[This post has been written by Camila Picchio, Research Assistant, and Jeffrey V. Lazarus, Associate Professor and head of the Health Systems Research Group at ISGlobal. Illustrations by Elise Mattaliano]
Fewer than ten weeks after the identification of the novel coronavirus, SARS-CoV-2, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) a pandemic. Since then, human-to-human transmission of the virus has exploded globally.
As registered cases escalated, initially in concentrated areas in China, Iran and Italy, measures intended to contain this pandemic were rolled out, often slowly. Now, health systems are racing to analyse the abundant available evidence from many countries about the effectiveness of various policies for reducing transmission rates.
It is clear that the success of the measures depends on strong leadership, the public’s support for the response, effective management of the pressure placed on the health system, and a continuous flow of needed resources, particularly protective gear, for healthcare workers and now also for the population at large.
However, if government policies do not explicitly address the needs of vulnerable groups such as homeless people, sex workers, prisoners, drug users, and migrants, efforts to bring the pandemic under control will fail given that COVID-19 is highly transmissible, highly prevalent, and often asymptomatic.
If government policies do not explicitly address the needs of vulnerable groups, efforts to bring the pandemic under control will fail given that COVID-19 is highly transmissible, highly prevalent, and often asymptomatic
Migration and the mobility of persons across borders have been linked to poor health outcomes. Studies have reported that migrants encounter varying levels of health inequalities and have greater challenges to accessing care for infectious diseases, mental health, diabetes, occupational health hazards, and maternal and child health needs, for example. Migrants often have limited access to information regarding health services, which leads to poor utilisation or underutilisation of available health services. As highlighted recently in The Lancet by the WHO Regional Office for Europe, migrants and refugees are particularly vulnerable to the impact of COVID-19 on society at large, and on the healthcare system in particular.
Under normal circumstances, many European health systems already are failing to implement policy initiatives that go beyond migrants’ statutory or legal entitlement to care and are doing little to address the diverse needs of migrant populations. In extraordinary circumstances, such as those brought on by a pandemic, such failures are exacerbated and can push these often vulnerable populations even more to the fringes of society. Health promotion activities, including providing information in local languages, are often neglected. Cultural barriers may hinder full integration into the system and cause many migrant to not utilise primary health services, relying instead on emergency departments or informal healthcare services.
Illustration by Elise Mattaliano @elise.mattaliano
To combat COVID-19, many national and subnational governments have instructed people to stay home if they feel ill and report symptoms through a smartphone app if possible or through a call to their primary care physician. Who, then, will migrants who do not use primary care services or do not have a smartphone with this app translated into their language contact in order to report any possible symptoms?
The policies that countries around the world have implemented are helping to curb the epidemic. Although these policies are disruptive to everyday life, they are clearly reducing human-to-human transmission and lowering the disease burden. However, in many cases they are not sufficiently nuanced to safeguard vulnerable populations, including migrants.
In many cases policies are not sufficiently nuanced to safeguard vulnerable populations, including migrants
When these policies were devised, did politicians ask themselves any of the following questions?
- Can everyone afford to self-isolate and not go to work, or do employers offer flexibility when working from home?
- How many people on average are living in a typical household, and how much space do they have?
- Does everyone have access to information in their language about the importance of proper hand hygiene and social distancing?
- Does everyone have access to accurate information sources through unlimited or large amounts of mobile data and Internet access?
- Do policies identify measures for making COVID-19 prevention, diagnosis and treatment efforts inclusive of marginalised populations?
The economic impact of confinement and other preventive measures will be even more profound for migrant populations, in particular those who have an irregular migratory status. They often work in harsh and precarious conditions or in the informal sector, and will not benefit from social and economic relief initiatives. A loss of income will plummet them further into poverty and aggravate health inequity.
The economic impact of confinement and other preventive measures will be even more profound for migrant populations, in particular those who have an irregular migratory status
Migrants enrich the diversity of countries across Europe and make important contributions to society and the economy. They often hold low-wage essential jobs as home aides taking care of the elderly; others work in restaurants and prepare our food, and some are domestic workers that are indispensable for families. Just and effective containment and deconfinement policies need to take into consideration the diversity of the population and take a public health and human rights approach. Let us not let legal entitlements or resident status stand in the way of defeating COVID-19.
Testing, which is crucial for controlling the pandemic, and other health services should be available to everyone, irrespective of migrant status, such as Portugal has announced, and future social and economic relief policies should not exclude migrant populations in any way. Remember, the COVID-19 pandemic started in one city and quickly travelled around the world. Until everyone is virus-free, we are all at risk.
The authors are leading a study in Spain to simplify the hepatitis B care pathway for west-African migrants in greater Barcelona, through community-based screening and vaccination, and linkage to care.
Key Resources in Spain