Covid-19 vaccine: Migrants hit many hurdles in way to get a jab

Celani Kamwambo can't wait to get vaccinated but first she needs to recover from breathlessness and "flu-like" symptoms that have much in common with Covid-19.

When the 42-year-old Zimbabwean went to a Cape Town clinic recently, she was not offered a test or treatment, she said. "They said it was not Covid and I must go back home to rest," said Kamwambo.

"When I am well again, I will go to be vaccinated. I have managed to register for the vaccine with my refugee status. My sister-in-law got vaccinated [last] Wednesday using her passport number."

Kamwambo's struggle to get equal treatment at a clinic is common among migrants, who face a number of barriers to getting Covid-19 jabs - despite President Cyril Ramaphosa's promise "to make the vaccine available to all adults living in SA, regardless of their citizenship or residence status".

The social justice organisation Section27 has received calls from undocumented migrants about being denied jabs, said attorney Sibusisiwe Ndlela.

"For instance, we received a query that an undocumented migrant person, who lives in an old-age home, was denied access to the vaccine when it was administered at their facility, in spite of the fact that they were resident in a congregate setting," she said.

In another case, a community health worker whose asylum-seeker permit had expired was not able to access the J&J vaccine under the Sisonke study.

"Essentially, eligible documented persons are being placed at the end of the vaccine queue," said Ndlela, referring to the likelihood that a unique patient identification number for undocumented migrants will be implemented only in the final stages of the vaccine programme.

Dr Nicholas Crisp, acting director-general for health, said this number would be provided to all undocumented persons to allow them to get vaccines. "The ID system that we want to use for undocumented people to get vaccinations is coming together and I hope we have a solution in the next week or two," he said this week.

Thandeka Chauke, head of the statelessness project at Lawyers for Human Rights, said: "Undocumented people should be allowed to present alternative forms of identity at the vaccination site, such as an affidavit that confirms their date of birth and contact details.

"The registration number that is issued upon registration should be sufficient for purposes of tracking vaccination doses and contact tracing."

Communities in informal settlements, South African citizens who are undocumented or have blocked IDs, and undocumented migrants have called Lawyers for Human Rights about their struggles to register for vaccinations.

But being able to register is only one of the potential obstacles. Independent researcher Nokuthula Dube has interviewed undocumented migrants in Johannesburg about their challenges.

Language barriers, limited access to accurate information, discrimination at clinics, conspiracy theories as well as opposition to vaccines by religious leaders all contribute to a slow uptake of vaccinations, she found.

"Even if language is not a barrier, many of them do not have mobile phones and there is a lot of misinformation on the ground. Some traditional churches are against the vaccine and there are a lot of conspiracy theories going around," she said.

A willingness to get vaccinated can be influenced by day-to-day concerns. Lumumba Chia, a leader in Cape Town's Cameroonian community, said people could not afford to take time off work to get their shots.

For others, getting a jab on an empty stomach was a concern. "They do not know how the vaccine will affect them if they haven't been able to get food to eat."

To protect migrants, human rights activists insist there must be a legal "firewall" between health officials providing the vaccine and immigration officials.

Wits professor Jo Vearey, director of the African Centre for Migration and Society, said this was critical to make sure undocumented foreigners could be vaccinated without risking arrest or deportation.

The departments of health and home affairs needed to issue clear directives to officials to reinforce this protection, said Vearey. "This would both reassure individuals that they can feel confident in accessing [vaccination] services and provide support to frontline health-care workers who may be uncertain about the process."

Chia said that civil society's campaign to make sure every person had equal access to vaccines was "ubuntu in practice. You can't discard some people when Covid-19 cuts across the world."

Leave nobody behind is their call.