Around the country, more and more people are getting their COVID-19 vaccine. But for immigrants, the experience can carry an additional stressor besides a jab in the arm.
We have seen some people waiting in line observe a security person at the entrance asking for ID and insurance cards — and walk away. A little later, as a police car pulls up and officers remind those waiting to keep a safe distance, more people discreetly drop from the line.
Immigration policing, whether real or perceived, and public health never mix well. In the midst of the coronavirus pandemic, vaccination is a public health strategy and policy makers must decrease the barriers and promote access for all. It is both an ethical and public health imperative to provide the option of registering for, and receiving, vaccines without verifying identification.
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Some states, like Massachusetts, have recognized this and don’t have ID requirements. The approach must be universalized across the country, to genuinely fulfill President Biden’s assertion that all US residents are now eligible for vaccines — not just those for whom providing ID is uncomplicated.
There are about 22 million noncitizen immigrants living in the United States, and roughly half are undocumented. Of all noncitizen immigrants, 13 million are presumed to be part of the active work force, accounting for 8 percent of the total work force. More than two-thirds fill essential roles in industries such as food production, long-term care, and other health care settings with direct patient contact. Their vaccination status matters, since they are generally more economically vulnerable and at higher risk of exposure, infection, and death from COVID-19.
There are several reasons why noncitizen immigrants may be reluctant to provide identification for vaccines. The most obvious one is the risk of deportation. The Department of Homeland Security, which oversees Immigration and Customs Enforcement, stated in February that it would commit to help ensure “that every individual who needs a vaccine can get one, regardless of their immigration status,” adding that “ICE does not and will not carry out enforcement operations at or near health care facilities, such as hospitals, doctors’ offices, accredited health clinics, and emergent or urgent care facilities, except in the most extraordinary of circumstances.”
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The fact that DHS needs to assure the public that ICE will operate only in exceptional circumstances at sensitive locations is, by itself, indicative of an awareness that immigrant populations face major barriers — when they should not.
Documented immigrant populations can also have reasonable concerns about sharing any information that may identify them and negatively impact their own or a family member’s immigration status. The Trump administration’s public charge rule meant that one’s chance to receive a green card or otherwise transition to a more secure immigration status could be lower if administrators determined that the person being reviewed might lead to longer-term cost for taxpayers (irrespective of the fact that the majority of documented and undocumented immigrants are actually paying payroll and other taxes).
There is robust evidence the public charge rule has led to a reduction of use in needed health care more broadly. Despite assurances by the US Citizen and Immigration Services that neither testing, treatment, nor vaccinations will be considered in public charge assessments, a similar trend is emerging for vaccines, with lower intentions to be vaccinated among immigrant populations due to the rules’ perceived consequences. Once more, neither public health nor equity is served if identification requirements mean immigrants who are otherwise willing to be vaccinated decline to do so.
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Fortunately, policy makers are increasingly adjusting identification requirements. For example, New Jersey, states: “You cannot be denied access to the vaccine for not having ID,” emphasizing also that sites will not ask for proof of immigration status. Wisconsin echoes this directly, as does Illinois. In North Carolina, a state in which more than a quarter of the population falls under the category of the most disadvantaged nationwide, the allocation framework expressly instructs that ID or proof of residency not be required because it can alienate, or present unreasonable barriers for, vulnerable populations including immigrants. Instead, the state proposes that name, address, and date of birth be required during preregistration or on-site, without verification.
These alternatives, too, of course, can function as a deterrent. And it appears that even when a state such as North Carolina could not be more clear on why ID should not be required, county health departments do so, regardless — but such misalignment can be addressed in the same way as any other implementation errors that are out of step and only emphasizes the need for an urgent review.
The bottom line is this: Empathy, equity, and public health all require that we remove, as much as possible, barriers for immigrant populations to be vaccinated, whether for documented or undocumented groups.
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Among other things, this means enabling people to register without an ID, and, likewise, to receive a vaccine without an ID.
As public health researchers, we are keen to know exactly who is being vaccinated — in part to monitor whether allocations need to be adjusted to better advance equity. Although requiring identification can be an effective way of curbing selfish behavior by people seeking vaccines when it is not yet their turn, barriers must be eliminated, on public health and equity grounds. Enabling COVID vaccines without identification protects immigrant populations along with all other residents, and is the fastest approach to population impact.
Harald Schmidt is an assistant professor of medical ethics and health policy at the University of Pennsylvania. Dr. Rebecca Weintraub is an assistant professor at Harvard Medical School, a faculty member at Ariande Labs where she leads vaccine delivery, and a physician at Brigham and Women’s Hospital.
