Making health equity a priority: Ensuring secure and dignified access to COVID-19 vaccines
It is estimated that there are up to 500,000 undocumented residents in Canada, many of whom are Ontario residents. Many of these individuals are our neighbours, colleagues, friends, childcare providers and essential workers, including healthcare heroes working the front lines. They are valuable members of our society who contribute in various ways including, but not limited to, paying taxes, maintaining our food supply, taking care of our children and elderly and supporting our healthcare system. Despite Toronto being named a sanctuary city, we live in a city and province that continues to exclude migrants and undocumented residents from many basic services and rights.
I have worked with this population of people for over a decade and it is evident that many people migrated here in hopes of a better future for themselves and their families. They are here to work and often get jobs that many citizens are not interested in doing because they are either too difficult, too dangerous or pay low wages. Our economy thrives because of migrant workers. The different levels of government in Canada must acknowledge and recognize their existence and needs, and think about them when developing COVID-19 related policies and practices.
In my capacity as a frontline social worker at South Riverdale Community Health Centre and as co-chair of the Health Network for Uninsured Clients, I work to improve access to health care for uninsured people with precarious immigration statuses. Without health cards and permanent immigration statuses, these clients often have to pay out of pocket for essential health care, do not feel safe in our healthcare organizations and experience poorer health outcomes. Immigrants and newcomers are a key population affected by hepatitis C, and ensuring they are vaccinated against COVID-19 could be the first step towards helping them get connected to testing and care for other viruses and infections.
The Health Network for Uninsured Clients collaborates with over 40 health and community service organizations that focus on capacity building, research and policy solutions related to uninsured communities and their needs, creating greater access to health care and promoting health equity.
How has COVID-19 impacted undocumented and uninsured Torontonians?
Contrary to popular belief, many undocumented migrants entered Canada through legal channels. Yet, they may find themselves without permanent status and health insurance for one reason or another, for example, denied refugee claimants, individuals experiencing sponsorship breakdowns, or perhaps people who have stayed after their visas have expired. Because of the COVID-19 pandemic, many individuals find themselves unable to renew their work and student visas, leaving them feeling stuck, unemployed and unable to access both public and private health insurance.
On March 20, 2020, after an open letter from over 600 health and social service providers called for improved health access for uninsured populations during the pandemic, the Health Network was pleased to see that, in response to COVID-19, the Ontario Ministry of Health directed all hospitals to provide all medically necessary care free of charge to uninsured patients without health cards. This included both COVID-19 and non-COVID-19 related care. As of May 2021, this policy is still in place and uninsured clients should not be charged by hospitals.
We’ve worked diligently to share this information widely in multiple languages with the community, migrant-serving organizations and frontline workers. This policy change is an important step towards health equity because it eliminates huge financial barriers to hospital care. We were thrilled to see the provincial government take swift action to ensure accessible healthcare services to all its residents. Unfortunately, we are not seeing such favourable outcomes with the COVID-19 vaccine rollout.
What are the unique barriers to getting vaccinated for undocumented residents?
As the general public starts to feel a sense of hope and relief with the vaccine rollout, many people living with precarious immigration statuses continue to face uncertainty, fear and stress. They are wondering if they can protect themselves and their families while doing essential work. I have witnessed how this population faces multiple barriers when attempting to get vaccinated in Toronto.
The province said the vaccine is to be accessible to all. However, this population is facing multiple barriers when attempting to book appointments in practice. People without health cards cannot book through the provincial website and are being turned away from pharmacies. Many clinics are requiring valid Ontario ID. The provincial government has not guaranteed that personal health information will be kept confidential and protected from immigration enforcement and police.
People are fearful because they feel they are risking deportation, employment, security and their livelihoods. These unnecessary barriers to vaccines are deterrents that risk all of our health and well-being. As Ontario works to vaccinate more people, we need to eliminate these avoidable barriers. If we do not make health equity a priority and ensure secure, dignified access to vaccines, we risk everyone’s public health and safety.
What now? Where can migrants and undocumented people get safer vaccine access?
The Health Network for Uninsured Clients, our members, and our allies (Migrant Rights Network and a coalition of advocates across the city) are working hard on addressing these vaccine barriers. Despite the province’s inaction, we have established a list of “safer” COVID vaccine clinics for people without health cards or recognized statuses in Toronto and Ontario, lead by the Migrant Rights Network. In addition, people living in the city of Toronto who do not have health cards can now book their vaccine appointment.
How can your organization create a safer vaccine clinic for people living with precarious immigration statuses?
All community-led vaccine clinics interested in increasing COVID-19 vaccine access to migrants and undocumented residents are encouraged to review and adopt these criteria: Declaration: Access without Fear Access to Vaccines in Ontario. The requirements outlined will help equip staff and clinics with the necessary guidance, tangible tools and information required to offer safer, dignified vaccine access to all residents, regardless of immigration status.
One thing is clear, even when faced with systemic barriers, it is our collective and ethical responsibility to join together and look out for all members of our communities, especially the most exploited and vulnerable.
If you are interested in learning more or joining the Health Network for Uninsured Clients, please visit our website.
Nadjla Banaei is a social worker at the South Riverdale Community Health Centre, who uses a systems theory, anti-racist and trauma-informed lens to inform her practice. She has over a decade of experience in Ontario’s community health centre sector, supporting racialized communities living with precarious immigration statuses, providing counselling, case management and system navigation support. She is also co-chair of the Health Network for Uninsured Clients.