COVID Knows No Nationality: What Non-Nationals Face in the Vaccination Process

Kuwait

Politics & Governance

Commentary

Reham Alawadhi

When I received my COVID-19 vaccine in mid-February 2021, I was taken aback. How had I gotten my appointment when several non-national acquaintances above the age of 60, with underlying medical conditions, were still waiting for theirs?

At the vaccine center in Mishref, I asked the two nurses taking my details whether they’d been vaccinated. They both looked shocked, with one of their expressions turning into a warm smile before nodding – as if this was the first time someone had even thought of her.

I got my jab and went to the 15-minute waiting area. I noticed several cleaners sanitizing the seats after people left. I asked one of them whether he’d been vaccinated. He replied, “Who, me?” He had not.

When vaccine registration started in December 2020, the Ministry of Health (MOH) spokesperson Dr. Abdullah Al-Sanad gave an interview to KUNA saying the early registration was intended to compile data to help the MOH identify which segments of the public to prioritize, taking into account the number of nationals, non-nationals, and stateless individuals.

But by February 2021, the MOH published data that showed that a total of 215,000 nationals registered, with 119,000 receiving the vaccine, and a total of 238,000 expats registered, with 18,000 receiving the vaccine. Accounting for the population of Kuwait, this is a nearly 7-to-1 ratio in favor of Kuwaiti citizens. The total number of vaccine registration has now gone up to 1,106,000, with 604,861 vaccines administered; further statistics on citizens versus expats were not recorded.

“Most governments provided comprehensive frameworks showing where each occupation, age group or comorbid individuals stand in the queue,” said Barrak Alahmad, a Kuwaiti doctor in public health, and a PhD candidate in population health sciences at Harvard University. “This is usually based on the rates of transmission, groups most susceptible to infection, logistics and economic impact. In public health practice, using nationality to prioritize COVID-19 vaccines is ethically indefensible.”

Migrants play a fundamental role in Kuwait’s society and contribute enormously to the economy, making up almost 70 percent of Kuwait’s population. They are entitled to the benefits their contributions make possible, said Alahmad.

Doctors Prioritized, Staff Ignored

A Kuwaiti doctor working at one of the hospitals that handle COVID cases spoke on the condition of anonymity, due to concerns that her job would be jeopardized. She said that she and her fellow doctors, both Kuwaiti and non-nationals, were prioritized in getting the vaccine. However, the stateless (Bidoun) doctors were not vaccinated for another three months.

“I know for a fact, the nurses – they signed up at the same time – yet most of them were not vaccinated,” she said, noting that many were given their shots two months later even though they have closer and more constant contact with COVID patients.

“Surgeons who have been home most of the time, they got vaccinated in the first batch,” she said. “Then you have nurses who work in the emergency department or non-Kuwaitis who work in the ICU, who show up every day to work and get exposed to patients that are either COVID-positive or susceptible to COVID, and they’re not vaccinated.”

The delays in vaccination, however, were due to many factors beyond discrimination. Many of the healthcare workers contracted COVID within the past three months, so they were not eligible for a vaccine yet. Another reason, she said, was that many of the nurses did not want the vaccine, with some claiming that they did not want to be the first to receive it and would wait for the second batch.

“What I see from the Ministry [of Health] is they are trying to facilitate; to set up clinics in all the different hospitals, that was a good move,” the doctor said. “And with that, many of the non-Kuwaitis and nurses were given vaccines. But was there a priority for Kuwaitis? Yes. That cannot be ignored.”

She also said that the nursing staff were also told to get the vaccine on their day off so they would not need to take a day off work if they had any side effects. The doctors in the hospital, on the other hand, were allowed to take the vaccine during working hours and take a sick leave if they needed to.

“There was a certain point in February when a bunch of my friends who can afford to stay home were getting vaccine appointments and I would show up to work and none of the nurses were vaccinated at that point,” the doctor said. “And yet my 16 or 17-year-old friends and cousins were getting vaccinated.”

Attempts were made to interview both the nurses and stateless doctors, but all declined due to fear of repercussions.

At the same time, porters, cleaners, security guards, technicians, and other staff working in hospitals had not been offered the vaccine either, she said. They were eventually vaccinated in June.

No Herd Immunity Without Vaccinating Non-Citizens

Most countries are relying on herd immunity to fight COVID-19. According to the World Health Organization, herd immunity is the indirect protection from an infectious disease that happens when the majority of a population is immune through vaccination.

“Herd immunity cannot be achieved without mass vaccination of the entire population,” said Alahmad. “Suppose we owe no responsibility to health equity for non-Kuwaitis. I argue that the prioritization of Kuwaitis, at the expense of migrant workers, would not guarantee full protection for Kuwaitis and would be a blow to the efforts made to curb community spread of the disease in the country.”

In fact, non-Kuwaitis are already more likely to catch the virus than Kuwaiti citizens. A significant portion of migrant workers in Kuwait live in confined dormitories with poor living conditions: dozens of men living together, neglected and shared bathrooms, and bad or no ventilation, said Alahmad. These poor conditions not only increase infection rates, but also make self-quarantine impossible.

Furthermore, many migrants speak neither English nor Arabic, the only two languages that the vaccine registration is available in. Ziad Alduaij, a Kuwaiti businessman, asked the Sri Lankan domestic worker at his household whether she had been vaccinated yet. She said no, because she did not know how to register. “There’s no information. These people have not been targeted with information guiding them on how to register in languages they speak,” Alduaij said.

Alahmad suggests the MoH begin facilitating in-person registration. “Registration kiosks in areas populated by migrant workers is a good place to start,” he said. “Reaching out to community and religious leaders in certain areas and working with foreign embassies will all help make the vaccines more accessible.”

Cultural Awareness Needed

Mary-Ann from Sandigan Kuwait, a support system for domestic and migrant workers in Kuwait, has seen some of the challenges to vaccine registration firsthand. There are many anti-vaccine sentiments among expat communities, she said, with a multitude of conspiracy theories about the dangers of the vaccine circulating on Facebook, WhatsApp, and other social media platforms.

It would be helpful to see an awareness campaign targeted toward expats, Mary-Ann said, suggesting that they could do interviews with people of different nationalities who have taken the vaccine, helping to dispel fears of taking it in their respective communities.

“The lack of a national awareness campaign is shocking. I heard there was a government bid  in November 2020, for a massive campaign on all platforms; press, social media, billboards, TV and radio,” Alduaij said. “But as usual with the country’s bids, we are where we are now, without any awareness campaign.”

Another hindrance to vaccine registration is the requirement of a valid civil ID. Many employers, according to Mary-Ann, are using the pandemic to avoid renewing the work visas of their employees. If your legal residency is a month away from expiring, she said, the registration system automatically rejects the application.

Geoffrey Martin, a Canadian entrepreneur and economic analyst living in Kuwait, faced similar struggles with registration because his Civil ID was scheduled to expire the same month the vaccine registration opened. “For paperwork reasons and slowness due to COVID, we couldn’t renew my residency,” he said – meaning he could not register for the vaccine for two months after registration started.

“The bureaucratic delays in applying for labor permits also complicate registering for vaccines,” Martin said, noting that it can take up to six months to renew a residency if the company has licensing or financial issues, a common problem due to the economic consequences of the pandemic.

With between 30 to 50 percent of businesses closing, according to Martin, thousands of expatriates have been left without work visas, taking away their ability to sign up for the vaccine. Due to travel restrictions, however, they are often also stuck in Kuwait, leaving them trapped in a legal limbo.

“The Virus Doesn’t Care Who You Are”

Mohammad Alyousef, a researcher in political affairs, believes the reason behind the government’s decision to prioritize Kuwaitis over expatriates is partially a political one. During a tense time that is already filled with indignation towards the government, Alyousef speculates that authorities would provoke a backlash among Kuwaiti citizens if it forced them to wait in line behind non-Kuwaitis to receive their vaccines.

“The government’s decisions, in general, are ill-conceived. They don’t spend time anticipating the impact of their decisions on a comprehensive level,” Alyousef said. “And that includes consequences on expats or other minorities.”

A Jordanian national born and raised in Kuwait registered for the vaccine a day after the website went live and has not heard back since. He has a chronic medical condition called Crohn’s disease which requires him to take an immunosuppressant drug – making him more vulnerable to serious complications from COVID.  He has not stepped foot outside his apartment door since March 16, 2020.

Samah Diab, a Lebanese marketing professional who has lived in Kuwait her whole life, registered her father over a month ago and still has not received an appointment. Her father is 60 years old and diabetic.

A 53-year-old Tunisian woman registered at the same time as one of her Kuwaiti daughters and is still waiting for the vaccine. Her daughters, aged 24 and 25, have both received the vaccine, even though one of the daughters registered three months after her.

A Palestinian man who is 50 years old and has uncontrolled diabetes, meaning his blood sugar levels are too high and cannot be treated by medication, registered a month ago and is still waiting for his appointment.

An asthmatic, 45-year-old Palestinian man born and raised in Kuwait is still waiting for his appointment. When he registered, he added that he was allergic to certain foods and medication, so the system rejected him. Now every time he tries to register, it tells him he is already registered. He does not know if he will ever receive his appointment.

“What’s concerning to me is that there’s this silence from the larger community about what is going on,” Martin said. “The virus doesn’t care who you are, what your nationality or residency status is. As a society, we’re all in this together, and many lives are at stake if we don’t do this right.”

Reham Alawadhi is a journalist based in Kuwait. Reham is a University of Arizona graduate and her research interests focus on human rights and social justice.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Gulf International Forum.