The country made vaccinations available for the 18 to 34 age group earlier than expected after the number of people willing to be inoculated against Covid-19 began to drop. The younger group has shown a willingness to get the jab, but there are still questions about how undocumented and other vulnerable people can register.
The Department of Health confirmed that registration on the Electronic Vaccination Data System is currently available only to people with valid identity numbers or equivalent passport, refugee or asylum permit numbers. The system generates unique patient identifier numbers, which are necessary to access the vaccine. But excluding certain groups from this life-saving medication poses serious risks to public health, and will impede the country’s ability to reach a manageable level of unvaccinated residents.
The Western Cape Department of Health recently tested a system in which undocumented people were able to register for the vaccine by using a paper-based form that did not need an official number. Undocumented people could enter “undocumented” in the section “identity number/passport number”. A circular sent out during the trial read: “Given their vulnerable status, undocumented clients should be prioritised for Johnson & Johnson vaccines according to the vaccination site’s stock availability.”
While this system has been used in the Western Cape, and similar systems are planned for undocumented and homeless people in the eThekwini municipality, the Department of Health is yet to reveal a national scheme for vulnerable groups. When asked about plans to include undocumented people in the nationwide drive, departmental spokesperson Popo Maja said: “We don’t have any new developments.”
Breaking the chain of transmission
Jo Vearey, a public health researcher and the director of the African Centre for Migration and Society at the University of the Witwatersrand, said: “For any vaccination programme to be successful, we need to ensure that we leave no one behind.
“This has implications for everyone and for the effectiveness of the vaccination programme. So we need to address the administrative challenges to ensure that we can provide vaccines to everybody who wishes to be vaccinated.
“It’s important to also emphasise that this is even more pressing given the Delta variant, its increased transmissibility and the importance of breaking those chains of transmission – that’s the key thing, and it’s a clear public health argument. It’s basic vaccine programming to ensure everyone is included.”
Vearey said it is critical to protect vulnerable groups, especially undocumented migrants. “We need to ensure that we can guarantee protection to non-citizens … Once they are able to access the vaccine, we need to ensure that they are protected.
“So we need what’s known as a legal firewall, which basically provides a legal directive that means individuals cannot face any penalty for accessing care, in this case the vaccine, [because of] their documentation status.”
Vearey added that it was important for the department to communicate clearly that people without documentation must still be vaccinated. She also called on the Department of Home Affairs to guarantee that undocumented people registering for a vaccine will not face penalties.
“We need to make sure everyone is vaccinated, but we [also] need to reassure those who may be hesitant to access a vaccine because of an undocumented status that … their safety is guaranteed.
“Many of those undocumented people have been rendered undocumented by the immigration management system, the restrictive Immigration Act and by challenges in accessing and renewing documents at home affairs,” she said.
Protecting migrants protects everyone
Sally Gandar, the head of advocacy and a legal adviser at the Scalabrini Centre in Cape Town, said because of the nature of the pandemic we will not be protected if we do not include everyone in our response.
“Our president has criticised several high-income countries for hoarding vaccines and engaging in vaccine nationalism. He’s right to be critical of vaccine nationalism, and we should ensure that we do not make the same mistake in our rollout by excluding undocumented persons in South Africa.
“It’s likely that undocumented persons are rendered more vulnerable because of their documentation status, which is a further reason to ensure inclusion. We need to protect everyone but especially the most vulnerable,” Gandar said.
According to Gandar, one of the biggest concerns for Scalabrini’s clients is the fear that healthcare providers will report people to immigration officials if they are suspected of being undocumented migrants. This might lead to immigration enforcement operations, and possible detention and deportation.
“There is also hesitancy because of past experiences with healthcare staff who have had xenophobic attitudes or refused healthcare to persons based on lack of documentation. In addition, we have seen a big challenge around the provision of information about the vaccine, registration and vaccine safety. There are materials available in SA’s official languages, but not many others.”
Gandar said the circular put out by the Western Cape Department of Health should be commended because it showed an approach to vaccine access motivated by public health. But a national circular and a well-publicised announcement from the health department and home affairs was necessary to ensure that health officials accept any eligible person for a vaccine and ensure they do not face discrimination based on documentation or immigration status.
“A further roadblock is ensuring people come for a second dose, where a two-dose vaccine is administered. The Western Cape Department of Health’s decision to prioritise Johnson & Johnson single dose vaccines for undocumented persons is commendable in this regard,” Gandar said.
Amir Sheikh, the spokesperson for the African Diaspora Forum, emphasised the importance of everyone getting vaccinated. “These undocumented people are part … of what makes South Africa a rainbow nation,” Sheikh said. “If we want … success in fighting this pandemic that has taken many lives and [caused the loss of] many livelihoods for the poorest of the poor, a large segment of the community … including those who are undocumented, need to get vaccinated.”