When Cynthia Garcia took her father to get his COVID-19 vaccination, he was turned away.
A 59-year-old diabetic, Cynthia’s dad qualified for a vaccine early in the rollout. But because he is an undocumented immigrant and couldn’t show identification when the pharmacy asked, he didn’t get his shot.
Garcia, national campaigns manager for community protection at United We Dream, an advocacy group supporting immigrant youth, succeeded in getting her father vaccinated at a second location they tried. But their experience highlights a nationwide problem that could hinder the government’s efforts to vaccinate as many people as possible and bring the pandemic to an end in the U.S.
More than 44 million immigrants lived in the nation in 2019, according to the nonpartisan Migration Policy Institute. That's roughly 14 percent of the U.S. population — including an estimated 11 million undocumented immigrants. Vaccinating immigrants will be critical to achieving President Joe Biden’s goal of having 70 percent of U.S. adults at least partially vaccinated by July 4.
Getting the vaccine to immigrant communities is often a challenge. Many immigrants face language barriers, mistrust the medical system, or cannot afford to take time off work to recover from vaccine side effects. Others are concerned about whether getting the vaccine could jeopardize their immigration status.
“The vaccination rollout has improved tremendously, but it still has huge gaps in meeting the concerns of the people who usually are the most impacted by health care lack of access and racism,” Garcia said.
The government’s official policy is that vaccines are free and available to all, regardless of legal status.
“DHS encourages all individuals, regardless of immigration status, to receive the COVID-19 vaccine,” a Department of Homeland Security spokesperson said.
The department’s statement on equal access to vaccines is available online in multiple languages, and civil rights officers from both DHS and the Federal Emergency Management Agency “are open to hearing from immigrant communities, confidentially, about any questions,” the spokesperson said.
The government does not collect vaccine data related to immigration status, so it is unknown precisely how many immigrants in the U.S. have been vaccinated. But a survey of Hispanic adults published in May by the Kaiser Family Foundation provides some clues.
Thirty-one percent of “potentially undocumented” Hispanic adults surveyed said they had received at least one dose of the COVID-19 vaccine, compared with 61 percent of legal permanent residents and 46 percent of U.S.-born respondents.
Among Hispanic adults who made or attempted to make a vaccine appointment, 32 percent reported being asked for health insurance information, 42 percent said they were asked to show government identification and 14 percent said they were asked for their Social Security number.
Among those vaccinated, more than half — 56 percent — said that they, like Garcia’s father, were asked for ID at the vaccination site.
Of course, many immigrants are not Hispanic, and many Hispanic adults are U.S. citizens. Samantha Artiga, one of the researchers who conducted the survey, stressed increasing rates of vaccination among Hispanic adults since the survey was conducted. But she also cited “increased concerns and barriers that are likely affecting foreign born Hispanic adults, particularly those who are likely undocumented."
Fear of government interaction
Hesitancy relating to immigration status goes beyond worries about having to show identification. Some immigrants fear that taking advantage of a public health service like free vaccinations could jeopardize their chances of earning permanent legal status, said Ninez Ponce, a professor at the UCLA Fielding School of Public Health.
Limits on the ability of immigrants to get green cards if they use certain government assistance have been on the books for decades. Proposed expansions of those criteria under former President Donald Trump eventually died in court challenges and under the Biden administration, but concerns over the policy remain.
“There’s still a lot of confusion about this notion that a reliance on government services may threaten your ability to stay here and work or may threaten the future of your children, your family and getting a green card and eventually becoming a citizen,” Ponce said.
Often, undocumented immigrants fear interacting with any federal agency, including the National Guard troops and other government workers operating some vaccination sites.
Some state governors conveyed early in the vaccine rollout that undocumented immigrants specifically would not be prioritized, despite their roles in frontline jobs in meat processing plants, medical fields, food services and other essential industries.
“There is pervasive fear in the farmworker community that isn’t just related to immigration, it’s any interaction with government agencies, or perceived government agencies,” said Diana Tellefson Torres, executive director of the United Farm Workers Foundation. Many workers she represents are undocumented immigrants.
Torres also pointed to logistical challenges in vaccinating the immigrant population, particularly those who work in jobs that cannot be done from home and don’t offer opportunities for paid leave.
Many farmworkers she speaks with are interested in the vaccine but don’t want to take time off to get it. It’s peak harvest season right now for many agricultural products, with farmworkers often working seven days a week.
“Having sick leave for very vulnerable workers on the ground is an important step, and then enforcing that is even more important,” she said, emphasizing employers’ role in ensuring their workers get vaccinated.
Some immigrants also face language and cultural barriers when seeking the vaccine, an issue that can be especially difficult to surmount when communicating about a sensitive, complex medical issue.
“There are so many voices unheard right now who are afraid of speaking up — if only somebody can answer their question about the vaccine, they really want to get it,” said Ogbonnaya Omenka, assistant professor and public health specialist at Butler University.
“It’s almost like you go to a party, and you are not familiar with the food, but you’re too shy to ask somebody, ‘Is there another food option here?’ So you basically go hungry.”
Simply having a translator present, Omenka said, is not always enough — communication must take into account the nuances involved in explaining a recently developed vaccine.
The federal government, as well as state and local agencies spearheading the vaccine rollout, have made significant progress in expanding vaccine access, from pop-up sites that don’t require an appointment to partnerships with ride-hailing companies offering free transportation to vaccination sites. In April, Biden called on employers to provide paid time off for employees to get vaccinated.
Neither the Centers for Disease Control and Prevention nor the White House’s COVID-19 Health Equity Task Force responded to requests for comment for this report.
Other details still need to be worked out, advocates say. Garcia would like to see specific messaging that conveys to immigrants they do not need government ID to get a vaccine. Torres wants vaccines to be administered at farms to accommodate farmworker schedules during the busiest time of the year.
“What’s really needed is an information campaign, to say that you can get the vaccine, regardless of your ability to pay or your immigration status,” Ponce said.
There is continuing concern that the vaccination effort could ultimately leave behind the same vulnerable populations that faced the greatest risk as COVID-19 took hold, and are often the hardest to reach.
“If you identify the weakest link, or the most significant source of the problem, that also means that that should be the priority,” Omenka said. “But that has not been the case with the way we approach these population health problems.”