On the 25th of March 2021 SALO, in partnership with the Norwegian People’s Aid, held an online public multi-stakeholder dialogue titled: “Access to the COVID-19 Vaccine for Migrants in South Africa.” The event was attended by members of the public, ANC Alliance members, academics, and civil society and was live-streamed on Facebook. The speakers for this event were Zane Dangor, advisor to the minister of the Department of International Relations and Cooperation, and Professor Jo Vearey, from the African Centre for Migration and Society at the University of the Witwatersrand. The event was chaired by Dr Rob Moore, SALO board member and Executive Director of the Gauteng City Region Observatory.
The event sought to address one of the major concerns around the COVID-19 vaccination process in South Africa – whether migrants and undocumented nationals will have access to the vaccine. On this issue, the South African government has released conflicting statements. Remarks attributed to Dr Zweli Mkhize have prioritised South African nationals and permanent citizens, whereas a statement from President Cyril Ramaphosa affirmed the availability of the vaccine for everyone, regardless of their nationality or residence status. This event sought to consider the importance of vaccinating migrants and all people within the borders of South Africa.
Context/ Importance of the Problem
On 30 January 2020, the World Health Organisation declared the COVID-19 pandemic a “public health emergency of international concern.” As vaccines against the coronavirus are being produced and distributed across the world, the issue of vaccine nationalism has become apparent. Vaccine nationalism is defined as when “governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines, ahead of them becoming available for other countries.” The World Health Organisation has stressed that this is not the best way of addressing the global health crisis and that it is important that states have equitable access to vaccines and subsequently distrubite them to their populations guided by policies founded on evidence. 
Special advisor Zane Dangor spoke extensively about the problem of vaccine nationalism, internationally and nationally:
“The unequal distribution of vaccines due to what we refer to as vaccine nationalism, and the hoarding of vaccines by some countries [has] led to significant shortages in many parts of the world, especially in the Global South. That, of course, includes Africa and South Africa.”
Not only is inequitable access to vaccinations a problem on a global scale, it is also a problem within countries. When shortages of vaccines occur and migrants are left out of the vaccination rollout process, this leaves them unable to survive in those countries as they will not receive appropriate protection.
Mr Dangor clarified the government’s policy around the distribution of vaccines. President Cyril Ramaphosa has clearly stated that migrants and refugees (regardless of their documentation status) will be included in the vaccination rollout programme. He explained that this policy is in line with several international and national legal instruments and that it makes sense scientifically:
“Section 9 of our Constitution prohibits discrimination against anyone, including on the basis of race, colour, ethnicity, social origin, [and] sexual orientation amongst other statuses… In our domestic law, it is the duty of the government to protect and promote the rights of all living in South Africa, as equality and dignity are at the core of the society that we want to build and have been attempting to build over the last 20 years. This includes protecting the rights and dignity of undocumented migrants, refugees and asylum seekers.”
Dangor explained that there are over 30 soft and hard international legal instruments, agreements and conventions that support this policy. These include the African Charter on Human and People’s Rights, the International Covenant on Civil and Political Rights, and the International Covenant on Social, Economic and Cultural Rights.
Furthermore, he argued:
“The prevailing science suggests that leaving out large sections of any population from being vaccinated limits countries and the globe’s abilities to break the chain of transmission in a manner required for what is termed as ‘global population immunity.’”
Professor Jo Veary seconded this notion by stating, “Nobody benefits unless everybody’s involved.” As such, the question of whether migrants should have access to vaccines or not should not even be asked – everyone needs to be included in the vaccination process to successfully overcome the pandemic. She was optimistic and believed that this point in time could be a strategic moment and opportunity to address the problems that migrants face at the moment. However, she also noted the tensions in the country around immigration and migration. She gave an example of this:
“We have seen the language around [sanitising] for example, there were outbreaks of violence earlier last year in the context of COVID-19 in Soweto, and there was a very clear language of ‘we’re here to sanitise’. All of these issues are permeating the debates around programming around vaccines.”
Critique of policy options
The issues mentioned by the speakers above should be addressed through an effective science-based policy. Such a policy should also take into account the importance of protecting the rights of migrants, in particular the rights to dignity and equality. However, even if such a policy exists, the proliferation of vaccine nationalism across the globe would threaten its implementation. Mr Dangor expressed a thought-provoking view regarding the the speed at which COVID-19 vaccines were produced and the subsequent emergence of vaccine nationalism experienced across the world:
“We should not be blind to the likelihood – I’m using likelihood in a diplomatic manner – that the very reason there was such efficiency in developing these vaccines so quickly was because people in rich Western countries were badly affected by COVID-19.”
Dangor noted that between the end of 2020 and the beginning of 2021, 14% of the world’s population had bought over 53% of the available vaccines (outside of those produced by Russia and China). Wealthy states in the West that were badly affected by the virus have been stockpiling vaccines for their own gain, without regard for other countries. He stated that this is not a new phenomenon and that it also occurred during the previous SARS and H1N1 virus outbreaks.
Dangor explained that vaccine nationalism suggests that while the pandemic affected people all over the world, the historical phenomenon that ‘not all people matter’ was clearly seen:
“In other words, vaccine nationalism, in my view and the view of others, is a variant of racism and other ideologies of superiority that has shaped North-South relationships.”
Professor Jo Vearey expanded on this by adding that the global COVID-19 pandemic has been used as a justification for nation-states to act in a nationalistic manner regarding their vaccination processes. The discussion about migrants’ rights to vaccinations is being blurred by conversations around ‘keeping people out,’ border management, the control of infectious diseases and global health security. Vearey stated:
“This is the social, political, [and] economic reality globally, and particularly within our context. I want to say that politics and power, issues around securitisation, fear of the other, [and] global health security … are conflating at the moment and … are providing opportunities to justify responses that nation-states are making towards COVID-19.”
Furthermore, Mr Dangor expressed the fear that, internationally, migrants and other vulnerable groups may be completely excluded from vaccination programmes. The People’s Vaccine Alliance uses the phrase ‘no one is safe until everyone is safe’. This is a good and moral political slogan but it is also a scientifically sound idea. Leaving out large groups of people in the vaccination programme will only ensure that new variants of the virus emerge, and, according to Mr Dangor, “the virus will continue and economies will continue to be decimated.”Mr Dangor believed that this should not be replicated in South Africa as it constitutes a similar type of vaccine nationalism:
“At the same time, if we have our own version of differentiated access based on whether you’ve got a green ID book, whether you are an asylum seeker, a refugee, [or] are undocumented, we are only replicating the vaccine apartheid and the consequences that we complain about at the global level.”
On the topic of documentation, Professor Jo Vearey flagged the issue of expired permits for asylum seekers in South Africa which renders them vulnerable:
“We have 220-odd thousand asylum seekers whose permits have expired over the past year, and there is no plan for supporting the renewal of their permits as offices reopen, apparently, on the 31st.”
The World Health Organisation (WHO) has suggested that not only should vaccines be equally distributed to all countries but that there is a vital need to distribute vaccines equitably to entire populations, regardless of nationality or citizenship. Tedros Adhanom Ghebreyesus, the director of the WHO has stated, “While there is a wish amongst leaders to protect their own people first, the response to this pandemic has to be collective… Sharing finite supplies strategically and globally is actually in each country’s national interest.”
Further policy recommendations came forth from the discussion:
- The know-how and technology necessary to produce medicine and other commodities should be made readily available. On this point, Mr Dangor discussed the proposal made to the World Trade Organisation by South Africa and India (supported by 120 countries at the time and co-sponsored by 58 countries). The proposal aims to temporarily waive provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) in order to support the global COVID-19 pandemic response.
- Migrants should not be placed into a separate category of peoples in the vaccination roll-out strategy. Rather, migrants should be integrated into the existing strategy. For example, when those with co-morbidities are being vaccinated in the country, migrants with co-morbidities should be included in this process.
- A system of documentation should be put in place to register and manage the vaccine roll-out. This is important particularly for double-dose vaccines and for keeping track of the number of people who have received the vaccination.
- Political leaders and those in programming should be better literate in the language around migration and mobility. Vearey explained:
“We have to also think not only in the context of migrants and individuals coming from other countries, but we have to talk about migration and movement… Programming is not only about ensuring the right to access, it’s about how we enable and enact that, and movement has the potential to interrupt any form of programming, including for South Africans themselves who may move between the country. One example is if we have a two-dose vaccination – if I have my first dose in one space, where do I have to be for my second dose?”
- The public health argument should be stressed, as this is the best way to ensure that all people will be included in the vaccination scheme. As Vearey argued:
“When we’re faced with some of these political tensions and challenges, we need to be arguing the public health argument. We know that it’s about rights, we know it’s about dignity, but that doesn’t win the arguments.”
- Existing tools and opportunities should be utilised to ensure equitable access to vaccines. Vearey pointed out that one such tool is the action plan that is being developed by the United Nations through the World Health Organisation which prioritises the health of refugees and migrants.  There have also been initiatives by the African Commission on Human and People’s Rights, such as the resolution passed at the end of 2020 which aims to protect refugees, migrants, internally displaced peoples, and asylum seekers in the fight against COVID-19.
- Reframe the narrative around migrants in order to ensure their inclusion in domestic and regional COVID-19 strategies. There has been a focus at the level of the African Union to support Regional Economic Communities (RECs) and states to ensure that they are thinking about non-citizens in different ways within their COVID-19 responses. It is vital that this continues.
- Extend the responsibilities of the private sectors that benefit from migrant labour. Vearey noted that in the past, the private sector has been required to provide healthcare services in relation to HIV/Aids, tuberculosis and other health-related issues to mineworkers and their families. There is a space for these same responsibilities to be applied to the COVID-19 vaccines.
- A collective response to finding the best ways of ensuring vaccine availability to migrants, including civil society, research communities, partnerships with international organisations and supranational structures.
- A way to address the issue of migrants being unwilling to make themselves known to the authorities out of fear, which will curb their access to vaccines, is to implement a clear and legislated firewall. Professor Vearey explains:
“This is where a formal structure is in place that ensures individuals [and their information] are kept away from anything to do with the management of immigration. Unless we move into clear recognition that this is essential in our response, I fear that we’re going to have a version of vaccine hesitancy which is not about a fear of a vaccine but is about a fear of engaging with the state.”
Questions and Comments From the Participants
Dr Rob Moore opened the question and comments section by discussing the complicated question of how a vaccination programme might include migrants in the system. One way is to use an Electronic Vaccination Data System (EVDS). A key feature of the EVDS is that it requires some kind of an identifier. When the system was first explained to the public, it was done so very nonchalantly by claiming that it is easily used by filling in a South African identification number. Dr Moore’s reservations to this are that it would immediately exclude all those who don’t have South African ID numbers, which is a very large number of people. There have been alternative proposals such as using a cellphone number instead, which he believes seems much more inclusionary. This, however, raises another set of questions around whether cellphone numbers can be used to accurately identify people and whether second doses will then be given to the right person. Many audience members also asked engaging questions and made insightful comments:
Practice versus intentions
Ursula Arends asked: Prof. Vearey, what are the ways of resolving the disjuncture between the government’s stated intentions and legislation, and the intransigence of the migration authorities on the ground?
Prof Vearey answered this by emphasising the importance of education and spreading accurate information. Proper economic analysis should be carried out which will assist in creating awareness about the positive effect migrants have on the economy.
Munjodzi Mutandiri commented on this and confirmed that the information that is available for people on the ground is not adequate. He stated:
“Even here in South Africa as we look at migration and the issue of vaccination, I think that there is a lack of information in terms of what’s happening, and that has put a lot of discomfort from citizens, whether migrants or local citizens, around what this vaccine programme is really about and how it will be rolled [out], and what exactly will happen.”
Further, he highlighted issues such as the autocratic overreach and corruption that has been emerging in the vaccination programmes in the region, especially in the SADC region. SADC has also failed to articulate a clear regional programme for inoculation.
Proffessor Vearey also underscored that politicians should be held accountable when they use language that scapegoats migrants for failures on their part:
“We need to be having a Human Rights Commission that can follow through with holding people to account around issues of xenophobia and hate speech. We need to ensure perpetrators of xenophobic violence are held to account, and we need to ensure the state acknowledges xenophobic violence as that, and not simply as illegal activity.”
Mr Dangor added to this answer by situating the act of scapegoating within the larger problem of scarcity and inequality. As such, there is a need to look into systemic deficits not only within South Africa but also across the world. Those in the global South are facing a scarcity of vaccines and this should be mitigated through African solidarity. As such Dangor states that addressing vaccine nationalism cannot be addressed effectively by prioritising South Africa over other African nations. He states:
“ What we advocate for on the international stage must be exactly what we practice at the national level, state practice and international practice must coincide.”
Further, Dangor suggested some practical ways forward, such as:
- Public servants should be constantly reminded and kept accountable that they cannot discriminate against migrants.
- Having a minister of vaccinations who purely focuses on the vaccination programme.
Civil Society and solidarity
Miriam Saohatse commented on the ways in which collaboration can open up the conversation around the vaccine roll-out programme as well as health in general:
“One of the things that we would like to see is … regional collaboration, to have one big voice from ordinary people [and] civil society around issues of access to the vaccine, but not just [the] the vaccine. Somebody has indicated that the whole access to the health system, especially by migrants, becomes very important.”
In the same vein, Athenkosi Thoba asked a question to all participants to be reflected upon:
“What is civil society doing in terms of speaking to the issues of access to vaccines for migrants, and also other vulnerable groups within South Africa?”
Bram Hanekom touched on the possibilities which could arise from the pandemic:
“Is there not a golden opportunity [here]? If one leverages the reality that migration is inevitable and that COVID-19 is an opportunity for people to look at regional and continental, if not international solutions? Because it will be quite fruitless to not deal with the entire region because we’ll then get recurring waves and different variants of the coronavirus…COVID-19, rather than being a divisive issue, if one puts in the right kind of advocacy campaign, and if government comes on board, could maybe [be] unifying issue.”
Proffessor Vearey agreed that this is indeed an opportunity for people to learn about migration. Officials, international organisations and others are recognising that the continent and the world is interconnected. This was seen in the SADC region when states realised that goods cannot be transported with closed borders. The first people that were considered essential to cross borders were the truck drivers of these goods.
Joan Brickhill asked about the experience of the UK, where they have centres which are set up for the purpose of vaccinating undocumented migrants. She inquired as to whether it would be feasible for South Africa to implement a programme similar to this. An issue that arose in relation to this suggestion was that such a system would be easily exploitable as no information is required from patients. Prof Vearey responded to this question by referring back to her idea of a firewall to keep people’s information safe and private.
The COVAX scheme
Dr Rob Moore asked special advisor Zane Dangor to speak about the COVAX initiative and the potential opportunities it presents for vaccination campaigns in South Africa and beyond. He responded that, initially, COVAX was a good idea based on multilateralism but what has happened since is that richer countries have been buying what they need and then donating some vaccine doses to COVAX. This is what Mr Dangor calls philanthropy-centred multilateralism which does not address the systemic issues. As such, not enough money has been put into the COVAX scheme to make a big difference.
Further, South Africa is a self-paying member of COVAX and thus buys vaccines from the COVAX scheme, at rates that are often not much lower than those from the pharmaceutical companies. Mr Dangor believes that the issues with COVAX should be mitigated if its goal is to make sure that vaccines are distributed equally. This could be done by Africa bulk-buying vaccines and then distributing them equally. A different option to overcoming these problems is to ramp up local manufacturing of vaccines in the region, which can only happen if the intellectual property rights are waivered. Dangor stated:
“If we get the waiver in South Africa, then [we’ve got about] four institutions that will be able to ramp up and repurpose the facilities in the next 9 to 12 months to not only pack and fill, but to actually produce [vaccines], and there are 10 other similar institutions across the continent.”
This dialogue brought many stakeholders together to engage on an important question – how to address the uncertainty around access to COVID-19 vaccines for migrants in the growing context of vaccine nationalism. Many policy recommendations and questions to reflect on came from this fruitful discussion.
The analysis and recommendations included in this brief do not necessarily reflect the view of SALO or any of the donors or conference participants, but rather draw upon the major strands of discussion put forward at the event. Participants neither reviewed nor approved this document. The contents of the brief are the sole responsibility of SALO, and can under no circumstances be regarded as reflecting the position of the donors who provided financial assistance for this policy dialogue session.
SALO would like to thank
The Norwegian People’s Aid (NPA) for their direct support for this event
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 World Health organisation 2020- Strategic considerations in preparing for deployment of COVID-19 vaccine and vaccination in the WHO European Region. 21 September 2020. Copenhagen: WHO Regional Office for Europe; 2020.
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