highly transmissible variants will impact their communities. Because many countries that host a large refugee population lack the capacity to perform the genetic sequencing necessary to detect the variants, there is no way of confirming how far they have already—or will—spread. That is worrisome because some variants appear to reduce the efficacy of vaccines.

And then there’s the simple question of access to the vaccines. U.N. Secretary-General António Guterres has implored countries to make vaccines available to “all people” and to see their distribution as a “global public good,” but not all nations have heeded his call. According to the UNHCR, only 51 of 90 countries, or 57 percent of countries, with national vaccination plans have said they will include refugees. Whether they will follow through on their pledges remains to be seen; so far, Jordan has been one of the few countries to begin vaccinating its refugee population. 

“Mentioning [refugees] and actually giving [the vaccine] are two different things,” Spiegel said.

Further complicating the issue is the fact that most refugees live in low- to middle-income countries, many of which are struggling to acquire vaccines in a competitive global market where rich countries—comprising just 16 percent of the world’s population—have secured 60 percent of the world’s total supply. Countries in need can procure them through COVID-19 Vaccines Global Access (COVAX), a global vaccination effort that is working to provide free vaccines to at least 20 percent of the world’s poorest countries before the end of 2021. To ensure that the world’s most vulnerable people are protected, COVAX has also established a last-resort emergency buffer that saves 5 percent of doses for humanitarian purposes. 

“It doesn’t matter whether you are a citizen or refugee for a public health pandemic—A virus will infect no matter what,” said Hazem Rihawi, senior programs manager at the American Relief Coalition for Syria. 

Even if the vaccines are available, people need to get the shots. But vaccine misinformation poses another challenge. Just as misinformation has hamstrung vaccination efforts in the United States—almost one third of U.S troops have refused the vaccines, a trend reflected in the U.S. population—it has also plagued refugees, many of whom fear becoming test subjects for possible experimentation or sterilization. 

“We need to work with them to make sure that when the vaccine is available, that they will actually want to receive it,” Spiegel said. 

All these obstacles matter because achieving herd immunity is the best way to protect against continued disruption from the pandemic. But experts don’t expect, even with all these efforts, that the majority of refugees will receive vaccines anytime soon. Attaining herd immunity requires antibodies in at least 70 percent of people. But with COVAX’s first delivery covering just 3.3 percent of participating countries’ populations—and most of the shots earmarked for frontline health care workers—it will take years for vulnerable groups to reach herd immunity. 

“There is no way we are anywhere close [to herd immunity] or even will be close in the next two to three years,” said Mesfin Teklu Tessema, head of the health unit at the International Rescue Committee. Thanks to the new variants, the threshold for herd immunity could be even higher, he noted.

The implications aren’t limited to crowded camps or displaced people—but to the global fight to bring COVID-19 to heel.

“The stakes are enormous,” said Mike Woodman, a senior public health officer at the UNHCR. “If you don’t make sure everyone gets the vaccine, we will not control [the pandemic], and the impacts will be felt by everyone.”

Christina Lu is an intern at Foreign Policy. Twitter: @christinafei