Over the past year, coronavirus infections have skyrocketed in meat-processing plants. About 8% of all U.S. cases early in the pandemic were linked to outbreaks at those sites. Factories, forced to stay open by the Trump administration, were given no federal safety guidelines or mask mandates. This allowed the virus to ravage in rural states that rely heavily on the meatpacking industry.
In Nebraska, about 66% of meatpacking workers are immigrants, many of whom are undocumented. But when Governor Pete Ricketts was asked if those individuals would get their COVID-19 vaccines with the rest of the meatpackers, he replied: “You’re supposed to be a legal resident of the country to be able to be working in those plants, so I do not expect that illegal immigrants will be part of the vaccine with that program.” Such policy would affect the well-being of the state’s approximately 60,000 undocumented immigrants—which then threatens the entire surrounding population.
That’s raised a question of where undocumented immigrants (many of whom are frontline workers) stand in the priority line, and how they’ll receive their vaccinations. Even without explicit government xenophobia in places like Nebraska, the 10.7 million undocumented immigrants in the U.S. will face various indirect barriers to vaccinations due to their legal status, with an ever-looming fear of being identified when registering through systems that haven’t taken their needs into account. Even municipalities with good intentions have had to rapidly roll out vaccine programs, leaving gaps that local community organizations are now trying to help rectify.
Sanctuary cities like New York and Washington, D.C., have policies in place that are generally more friendly to undocumented immigrants. They have promised emphatically that undocumented people won’t be pushed further down the priority line, rather that they will be included in age or employment categories just like everyone else. Many undocumented immigrants are essential workers, meaning they’re already eligible for vaccination. “They are the people who have kept this state running for the last 10 months by working day in and day out,” says Max Hadler, director of health policy at the nonprofit New York Immigration Coalition.
But signing up for a shot poses problems. Those cities have firmly stated they would not send any personal data to governmental authorities. Yet there are still hurdles. “It’s not that people are specifically excluding immigrants, but in practice, the social environment doesn’t permit them to participate,” says Catalina Sol, executive director of La Clínica del Pueblo, a nonprofit community healthcare clinic in Washington, D.C. The practice serves 5,000 patients, the majority of whom are Latino, ranging from children of citizens to people who arrived by land a few days ago. “These are systems that are not necessarily exclusionary by intent, but by default.”
For instance, those eligible for a vaccine in Washington must register on the D.C. Department of Health website before choosing an immunization location. But registration requires an email address. As well as lacking internet access and digital literacy due to low income, many undocumented immigrants may not want to create an email account for fear of being identified.
“If you’re an undocumented immigrant, you’re concerned about being on the grid,” Sol says. Official structures inherently create fear. “Any relationship to any system can get you deported, or somehow identified, and then have all of your life come crumbling down.”
In New York State, anyone getting the vaccine has to bring to their appointment proof of eligibility. To prove their age, they’d need a government-issued ID that includes their date of birth. While Jonah Bruno, the state’s director of public information, says any New Yorker can apply for a driver’s license or learning permit (or, in New York City, an IDNYC card) “regardless of their citizenship or lawful status in the United States,” that still poses a fear of being on government records. Essential workers need to show proof of employment, such as an employee ID card or pay stub; many undocumented people who are paid in cash don’t have those items. (It’s also unclear which essential workers are eligible—many undocumented people clean homes or deliver food, but those roles are not listed as qualifying options.)
Also out of fear, many immigrants may not want to go to a pharmacy for their shot, Sol says. Walgreens is currently working with federal, state, and local governments to plan its scheduling system, so while the process varies across the country, according to Rebekah Pajak, a Walgreens spokesperson, the pharmacy does require a government ID to show eligibility. “That’s not the best answer in terms of this population,” she says, “but that’s what we’re required to do.”
The Trump administration did initially want to collect information from all registrants, including Social Security and passport numbers, prompting a back-and-forth with New York Governor Andrew Cuomo, who argued there’s no reason they’d need it. “I’m not going to give information that can be used to deport people,” he said in a press conference. The federal government dropped that requirement after Cuomo and other leaders and public health experts argued that it’s in the entire country’s best public health interest to remove vaccination barriers for everyone in order to increase the number of people getting immunized and achieve herd immunity.
That’s just one of the draconian attempts from the federal government that was alleviated by public health arguments. The “public charge rule,” implemented in 2019, seeks to deny visas and green cards to immigrants who have used public benefits like Medicaid or supplemental income to ensure “people who are immigrating to this country don’t become public burdens.” But U.S. Citizenship and Immigration Services later clarified that the rule will not apply to benefits related to COVID-19, including the vaccine, because of the communicable nature of the disease.
Still, those endeavors have eroded confidence. Sol says federally qualified health clinics (FQHCs) such as hers can be the trusted middlemen between states and at-risk populations. La Clínica, and many others, are trusted “medical homes” for immigrants, where staff speak and answer phones in Spanish. La Clínica started vaccinating patients last week, receiving as many doses from D.C. Health as it needs to fill its appointment slots. Sol is working with D.C. in an effort to allow people to schedule directly with the clinic in order to remove the pain points.
Mon Yuck Yu, executive vice president of the Academy of Medical & Public Health Services, a nonprofit health organization in New York, echoes Sol’s sentiments. “To the extent that’s possible, I do hope that the city considers working with community-based organizations,” which she calls a “safe space” for immigrants. While Yu’s organization hasn’t begun vaccinating yet, due to capacity constraints, she says its fall flu shot drive showed patients’ confidence in the center, as large numbers chose to line up in the cold to get immunized there rather than making an appointment at any other pharmacy.
In order to overcome the fear, says the Immigration Coalition’s Hadler, local governments will also need to put into place “well-funded and well-thought-out public education and outreach campaigns” to counteract any negative concerns. And that messaging should be “culturally and linguistically competent,” Yu says, because language is often another barrier. Some states and cities have been better than others at addressing this: Washington State, which is also promising not to release identifiable data, has produced vaccine education materials in 37 languages. Philadelphia has been doing targeted outreach in ethnic media, including in Spanish, Russian, Chinese, and Korean outlets, according to James Garrow, a spokesperson from the city’s department of health. That sanctuary city is also working with its local FQHCs to spread the word.
Other states don’t have the support of sympathetic policy. Hadler voiced his concern about Nebraska’s ruling: “The governor of Nebraska is playing politics and clearly doesn’t know how to handle a public health crisis,” he says, “because that is a terrible approach to public health.” In an update email to Fast Company, Julie Naughton, a spokesperson for Nebraska’s health department, said: “We expect the federal government to provide enough vaccine for everyone in the state. . . . Proof of citizenship is not a requirement to receive the vaccine.” Still, the governor’s press secretary tweeted that while there will be enough doses, “Nebraska is going to prioritize citizens and legal residents ahead of illegal immigrants.” (The governor’s office did not respond to a request for comment.)
Sol says that ultimately it will take constant attentiveness and hard work by local organizations to ensure that states and cities prevent the exclusion of undocumented people, even if unintentional. After all, they were left out of the original stimulus payments in the Coronavirus Aid, Relief and Economic Security (CARES) Act. “So, if things are working well, it’s because there’s been vigilance and there’s been prior work,” she says. “We can never assume that it will be automatic.”
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