key: cord-0928110-ylu51i3w authors: Ibrahim, Abdulmumin Damilola; Akpus, Adigizi Iliya; Aborode, Abdullahi Tunde; Babatunde, Abdulhammed Opeyemi title: Will refugees also get vaccinated against COVID-19 in Africa? date: 2021-04-06 journal: Public Health Pract (Oxf) DOI: 10.1016/j.puhip.2021.100118 sha: 270f19c8c4cee0c7050a1030729bf1b8f7aeee9c doc_id: 928110 cord_uid: ylu51i3w Africa has the second-highest number of displaced persons in the world. This number increases continuously due to the ongoing crisis in different countries in sub-Saharan Africa. African refugees are not only prone to COVID-19 but they are also capable of transmitting it across country borders. This article aims to highlight the need for equity in vaccine distribution in Africa to include refugees in each host countries. Africa has the second-highest number of displaced persons in the world, with about 6.6 million displaced persons in Sub-Saharan Africa [1, 2] . This number increases continuously due to the ongoing crisis in different countries in sub-Saharan Africa including the Central African Republic (CAR), Nigeria, and South Sudan. These refugees are mostly camped along country borders, characterized by overcrowding, poor hygiene, and sanitation, lack of infrastructure resulting in disease outbreaks and high mortality especially among children and women [3] . COVID-19 Infection Prevention Control (IPC) strategies may be difficult for refugees to adhere to because of the improper movements and lifestyle they will have to adapt to while migrating. Besides, African countries have a lower testing capacity and infrastructure for treatment of COVID-19 compared to countries in Europe, America, and Asia and would be significantly worse among segregated populations like refugees. African refugees are not only prone to COVID-19 but they are also capable of transmitting it across country borders. This article aims to highlight the need for equity in vaccine distribution in Africa to include refugees in each host countries. With the recent development of COVID-19 vaccines globally and the commencement of administration of these emergency vaccines, African countries should prioritize equity and universal coverage for a sustainable action plan for mass vaccination. The global initiative through COVAX aims to start Africa's largest-ever mass vaccination campaign by supplying about 90 million COVID-19 vaccines to African countries [4] . The initial phase of 90 million doses will support countries to immunize 3% of the African population most in need of protection, including health workers and other vulnerable groups in the first half of 2021 [5]. As production capacity increases and more vaccines become available the aim is to vaccinate at least 20% of Africans by providing up to 600 million doses by the end of 2021 [5] . However, the distribution guideline does not include the refugees in Africa who are more prone to this disease and may be unable to access healthcare services in their host countries. Considering the typically densely populated refugee camps, nonpharmaceutical measures for prevention of the spread of COVID-19 like social distancing, washing of hands regularly is difficult and if basic sanitation is not provided, proper hand hygiene is close to impossible. COVID-19 cases have been confirmed amongst refugees in Ugandahosts the largest population of refugees in Africa with about 1.35 million people seeking refuge in the country [6] . Besides, over two million Nigerians have been displaced due to the Boko Haram insurgency in Northern Nigeria; Ethiopia hosts about 770,000 refugees while Sudan hosts over 159,857 refugees amongst others due to various internal or external crises which often force citizens to seek refuge in neighboring African countries across Africa [7] . These refugees may never get tested for COVID-19 and may also lack access to health information regarding the pandemic and the preventive measures. Although the transmission of COVID-19 in Africa has not been reported to be higher amongst refugees with adequate testing and surveillance system, there could be a relatively higher incidence among the refugee population compared to the general population. The World Health Organization also fears the risk of poorer treatment outcomes in COVID-19 patients with underlying infectious diseases like tuberculosis [8] . This prediction is alarming, considering that tuberculosis and malaria are more prevalent among the refugee population. Besides, undiagnosed or unmanaged diabetics and other chronic diseases may be prevalent among this population due to lack of quality health services in refugee camps. Hence, refugees are also prone to COVID-19 complications and mortality. In a bid to ensure that all countries get equal access to COVID-19 vaccines, an international coalition called the COVAX facility was formed. COVAX stated that priority will be given to healthcare workers and vulnerable groups [5] . There is a need to ensure to all refugees get vaccinated as well as they are a crucial point in totally eradicating coronavirus in the continent. Refugees should be included in the global efforts to fight against the COVID-19 pandemic. High-income countries and philanthropists should invest in COVAX to ensure wider coverage. Jordan is leading in this regard as it has started administering the COVID-19 vaccine to both her citizens and the refugees within her border alike. There is a mantra going around the international community now and it is that "No one is protected until everyone is protected". Hence, vaccinating the refugees is as important as vaccinating the legal citizens in a country. In conclusion, refugees represent a significant proportion of the African population and must not be neglected in COVID-19 vaccination in African countries and globally. Although mass vaccination has not commenced in any African country. African governments in conjunction with NGOs and international bodies should incorporate vaccination of refugees in their national policies for COVID-19 mass vaccination guideline because "No one is protected until everyone is protected". AOB and ATA conceptualized the idea; ADI and AA drafted the manuscript; AOB and ATA reviewed the manuscript; All authors approved the final manuscript for submission. Authors declare no conflict of interest. No external funding was received. Ethical approval was not required for the manuscript. United Nations High Commissioner for Refugees, Sub-Saharan Africa hosts more than 26 per cent of the world's refugee population What you need to know about Africa's refugees COVID-19 Responses in Africa Must Include Migrants and Refugees [Internet], Institute for Security Studies Today COVID 'vaccine Hoarding' Putting Africa at Risk: WHO. UN News The socioeconomic and psychosocial impact of Covid-19 pandemic on urban refugees in Uganda COVID-19): Tuberculosis, World Health Organization The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.