BRUSSELS — For people living on the margins of society, from the homeless to undocumented workers, the coronavirus has long posed a heightened risk. Yet here in the European Union’s de facto capital, many are terrified of getting vaccinated.
“People said it would paralyze me,” said Rouguiatou Koita, a 32-year-old immigrant from Guinea and mother of four, including 8-month-old twins. “I was very scared,” she added. “I didn’t know what would happen to my children.”
But then a team of health and social workers visited the homeless shelter in Brussels where she lives, and a friend got a vaccine shot and was fine. Ms. Koita was convinced, and on June 21, she was inoculated, too.
As the vaccination drive in the European Union has gained speed, with more than half of the adult population now fully inoculated, governments are stepping up efforts to reach marginalized populations, including people like Ms. Koita. At the same time, they are redoubling efforts to combat disinformation about vaccines.
Widespread vaccination, epidemiologists say, is the only way out of the pandemic, but reaching everybody — including those on the edges of mainstream society — is not easy. In the European Union, there are an estimated 4.8 million undocumented people, about 1 percent of the population. And they tend to fill jobs at increased risk of exposure, such as in the domestic care and hospitality sectors.
The European Union, like the United States and other wealthy places, is now in the fortunate position of not struggling for supply. But each country in the bloc has devised its own plan, and the arrangements vary widely in terms of how accessible vaccines are.
In the Netherlands, medical teams administer the shots directly in homeless shelters, and anyone can book a vaccination over the phone without a national registration number. Portugal has created an online platform dedicated to undocumented people, though people signing up for a shot still need to provide an address, birth date, phone number and nationality. In France, since late May, no documents have been required to sign up for a vaccine.
In Belgium, navigating between local, regional and federal administrations was a challenge even before the global health crisis.
The original plan of the federal Belgian health authority, to be implemented starting in December, stated that vaccinations would be based on each resident’s home address and employment status, according to an overview in the medical journal The Lancet. Using those criteria, reaching people with irregular jobs, temporary living arrangements or no documentation was a problem.
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Since then, the authorities at both federal and regional level have promised to include undocumented migrants and homeless people in efforts to widen the vaccination drive, which in Belgium is implemented by local governments.
The issue is particularly pressing in Brussels, the capital, which has about 1.2 million residents and an estimated 80,000 undocumented migrants. According to the European Center for Disease Prevention and Control, migrants have been “disproportionately impacted” by the pandemic.
In those marginalized sections of the population where distrust of the authorities runs deep, vaccine hesitancy is also high.
To try to simplify matters around inoculation, the authorities in Brussels have deployed mobile vaccination teams to register people for shots and any follow-up treatment using a special number issued on the spot with no background checks. People thought to need special attention, including pregnant women, can also be referred through that system to a vaccination site at a hospital in central Brussels.
Ms. Koita said the outreach had helped.
“I came up to do my laundry, and I saw the queue,” she said. “I got curious and spoke to nurses who explained everything to me.”
The mobile teams — composed of doctors, nurses, pharmacists and interpreters for languages including Arabic and Tigrinya — inoculate everyone, regardless of legal status.
“Vaccine hesitancy is a problem to the same extent as in the general population,” said Lily Caldwell, 36, an American aid worker from Doctors Without Borders and coordinator of the mobile vaccine drive. “The difference is that migrants often don’t know many people who already got vaccinated.”
Her team has been moving among different venues, including aid centers for migrants in transit and homes for victims of domestic violence.
The crew hopes to vaccinate 5,000 people by the end of September. It has vaccinated 1,190 since June.
The vaccination teams are deploying the Johnson & Johnson shot, the only one registered in the European Union that requires just one dose.
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At a recent three-hour information event at a former hospital in the center of Brussels with representatives of migrant communities, social workers spent a lot of time countering disinformation. The vaccination teams must also deal with the migrants’ anger about how they have been treated in the pandemic, with many feeling that the state has failed them during the crisis.
About 450 migrants went on a two-month hunger strike recently, calling for the legalization of their status and more clarity on how to get Belgian residency.
The idea was born out of desperation, said Tarik, a spokesman for the hunger strikers, who declined to give his last name for fear of repercussions from the authorities.
“Most of us have been here for decades, and we are being exploited,” he said. “We work like Belgians, but we earn 30 to 40 euros per day” — about $35 to $47.
Because people without papers often work in the sectors most heavily affected by the pandemic, like restaurants, cafes and hotels, many lost their jobs.
Mehdi Kassou, the founder of the Brussels-based Citizens’ Platform for the Support of Refugees, who represented the hunger-strike protesters in negotiations with the government, called the pandemic “a real accelerator of poverty and insecurity among undocumented migrants.”
The protesters suspended their hunger strike last week, with some said to have been left in a serious condition.
“People are in a really bad shape,” said Tarik, who lost 31 pounds and was hospitalized twice. “We suspended the hunger strike because we saw some progress in the negotiations.”
The issue of migration is as politically explosive in Belgium as it is in many other countries. The current government was cobbled together from seven political parties and nearly fell apart during the hunger strike, when the Socialists and Greens, both members of the coalition, threatened to pull out if a protester died.
For many undocumented migrants, the urgency of the vaccination campaign has been revealing.
“There is a health crisis, and all of a sudden we exist,” said Abdel, a 37-year-old undocumented migrant from Morocco, who also asked to be identified only by his first name to avoid attracting the attention of the authorities.
“We don’t want vaccination without regularization,” he added. “They cannot come and say to us: ‘Now you exist, now you have to get vaccinated.’”