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Key Steps the Government Must Take to Provide COVID Vaccines to People in Immigration Detention

COVID-19 has taken a terrible toll on people in immigration detention. There have been devastating outbreaks in detention centers across the country, driven by authorities’ disregard for public health guidance and the human rights of detainees. A January report co-authored by our organization, Physicians for Human Rights, exposed widespread violations of basic protective protocols, with 96 percent of detainees reporting they could not maintain social distance and 17 percent not offered masks. One detainee said he “could feel the other person’s breath” while he slept, and another described scenes of 80 detainees eating meals “elbow-to-elbow.” 

The world has since gained the powerful tool of vaccines to protect people from illness and fight the pandemic, yet people in immigration detention continue to largely be denied access to vaccines. Contrary to the advice of the Centers for Disease Control and Prevention (CDC), the Department of Homeland Security (DHS) began vaccinating employees in January without a plan to vaccinate detainees. Four months later, DHS still does not have a plan

In response to the ongoing lack of vaccines for detainees, Physicians for Human Rights recently published a letter to DHS demanding a commitment to offer vaccines to people in the federal government’s custody. Beyond publicly committing to honor detainees’ human right to the vaccine, DHS and its contractors must take several important steps to ensure that people in detention can receive the vaccine in a timely and ethical manner. Given the grossly inadequate health care track record of Immigration and Customs Enforcement (ICE), we urge DHS (which oversees ICE) to heed the following advice. The best way to guarantee vaccine doses for detainees is to earmark vaccine supplies for ICE. Vaccine allocations for distribution in ICE and ICE-contracted detention facilities should be separate from, and must not rely on, state or jurisdictional supplies. For months, detainees have been the victims of finger-pointing and buck-passing by state and federal authorities who refuse to take responsibility for vaccines in immigration detention. Direct allocation to ICE would resolve this supply issue. 

When vaccines are made more widely available to people in detention, they must be presented as an option to detainees honestly, accurately, and in a culturally and linguistically responsive manner.

The contents of the supply also matter, and ICE should prioritize the “one-and-done” Johnson & Johnson (J&J) vaccine. The length of time a person spends in ICE custody varies greatly, due to unpredictable transfer, deportation, and release schedules, making a two-dose vaccine regimen unfeasible. The J&J vaccine does not require special refrigeration and is easy to store. It presents an opportunity to protect many people quickly and start to make up for the lost months during which most detainees were denied access to vaccines.  

Once a reliable supply is established, adequate staffing and trust must be developed, a tall order in a context of severely imbalanced power dynamics and ICE’s well-documented history of coercion of detained immigrants. ICE should consider external staffing solutions to ameliorate trust gaps. Vaccination protocols and plans should be developed with input from external medical experts, reviewed by third parties, and made public as part of DHS’s COVID-19 protocols. Regardless of where personnel come from, ICE must ensure training for nurses and other qualified health professionals to administer the vaccine according to CDC guidance, and to identify and manage side effects. ICE medical clinics should also be prepared to accommodate and treat a larger volume of detainees for side effects in the days after vaccination.  

When vaccines are made more widely available to people in detention, they must be presented as an option to detainees honestly, accurately, and in a culturally and linguistically responsive manner. That is more likely to happen if detainees trust the messenger. Community-based organizations with relevant expertise should have access to detention facilities to present accurate and independent information about vaccines, as they already do for legal orientation programs

But no matter how good the information or access, some number of detainees will understandably refuse vaccination while in ICE custody. Even so, no one should be kept in a detention facility for the purpose of being vaccinated or as retaliation for not accepting the vaccine, yet there are already reports from advocacy organizations of detainees being denied bond because they declined to receive the vaccine. Such a coercive tactic is an unacceptable abuse of authority that runs counter to the important task of encouraging vaccination based on accurate information and informed consent. Keeping people in detention also defeats the underlying goal of preventing virus transmission because releasing detainees to community settings where they can more easily distance or isolate themselves will always be a better public health strategy. 

The U.S. has more than enough vaccine supply for every person in this country, yet the federal government continues to restrict access to vaccines to tens of thousands of people in its custody.

ICE also has a track record of unsafe medical discharge planning and has released detainees without providing them access to their own health records, sometimes with devastating outcomes. Given the potential proliferation of proof-of-vaccination or “passport” systems, detainees should receive their CDC vaccine card upon release along with their full health records, including information about their vaccination status and any side effects. 

Even if ICE follows our vaccine advice to great effect, the high turnover and crowding in detention settings means public health protocols must still be rigorously followed. The availability and administration of vaccines should never be a reason for withholding or ending other COVID-19 prevention measures, such as mask-wearing, physical distancing, symptomatic and asymptomatic testing, implementation of screening protocols, or other improvements to the physical environment in detention. 

The U.S. has more than enough vaccine supply for every person in this country, yet the federal government continues to restrict access to vaccines to tens of thousands of people in its custody. This set of recommendations is designed to help right a wrong and a discriminatory practice that has gone on for far too long. The best path forward would be to release detainees to safer community settings, as we have repeatedly recommended. However, as long as ICE facilities continue to operate, they have an obligation to detainees, staff, and the broader community to offer vaccines appropriately and help end the spread of COVID-19 inside and outside of immigration detention.

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