**4. Vaccine Institutional Racism**

In the context of the European Union, the coordination of the European Commission and EU Agencies have supported the development of COVID-19 vaccines to be available promptly to the EU territory (European Commission 2020a). Most Member States launched their national vaccination campaigns in December 2020, and because of the limited supply of vaccines, they identified key priorities in forming their vaccination strategies. Most of the member states pursued the following criteria for prioritizing certain parts of the population (FRA 2021):


On the other hand, the Worl Health Organization's (WHO) Strategic Advisory Group of Experts identified low-income migrant workers, irregular migrants, refugees, asylum seekers and those unable to physically distance, including those living in camps and camp-like settings, as priority groups for the allocation of COVID-19 vaccination globally, specifically listing migrants and refugees as groups to be prioritized in stages II and III of the vaccine rollout3. In conjunction with the above, medical communities and the relevant literature state that "*globally, refugees and displaced persons must be prioritized to receive vaccines"* (Thomas et al. 2021) and "*that medical institutions need to implement policies that will support and protect refugees, asylum seekers, and displaced persons and reduce any network of transmission*" (Saifee et al. 2021). There is, accordingly, strong international guidance about the prioritization of the migrant-refugee populations to receive vaccination for the sake of the protection of the individuals but also of public health. In other words, there

was a global recognition of the precariousness of the said populations and the necessity to be protected receiving priority status.

The explicit rationale of the prioritization of the precarious migrant-refugee populations, as already stated, was not broadly implemented by the EU vaccination plans. Whilst, in 2020, the number of migrants in the EU/EEA (ECDC 2021) (defined as people born in a different country than the one they reside) made up 12% of the total population (453 million people) with the 4% being born in another EU/EEA country or the UK and the other 8% originating from outside the EU/EEA and the UK, more than 3 million refugees and asylum-seekers were registered in 2018, plus fo4ur million undocumented migrants; these groups remained mainly *invisible* for any national vaccine prioritization plan. Especially, concerning persons without legal status or with insecure legal status in the EU only 5 out of 27 Member States have prioritized them in their national vaccination strategies4. In addition, key figures about vaccination in the EU, as derived from the European Centre for Disease Prevention and Control (ECDC 2021), do not include any reference to the vaccination of the migrants/refugees populations though other target groups such as residents of long-term care facilities are explicitly mentioned.

Given the initial shortage of vaccines, the criteria for defining who is eligible to receive prioritized vaccination varied among the Member-States' vaccination program as Member States did not take into account the vulnerabilities and the risky living conditions of the precarious populations. Overall, Member States have focused on prioritizing vaccination for older citizens who are disproportionally affected by the COVID-19 virus. However, the age factor, along with the prioritization of other group characteristics, namely, health workers, was not the only variable lying beneath the prioritization scheme. Other 'ghost' factors were to a large extent lurking and set barriers to access to 'healthcare for all', notwithstanding Goal 3 and especially Goal 3.8 of the Sustainable Development Goals of the UN<sup>5</sup> and Article 35 of the Charter of Fundamental Rights of the European Union, which states that health should be ensured without any discrimination6. Instead, in the case of the current health crisis, the rollout of vaccination to combat the pandemic has revealed that State-run vaccination plans have been discriminatorily implemented on the basis of the legal status of a person and, particularly, citizenship rights.

According to the latest international research report by the WHO, which seeks to identify how the new coronavirus SARS-CoV-2 (COVID-19) has impacted refugees and migrants around the world, based on their own reported experiences, the following is noted (World Health Organization 2020a):


With respect to the above, the European and Member States' vaccination strategies reveal important deficiencies considering the relevant treatment of migrant and refugee populations, even though the International and Regional Bodies have made a statement for the necessity of inclusive approaches in Member States' health systems (Weekers 2020; ECDC 2020a, 2020b). In addition, European Commission has clearly defined that vulnerable socioeconomic groups and other groups at higher risk, along with groups without physical distance in place, can be defined as priority groups concerning vaccination Member States plans (European Commission 2020b). In addition, the UNHCR (2021a) states that "*by including refugees in their vaccine distribution, they mitigate the risks associated with exclusion* *and discrimination.* In particular, risk factors for increased exposure to COVID-19 are interrelated with occupational risk (over-representing in public-facing jobs including health and social care, transport, low-skilled jobs, precarious jobs, obliged to work throughout the pandemic, increased use of public transport), overcrowded accommodation (live in poverty and deprived areas, in camps, reception and detention centers, in shared or temporary accommodation, in multigenerational households) and barriers to public health messaging (lack of knowledge of the host country language, vulnerable to misperceptions and misunderstandings) (ECDC 2021). The current hygiene crisis due to the COVID pandemic has shown more clearly than ever that many works in situations of high risk are too often undervalued, i.e., in care facilities, cleaning and agriculture (PICUM n.d.). Even in the period of the highly infectious delta variant, the major vaccination gap for undocumented migrants and refugees is still present<sup>7</sup> .

Consequently, the lack of the prioritization or total exclusion of the marginalized migrant-refugee populations from vaccination underlines a State's unwillingness to address an urgen<sup>t</sup> and unprecedented health issue beyond the notion of State sovereignty and indicates the deportation/expulsion of populations managemen<sup>t</sup> (see Figures 1 and 2). This exclusionary and segregating policy rationale is an endemic part of the crimmigration regime that is currently manifested through a vaccination institutional racism (Stokely et al. 1967) and expresses the unequal distribution of the vaccines between groups because of 'otherness' and lack of citizenship rights.

**Figure 1.** Source: The COVID-19 vaccines and undocumented migrants: What are European countries doing? PICUM (Available online: https://picum.org/covid-19-undocumented-migrants-europe/ (accessed on 1 August 2021).

**Figure 2.** Source: The COVID-19 vaccines and undocumented migrants: What are European countries doing? PICUM (Available online: https://picum.org/covid-19-undocumented-migrants-europe**/** (accessed on 15 July 2021)
