Access to vaccines Potential challenges to ensuring that stateless persons access vaccines Despite public health guidance and human rights standards11 lining up in favor of the general inclusion of stateless persons in vaccination programs, in practice they risk being excluded. Lower vaccination rates among stateless persons predate the COVID-19 pandemic, as stateless persons generally face obstacles when accessing vaccination services. Stateless persons are likely to experience additional constraints in the current immunization environment due to the limited supply of vaccines globally. A number of potential challenges related to ensuring stateless persons benefit from vaccines can be identified. Nationality or legal status. Stateless people risk being excluded due to lack of nationality of the country of residence. A number of national vaccination roll-out strategies either prioritize their nationals over non-nationals, explicitly exclude non-nationals without legal status in the country, or make no explicit provision for non-nationals to benefit from vaccines. Lack of identity documentation. Stateless people may be excluded from vaccination programs either deliberately or de facto because they lack proof of legal identity. While some countries expressly bar undocumented persons from getting vaccinated, in other contexts they are in principle eligible but in practice face obstacles linked to their lack of identity documentation. The documentation requirement in practice stems from the need to keep track of who has been vaccinated, to invite persons for subsequent inoculations and to track the safety of vaccines. However, given that globally some 1 billion persons are estimated to lack proof of legal identity,12 the requirement that people show proof of identity to register for and/or receive vaccines may well undermine the effectiveness of vaccination programs. Alternative arrangements therefore need to be considered for those who lack proof of legal identity. The lack of documentation also makes it harder for authorities to reach these populations as they typically do not appear in civil registers or national population registers; their lack of legal identity documents has effectively made them invisible to the authorities. 4 Lack of awareness. The majority of known stateless people and those at risk of statelessness belong to minority groups and many live in remote, hard-to-reach locations. They may not speak the dominant national language and may or may not be literate. For a variety of reasons, they thus may not be aware of the possibility to get vaccinated and may face difficulties in obtaining information on how to access vaccines, especially where this requires navigating administrative systems. Information may not be provided in a language they speak or may be transmitted through a means of communication that they do not have access to. Due to a general lack of data on stateless populations, regular outreach efforts are likely to overlook these groups. Fear of coming forward for vaccination. Many stateless persons do not have legal status in the country where they live and are therefore generally reluctant to approach the authorities lest they be subject to arrest or detention. Registering and coming forward for vaccination is likely to be perceived as posing similar risks. Prohibitive cost of vaccination. Many stateless persons do not have access to healthcare insurance due to lack of legal identity and legal status, which can make accessing vaccination prohibitively costly. While vaccination in many countries is free of charge for nationals, in many countries this will not be the case for non-nationals without legal status. Discriminatory and inconsistent vaccination distribution practices. While most governments are developing vaccine distribution plans at a national level, implementation is often managed locally by a host of different actors. The urgency behind the roll-out of vaccination plans and lack of training and monitoring of vaccine distribution risks leading to inconsistent and discriminatory practices. Alternative arrangements for those not able to meet the usual requirements for vaccine registration, such as a national identity document, may not be consistently applied. This may lead to stateless persons and other groups not being able to get vaccinated despite being eligible. THE IMPACT OF COVID-19 ON STATELESS POPULATIONS