Op-Ed: Vaccinate Our Undocumented
Racial and ethnic minority communities continue to be heavily impacted by COVID-19. As the COVID-19 vaccine rolls out, it is essential that the most vulnerable have access — regardless of immigration status.
In 2018, foreign-born individuals comprised 14% of U.S. residents, with 10.7 million immigrants having undocumented status. Within the workforce, 5 million essential workers are undocumented, according to the Center for American Progress. The undocumented workforce has faced a host of challenges during the pandemic that both increase their risk of contracting and spreading COVID-19 and lead to more serious disease. This includes holding low-paying jobs, having little to no work benefits, having to work in-person without proper protective equipment, and living in multigenerational households without space to quarantine. Despite their increased risk of contracting COVID-19, many lack healthcare coverage. Immigrants may feel deterred from seeking medical care altogether because of fear of drawing unwanted attention to their immigration status, putting them at risk for worse health outcomes. Distrust in the medical system and other systemic barriers, such as lack of proper identification or access to language services, also prevent people who are undocumented from getting much needed care.
Getting the undocumented population vaccinated will require addressing a host of barriers.
Fear of Immigration and Customs Enforcement
Within immigrant communities, patient privacy and security are especially important because of generalized fears of Immigration and Customs Enforcement (ICE). Chicago, for example, is using self-verification systems to determine eligibility to receive the vaccine, requiring personal identifiers such as age and residency through items like a passport or consular ID. However, many individuals from mixed-status households often feel uncomfortable and unsafe providing this information because they’re afraid it will be used against them or their family. Many mixed-status families also don’t have access to IDs. Proof of identification may seem like a benign request, but for those who are undocumented, it’s equivalent to asking about immigration status.
Lack of Access to Vaccination Sites or Health Information
Many immigrants and people of color live in healthcare deserts, preventing them from easily accessing common vaccine sites. There’s also a significant “racial tech gap” in many communities of color that makes it extremely challenging to navigate the bureaucratic process of online vaccine registration. Using community organizations as vaccine sites can make it easier for community members to hear about the vaccine and register for it. Community organizations also may use alternatives to online registration to make it easier to sign up for a vaccine appointment.
Lack of language-friendly public health information is another barrier to vaccination for those with undocumented status. Providing information in multiple languages and media formats is necessary for immigrant groups to feel acknowledged and adequately informed about how to stay healthy and safe.
To remove unnecessary barriers for all immigrants, regardless of status, we recommend those at the forefront of the vaccination rollout work with and within diverse communities to take the following active steps:
1. Develop and distribute information about vaccine eligibility, vaccination sites, and health and safety information in multiple languages. Make sure translations are accurate, readable, and adapted to address the needs and realities of the target community. Offer multimedia formats, such as audio/video, infographics, written pamphlets, and live Q&A’s, to be inclusive and respectful.
2. Establish accessible vaccination sites within trusted community spaces. Offer “help desks” at vaccination sites for those with limited technology access or other barriers to vaccine navigation. This is a great way to involve youth leaders and provide paid hourly compensation for community advocates.
3. Train vaccination site staff to ask for names and phone numbers only, not IDs or social security numbers. If community sites need to document additional eligibility — for example, neighborhood residence — work with community leaders to spread the word.
When implementing these steps, trusted community leaders should be involved in creating materials, making decisions, disseminating information, and answering questions to reduce the spread of misinformation.
Documentation status, language, race, or ethnicity should not be requirements for getting vaccinated or staying healthy during or beyond the pandemic. While we acknowledge that public health departments are using demographic data as a way to track equitable vaccine distribution, individuals need to be reassured that they can “opt out,” and that immigration status and language are not requirements for vaccination.
Allowing health systems to do what they have always done may be easier, but it will only perpetuate inequities. We must take active steps toward promoting the health and safety of our most vulnerable and historically marginalized communities.
Isa Álvarez graduated from the University of Chicago and is an intern at the Medical Organization for Latino Advancement.
Pilar Ortega, MD, is an emergency physician and assistant clinical professor in the Department of Medical Education and Hispanic Center of Excellence at the University of Illinois College of Medicine. She is also co-founder of the Medical Organization for Latino Advancement.
Dana Rusch, PhD, is an assistant professor of clinical psychiatry and director of the Immigrant Family Mental Health Advocacy Program at the Institute for Juvenile Research at the University of Illinois at Chicago.
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