An equitable distribution of COVID-19 vaccine must include noncitizens

On Dec. 14, 2020, with the initiation of COVID-19 vaccine distribution, the nation saw its first glimmer of hope during the pandemic. However, that sense of hope is not necessarily shared by a vital segment of the population: noncitizens. Noncitizens work in high-risk, essential industries but have been overlooked in the pandemic response. To protect both the lives and livelihoods of all people in the United States, it is critical that noncitizens are equitably included in COVID-19 vaccine distribution.

The federal government must ensure that all people living in the United States have equitable and uniform access to the COVID-19 vaccine. Equitable access means that noncitizens receive access to the vaccine on the same terms as U.S. citizens — in the phase for which they qualify, and without cost as a barrier. This virus does not discriminate based on nationality, gender, religion, or immigration status. It doesn’t respect invisible geographic borders between cities, counties or states. If noncitizens are excluded or deterred from receiving the COVID-19 vaccine, we will face a prolonged pandemic with many opportunities for the virus to mutate and cases will continue to surge.

This is not simply a matter of fairness, although it is that, too. It is also a matter of keeping society functioning during this national emergency, ending the risk of contagion as soon as possible, and protecting the personal and economic liberty of the American people. Eighteen percent of the essential workforce in this country is foreign-born. We must protect this workforce, including the noncitizen employees, in order to keep critical industries functioning during the pandemic.

Although the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has issued recommendations for phased allocation of COVID-19 vaccines, states make the final decisions. This opens the door to geopolitical biases and increases vaccination inequities. Non-uniform state pandemic responses can exacerbate racial health disparities and increase risks of exposure for low-income workers who do not have the luxury of working from home. This includes noncitizens with various immigration statuses and those without legal status, the vast majority of whom are members of racial or ethnic minorities and have low incomes.

While states’ decisions about allocation of limited supplies of COVID-19 vaccine are ongoing, some have already deviated from ACIP’s recommendations. Nebraska has become the first state to declare that citizenship and immigration status will be a factor in its vaccine distribution plan. Some states, including Arizona, still do not have their state vaccine portals available in multiple languages, leaving non-English speakers that may otherwise qualify excluded.

Although other states may not follow suit, public health authorities in parts of the country subject to heightened immigration enforcement will need to take additional steps to persuade noncitizens to be vaccinated. Fears of negative immigration consequences from getting the vaccine must be addressed directly through active outreach and engagement with noncitizen communities.

The federal government’s messaging on this issue is unclear. The CDC and the Biden-Harris administration have promised no-cost vaccines for “Americans.” But who does this include? In contrast with the leading frameworks informing ACIP’s recommendations, its Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine does not recommend that noncitizens have access to the COVID-19 vaccine on the same terms as U.S. citizens. In addition to equitable allocation of the vaccine, meaningful access for noncitizens also requires unqualified assurances that vaccine recipients’ information will not be shared with immigration agencies for enforcement purposes or to jeopardize future immigration applications under the public charge regulations. Immigrant communities subjected to heightened immigration enforcement and harsh rhetoric by federal officials have reason to distrust unenforceable statements by political appointees. Clear communication, in culturally and linguistically appropriate materials, from the federal government and targeted outreach regarding noncitizen eligibility for the COVID-19 vaccine and confidentiality protections are essential to ensuring equitable access.

The Biden-Harris administration should seize this opportunity to plan for the equitable distribution of COVID-19 vaccine, including to noncitizens. Doing so will protect an often-disregarded population that is vulnerable to COVID-19 and in effect, protect our society as a whole. After four years of divisive policies and unprecedented corruption from the Trump administration, this is an important step toward rebuilding trust and transparency in the U.S. government, which has eroded considerably among citizens and noncitizens alike.

Rep. Raul M. Grijalva represents Arizona’s 3rd District. Medha D. Makhlouf in an Assistant Professor at Penn State Dickinson Law. Dr. Megan L Srinivas is an Infectious Disease Physician & Translational Health Policy Research Fellow at the University of North Carolina. Gilberto Lopez is an Assistant Professor at the School of Transborder Studies at Arizona State University. Makhlouf, Srinivas, and Lopez were named Senior Fellows in the Atlantic Fellows for Health Equity Program in 2020.