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COVID-19 Treatment and Vaccination Out of Reach for Millions of Undocumented Immigrants

With undocumented immigrants at a higher risk to receive COVID-19 and a much lower risk to obtain healthcare, what is the solution?

Like other more vulnerable segments of society, the undocumented immigrant population has experienced much higher rates of coronavirus (COVID-19) infection and deaths than the general population. We do not know the exact numbers, but we can be reasonably certain the rates are very high. One clue can be found by looking at infection and death rates among legal Latinx citizens since approximately three-quarters of undocumented immigrants are from Latin countries. According to the CDC, hospitalization rates for COVID-19 among Latinos have been 3.3 times higher than it has been for white people. On top of this sobering statistic, Kathleen R. Page, M.D. and Alejandra Flores-Miller, a physician and research coordinator respectively at Johns Hopkins Hospital in Baltimore, contend that “the COVID-19 case rate and mortality among undocumented immigrants are undoubtedly much higher than they are in the general Latinx population.”

High rates of COVID-19 infection among undocumented immigrants have been due to many factors including crowded living conditions, frontline work that puts them in regular contact with infected people, inflexible work hours that limit the ability to visit a doctor and poor access to quality healthcare. Some of these factors are also affecting when and, in many cases, if undocumented immigrants will receive the COVID-19 vaccine. Since undocumented immigrants are one of the groups most vulnerable to contracting COVID-19 and dying from it, one would think they should be among the first to receive a vaccine. However, traditionally poor access to healthcare will make it likely that many undocumented immigrants will either get vaccinated later than other frontline workers or not get vaccinated at all.

Besides being a health threat to undocumented immigrants, the combination of late and low vaccination rates will also pose a public health threat to the rest of the population. Dr. Ranit Mishori, senior medical advisor for Physicians for Human Rights, said, “I’m very, very concerned. If we are as a country to achieve herd immunity, that means non-citizens (undocumented immigrants) who live among us have to be immunized.” Dr. Manuel Pastor, head of the Equity Research Institute at the University of Southern California, said, "Imagine restaurants reopening when you haven’t also included the entire staff in your vaccination efforts.”

It is important to note that not only physical barriers prevent undocumented immigrants from receiving quality healthcare but also the fear of arrest and deportation are keeping many immigrants displaying COVID-19 symptoms away from community clinics. Years of punitive, aggressively-enforced immigration policies have also scared away many undocumented immigrants that need non-COVID-19 medical care. At the heart of the fear is the Trump administration’s Public Charge rule that renders undocumented immigrants unable to obtain a green card, extend their visa or be admitted to the U.S. if they are deemed to be likely to need public assistance. Anyone that receives free or low-cost medical care, like COVID-19 treatment or a vaccination at a community clinic, labels that person as someone likely to become a public charge.

Ominous federal warnings in the past few months about needing to produce documentation to receive a vaccine have only increased fears. New York state’s governor, Andrew Cuomo, threatened to not comply with the Trump Administration’s original requirement that anyone receiving a vaccination furnish personal information such as Social Security and driver’s license numbers. Trump’s Health and Human Services secretary Alex Azar then clarified that such information would not be required.

Even though a federal appeals court ruled against the Public Charge rule at the end of last year and the Biden administration is poised to review and likely reverse the rule, all this legal wrangling has likely left undocumented immigrants wary. And anti-immigrant rhetoric by other politicians keeps stoking these fears. In the first week of the new year, Nebraska’s Governor Pete Ricketts said that undocumented immigrants would not receive any vaccinations at all, a comment he was later forced to walk back.

Joel Diringer and Noe Paramo of the California Rural Legal Assistance Foundations say that to be successful, the vaccination effort among undocumented immigrants needs to address both this population’s well-founded fears of arrest and deportation as well as the logistical challenges of getting vaccines to undocumented immigrants who live and work in remote rural areas and/or work inflexible hours. They propose mobile clinics with flexible hours as well as aggressive outreach to educate undocumented immigrants about vaccines and to build their trust. Trust cannot be built overnight, though, when so much has been done to destroy it but it is imperative we move as fast as possible because we all know that COVID-19, especially with the spread of the more contagious strain, won’t wait.

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