The scene is banal, and looks like any pre-vaccination interview orchestrated in all the vaccination centers in the territory. After waiting a few minutes, Muftah enters the prefab and sits down, the time to answer a few questions. In front of him, a doctor juggles between French and English and fills out a questionnaire for him: “Do you have any particular pathologies?”, “Have you ever had the Covid?” Once this short exchange is over, the staff gives Muftah his patient certificate, which will allow him to return for his second dose three weeks later, and a box of Doliprane as a bonus. The operation is soon over for this fiftieth who arrived from Libya a few months ago. Muftah just has to go with the doctor to get his dose.
Porte de la Villette, in the 19th arrondissement of Paris, on this afternoon at the end of July, a dozen volunteers and employees of Doctors Without Borders (MSF) are working to vaccinate as many people as possible. In France, no nationality criterion is required to receive injections. Since May 24, vaccination is theoretically open to any migrant in a regular or irregular situation, whether or not they benefit from AME (medical aid from the State). “People hosted in FTM (house for migrant workers) were among the first to be eligible for vaccination. Since the beginning of June, all people in medico-social accommodation and on the street are eligible without conditions”, summarizes the Directorate General of Health (DGS) at franceinfo. In reality, however, there are many obstacles for these migrant populations established on French territory.
First, not everyone knows that access to the vaccine is so simple. At the MSF medical center, many people challenge Brice Daverton, doctor. Among the questions asked, the fact of knowing if the vaccination is paying. “Some also think they can’t get vaccinated because they don’t have social security,” adds the doctor. Others, who came to eat at the food distribution organized a few meters away, even discovered the initiative: “Can I get my injection today?”, is surprised a young man.
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If we go back in time, the vaccination of migrant populations began at the end of February, in the homes of migrant workers. Actions have been carried out jointly between the prefectures, the ARS (Regional Health Agencies) and structures such as the Red Cross or Doctors Without Borders to bring vaccination trucks to homes and vaccinate migrant workers over 60 year.
But in general, the vaccination of migrant populations has always been linked the vaccination schedule established by the government, according to age criteria. There has never been any prioritization of people in precariousness and far from the healthcare system, laments Corinne Torre, Head of Mission France at MSF: “Since December, we have been fighting for the State to pay particular attention to these audiences, but this was only made possible at the same time as for the rest of the population, during its extension at the end of May. However, we had found that homes were unsuitable places, therefore cluster nests. And people on the street are vulnerable people, more at risk. So they had to be vaccinated.
Vaccination can also appear tedious for migrant populations, because of the language barrier, which constitutes an obstacle to making an appointment, especially when they do not have a treating doctor. “These people do not have the sufficient linguistic and digital level to have a Doctolib account and make an appointment themselves”, explains Delphine Rouilleault, general manager of the France Terre d’Asile association. In La Villette, this is a problem that MSF has applied itself to solving. The team has an interpreter, present to communicate with people who come to be vaccinated and guide them as best as possible, as well as forms in all languages, provided by the public authorities.
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“Making appointments also requires a form of serenity in the pace of life that they do not necessarily have because of the personal and social emergencies they have to deal with. It is therefore very important to rely on the mechanisms vaccination without an appointment”, continues Delphine Rouilleault. On Twitter, associations such as the Chapelle Migrants Support Committee also communicate about the Parisian centers where it is possible to come without having to find a slot.
List of anti-covid vaccination centers WITHOUT an appointment in Paris
pic.twitter.com/cCj6juyGaB— MigrantSupport Committee (@MigrantChapelle) July 21, 2021
In Nantes (Loire-Atlantique), the association AMI (Accompaniment Migrants Integration) has struggled to obtain special vaccination slots at the CHU, intended for migrant populations. An initiative that facilitates administrative procedures on site, with the support of populations at the vaccination site by a specially mobilized interpreter. “We help them from start to finish, right up to downloading the health pass on the TousAntiCovid application”, explains Catherine Libault, president of the association.
Beyond the many constraints, the vaccination of migrant populations also comes up against their reluctance. Doubts around the vaccine and its side effects exist, like the distrust observed in the French population. Samim, mediator and interpreter with the vaccination team of Doctors Without Borders, talks about those who do not feel “concerned”, who have “fear of becoming sterile” or who reject something“unknown”. “People are afraid to get vaccinated because the shots are scary”, slides on his side Corinne Torre.
“The barrier is not just linguistic, but also psychological, even cultural.”
Delphine Rouilleault, Director General of France Terre d’Asileat franceinfo
The various actors interviewed, from Doctors Without Borders to Utopia56, an association created in Brittany, evoke, among other things, a fear of public authorities and institutions among migrants. And their fear, by being vaccinated, of attracting the attention of the authorities, who could expel them from the accommodation centers or from the territory. “There is a fear of authority. When you’ve traveled three years to leave your country and cross borders, it’s hard to trust.” decrypts the director of France land of asylum. In addition, for many newcomers or people on the street, “the concern is not the virus, insists Yann Manzi, founder of the Utopia56 association. When you already have to find something to eat, where to sleep, you have other concerns, and vaccination is not your priority.“
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Faced with these concerns, “it takes a lot of awareness” and “an ability to reassure them”, specifies Corinne Torre, who notes deficiencies in the support. “There is a lack of teams accustomed to working with people on the street and with migrants. We cannot direct them to traditional vaccination centres.“
The associations are also not certain that migrant populations, often young and therefore affected by messenger RNA vaccines, will return for their second injection. “We would have preferred the single-dose Janssen vaccine, but it is reserved for adults over 55, so we end up administering the Pfizer vaccine, with the risk of losing them between the two doses because these are populations that are on the move”, worries Corinne Torre. A question that arises particularly in certain areas, such as Calais (Pas-de-Calais) and Grande-Synthe (Nord) where many people are trying to reach England. Two weeks after the opening, on July 13, of a permanent vaccination service by the Calais hospital, less than 50 injections had been carried out, while the prefecture of the department estimates at “about 800” the number of migrants in the city.
Total vagueness also surrounds the vaccination coverage of migrant populations, the number of which is difficult to assess. In 2020, the Ministry of the Interior counted 95,000 asylum applications registered by the Ofpra (French Office for the Protection of Refugees and Stateless Persons), without this data being able to reflect all the people present in the territory. The NGO Doctors Without Borders, which has already vaccinated more than 5,000 people in Ile-de-France, hopes to carry out around 12,000 injections by the end of September among precarious and migrant people.
It must be said that the association is concerned about a risk of marginalization of these populations with the extension of the health pass to many places of life, from coffee to long-distance transport, and asks for more resources from the State.
“The health pass is a brake on a number of things: access to their fundamental rights, food distribution, public showers…”
Corinne Torre, Head of Mission France at MSFat franceinfo
Beyond the accessibility of certain places, the health pass complicates travel. “With this pass, some asylum seekers (far from the Paris region and not vaccinated) will not have access to transport and therefore to the asylum application systems in Paris”, explains Corinne Torre. For Yann Manzi, from Utopia56“newcomers could find themselves stuck”.
Logically, vaccinations have exploded since Emmanuel Macron’s announcements in mid-July on the extension of the health pass. “The impact of his speech was very strong, explains Corinne Torre. The question no longer even arises whether they should be vaccinated, today they have to go.” At La Villette, the vaccination center was stormed in the weeks following the speech by the President of the Republic. MSF now performs more than 150 injections a day and had to spend three to five days on site to absorb the requests. Aboubakar is a Sudanese refugee. He works in construction and that Wednesday he received his first dose, after having waited a long time due to fears. Today he wants to be vaccinated “for health but also for travel, for work”. “Before, you had to make them aware, tell them to come and get vaccinated, explains Bamba, security officer at the vaccination office. But since Macron spoke, there are plenty of people.” And it could still ramp up. August 3, the government has asked to the prefects and directors general of ARS to accelerate the vaccination of asylum seekers and precarious refugees, reiterating its objective set on July 5 to vaccinate them all “by the end of August”.