Undocumented and unvaccinated yet still essential

When the COVID-19 pandemic first swept through the U.S., the public learned of a new labor category: essential workers. These are people who work in low-wage high visibility positions in health care facilities, educational institutions, food production facilities, even grocery stores.

But what we did not learn was that over 5.5 million of the workers in essential industries in the U.S.— one out of every 20 — are undocumented immigrants. And these people — so vital in how our country made it through the pandemic’s first year — face difficult if not insurmountable hurdles in getting vaccinated.

Undocumented immigrants have faced immense risks, burdens and obstacles during the COVID-19 pandemic. The U.S.’s distribution of the COVID-19 vaccine — which has fostered confusion, contributed to vaccine hesitancy and perpetuated health inequities — has not helped. As states continue to accelerate the rollout of vaccines, undocumented immigrants of all races and ethnicities are being systematically overlooked. 

If the Biden administration and state governments are committed to reaching herd immunity in the U.S. population by the end of 2021, undocumented individuals must have equitable access to COVID-19 vaccines.

In February 2021, the Biden administration joined the Centers for Disease Control and Prevention (CDC) and The National Academy of Sciences, Engineering, and Medicine to call for all individuals in the United States and its territories to receive the COVID-19 vaccine irrespective of their legal status. The Biden administration instructed vaccination sites across the country to ensure undocumented migrants are able to receive COVID-19 vaccines, calling their inclusion in vaccine distribution a moral and public health imperative.

Each state, however, sets their own requirements regarding who can be vaccinated and what identification they must show — and enforcement of these regulations vary considerably. Instances of undocumented immigrants being denied access to vaccines in Florida and elsewhere contradicts the Biden administration’s promise. We examined the current COVID-19 vaccination plans for the 50 states and the District of Columbia and found that 31 states (62 percent) require individuals to demonstrate that they are either a resident or a worker in the state where they are receiving the COVID-19 vaccine. Six states require individuals to be residents of the state. 

As states continue to require government issued IDs and fail to communicate which documents will be required for undocumented immigrants to receive the vaccine, undocumented immigrants will continue to lag behind.

Tellingly, while the majority of undocumented workers are found in the construction, grocery and food services and agricultural industries, 25 percent of the state COVID-19 vaccination distribution plans have failed to prioritize workers in these industries. Similarly, while individuals who are detained in U.S. prisons and jails have been prioritized in 71 percent of state vaccine plans, immigration detention facilities are absent in all but two state vaccine prioritization plans. 

Even in the states where workers in these industries were included in vaccine priority groups, residency requirements, fear of legal repercussions, and uncertainties about what documents must be provided to demonstrate eligibility have continued to hamper vaccinations. 

The U.S. must do a better job of prioritizing. The inclusion of undocumented immigrants is fundamental to the overall success of the U.S.’s vaccination effort and recovery from the COVID-19 pandemic. States leaders must work with immigrant community leaders and organizations and meet their needs. If the 13 million undocumented immigrants who currently reside in the U.S. continue to be excluded and left behind in the vaccination efforts, immigrant communities will continue to bear a disproportionate burden of COVID-19 cases and deaths. 

As states across the country open up access to vaccines to the wider adult population, each state must make a renewed effort to explicitly state what types of identification are necessary to demonstrate eligibility. The CDC should reinforce the Biden administration’s commitments by mandating that states cannot require undocumented immigrants to demonstrate citizenship or residency in order to receive a COVID-19 vaccine. 

The pandemic has taught us that our health is inextricably linked to the health of all of our neighbors. Prioritizing undocumented and detained immigrant communities’ access to the COVID-19 vaccine should be a priority for state and federal governments alike. Immigrants in detention facilities and undocumented workers in industries such as construction, agriculture and food services should have a spot at the front of the line for the COVID-19 vaccine. Until these essential members of our communities and country are protected from this virus and provided with the resources they need to stay healthy, no state or community will be able to fully recover from the COVID-19 pandemic.

Dana McLaughlin, MPH, is a global health associate at the United Nations Foundation and a research assistant at the Johns Hopkins Bloomberg School of Public Health’s Center for Humanitarian Health.

Paul Spiegel, MD, MPH, is a professor of the practice at the Johns Hopkins Bloomberg School of Public Health and director of the Johns Hopkins Center for Humanitarian Health.