Zackary Berger, one of the authors of this article, works part-time as a GP at the Esperanza Center Health Clinic, which cares for undocumented Spanish-speaking immigrants in Baltimore. One final afternoon he asked one of his patients (a man in his forties, in work boots and jacket who wondered why his shoulder was hurting so much) if he was suffering from pandemic stressors, like so many in the practice. Did he have problems with food, rent, medicine? Yes, yes and yes. Then the man looked up and said, “This pandemic has destroyed so many. We all hope for the vaccine. "
Eillen Martinez (co-author of this article) also worked as a patient services coordinator at this clinic for some time. Motivated by our work there, we are about to start a research project to understand the Baltimore Latinx people's experiences during COVID-19. We are seeing more and more clearly that undocumented immigrants have borne a significant burden at every turn in the pandemic without relief. When introducing vaccination distribution plans, it is important to focus on caring for the undocumented community. Otherwise undocumented immigrants would be denied protection against the virus and herd immunity would be undermined through vaccination, which would affect the United States' ability to recover from the COVID-19 pandemic.
Undocumented immigrants are often suspicious of public services, and this was compounded when in January 2020 the public fee rule mandated that undocumented immigrants using certain government services could be denied approved residency status. When cities first introduced stay-at-home contracts in March, that community was forced to step up the system. Hundreds of thousands in the undocumented community continued to work across the spectrum of essential work: healthcare, meat packing, grocery, agricultural work.
Undocumented farm workers were picking strawberries in California's Salinas Valley in August when the air was choked with ashes from nearby forest fires. However, when the Coronavirus Aid, Aid and Economic Security (CARES) Act was implemented and stimulus checks were released, undocumented immigrants, many of whom are rooted in poverty, were excluded. In Baltimore City, where our work is located, an undocumented patient who was afraid of unstable work, evictions, food shortages and caring 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, educate, and build trust the undocumented community at what may be a pivotal turning point in the U.S.'s fight against the pandemic.
It is true that, according to the federal government, the COVID-19 vaccine should be available for free regardless of insurance or immigration status. US Surgeon General Jerome Adams reiterated in December: "No one in this country should be denied a vaccine based on their documentation status, as it is ethically improper to reject them." President Joe Biden has also said his government will not discriminate against immigration status in its $ 1.9 trillion stimulus plan to vaccinate people for free.
Regardless of these statements, however, if barriers to access to the vaccine are not specifically addressed, they are empty gestures. The current lack of specific action by federal, state and city governments to combat undocumented immigrants for vaccination distribution plans is causing the community to slip through the cracks. To ensure that the undocumented community is not neglected, at least three concerted actions need to be prioritized: addressing fear of deportation; Establish trustworthy vaccination sites with open hours for the undocumented community; and disseminating culturally and linguistically aware information to build trust and address concerns.
The Centers for Disease Control and Prevention (CD) Advisory Committee on Immunization Practices has published guidelines recommending a gradual distribution of the vaccine into priority groups. However, the methods of distributing vaccines are ultimately at the discretion of state governments. Many states are in the process of introducing "Phase 1b" under CDC guidelines, including vaccinating key workers, 6 million of which are undocumented, according to the Institute for Migration Policy. In fact, undocumented immigrants encompass every single priority group set by the CDC. Nowhere, however, is it specifically stated that these priority guidelines apply to everyone, regardless of immigration status.
That omission set the stage for rhetoric against immigrants in Nebraska, where Governor Pete Ricketts falsely claimed that undocumented immigrants would be the last in line to receive the vaccine. As untrue, impractical and possibly illegal as his proposal may be, his statements reflect a nativism that arouses fear and distrust in the undocumented. This fear has reportedly prevented many from getting vaccinated. It is therefore crucial to provide clear information on the involvement of undocumented individuals and to make it clear that personal data collected for dose monitoring will not be shared with government agencies.
This privacy was upheld by the CDC after New York Governor Andrew Cuomo objected to the Trump administration's request to collect 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 important to emphasize the protection of data in all information distributed by local governments in multiple languages to allay the reluctance to do so.
Because each city's immigrant community is different, it is vital for local governments to work with trusted community organizations to disseminate linguistically and culturally aware information and to set up accessible vaccination sites that meet the needs of local undocumented communities. Health officials can draw on approaches taken during the 1918 pandemic influenza, which coincided with an influx of immigrants into the United States. Community groups disseminated public health information in a culturally sensitive manner and in the languages of newcomers to help fight the pandemic of this era. Similar models are being implemented by the Chicago Public Health Department and Baltimore City. An initiative based on the Stop the Spread program is being proposed in Boston. While these are prudent steps, plans need to be further developed and implemented nationwide to tackle barriers to entry.
A particularly destroyed subgroup of undocumented immigrants is in ICE prisons, where infection rates are 13.4 times higher than in the general population. This group urgently needs attention. When detainees can not be released, vaccination of detainees is a basic human right and of paramount importance in preventing transmission to other communities. While the CDC encourages the judiciary to "vaccinate staff and detainees at the same time because of their shared increased risk of disease," most states have only included law enforcement officers in their high-priority vaccination groups, and only Louisiana has explicitly stated its intention to vaccinate its imprisoned population. ICE must prioritize vaccination of detainees to repair its long history of substandard medical care, prevent further human rights abuses, and protect against transmission by the COVID-19 community.
The pandemic can be tackled with continued attention to the most vulnerable and at risk, not by making vague statements that will effectively lead to their exclusion. It is critical for states and cities to make explicit plans to reach out to the undocumented community and establish accessible vaccination sites. Not only would it be inhuman to exclude undocumented immigrants, it would also be inhumane to enforce public health strategies that would threaten the country's ability to counter the COVID-19 pandemic.