The issue of vaccinating children against Covid-19 has been debated worldwide. But what do we know about access to vaccines for street children?
As long as the world’s governments have had access to Covid-19 vaccines, each has designed different vaccination schemes to protect their populations. Immunisations started with vulnerable groups, the elderly, and frontline public sector workers, and eventually reached the younger age groups. Vaccination of children and young people under 18 years has been highly debated. Unfortunately, the heated debates do not necessarily address the concerns of street-connected children. In this blog, we want to highlight some emerging issues for street children and access to vaccines.
The Convention on the Rights of the Child states that children have the right to high-quality healthcare and the right to development, life, and survival. Taking this into account, all countries that ratified the Convention must ensure that children are vaccinated, as failure to do so puts them at risk and is a violation of their human rights. Street children, regardless of their age or gender, have the same right as any other child to receive a vaccination if they so choose. However, street-connected children may face negative attitudes from their community if they receive vaccinations or medical care during the pandemic.
Access to health services
Street-connected children regularly face many barriers to accessing quality health care and services. Even before the pandemic, approaching a health facility could be an uncomfortable experience as they faced challenges, unique to their situation. For example, hospitals are often unwilling to provide any treatment if they lack identity documents, even in an emergency. Another common situation they encounter when approaching medical services is being discriminated against based on their living conditions, turned over to authorities without their permission, or treated poorly.
In times of a pandemic, one of many risks to street-connected children’s rights to a safe childhood is the refusal of medical care by trained health care workers and a refusal to vaccinate them, even when they ask to be vaccinated. The denial of vaccinations to street-connected children violates essential articles of the Convention on the Rights of the Child, such as article 24, which states their right to the highest standard of health and article 6, their right to life and development. However, street-connected children may face negative attitudes from their community if they receive vaccinations or medical care during the pandemic.
Vaccination registry
Certain vaccination programmes require pre-registration via online services. Street children do not always have access to electronic devices to access the internet or do not have the knowledge to register successfully. Vaccination programmes that use this method to ensure coverage run the risk of excluding large segments of the population, so it is recommended that street children be assisted on the streets as part of the vaccination campaigns.
As vaccination appointment registration is carried out online, not having access to the internet often also means not receiving an immunisation appointment. In other cases, transport to the vaccination centre is unaffordable, or there are no vaccination locations nearby. Vaccination certificates present another risk for the daily activities of street children. If they are employed, the employer could turn his back on them if they do not have this new documentation that is becoming more frequently required. Another possible scenario is that schools refuse access because they do not have proof of vaccination. Such a case would result in additional disruption to learning opportunities, making the lack of vaccination another factor that threatens the right of access to education as set out in article 28 of the Convention on the Rights of the Child.
Considering this, governments mustn’t forget that any children’s vaccination scheme must consider children’s interests and rights as a significant consideration in line with the Convention of the Rights of the Child, including street children’s interests. If governments do not listen to street children’s concerns about access to vaccination, it violates children’s rights and their right to health. Protecting street children must include assessing whether the existing health measures in place – such as compulsory vaccination cards to gain access to facilities – protect them or to what extent they affect them. Considering street children in health policies mitigates further challenges to their daily activities and suffering additional social stigmatisation.
Not enough doses
Population surveys often do not consider street-connected children as they are usually carried out in settings which street children do not inhabit or spend extended periods. It is, therefore, often not possible to estimate the number of street children that exist at the national and international levels. Lack of data on the current population of street-connected children makes it problematic for vaccination programmes to target them, thus leaving them on the side-lines of communities’ efforts to vaccinate their entire population. In the absence of accurate estimates of the number of people in street situations, there is a risk of not sourcing enough vaccinations.
One of the most common problems, especially for countries in the global south, is obtaining sufficient doses to vaccinate their populations. The number of quantities available largely influences the speed of vaccination delivery in each country. As a result of the lack of available doses, children may be one of the groups that take the longest to be targeted, with street-connected children being one of the overlooked groups that may be largely left behind, giving way to those who are considered a priority.
Given this, countries with a surplus of vaccines available mustn’t hesitate to transfer them rapidly so that all countries have sufficient supplies to vaccinate their entire population, including street-connected children. Fortunately, the production of vaccines has been very successful. So, we should not let it come to the point where some people are prioritised for vaccines over others, with street-connected children facing such a scenario. Even without knowing exactly how many street-connected children there are at present, efforts must be made to ensure that all street children know that there are sufficient doses available for them to use.
Due to the lack of available Covid-19 doses, some communities may have negative attitudes towards populations perceived as ineligible to receive them, such as street-connected children. It is imperative that every effort is made to ensure that vaccination programmes assure communities of the right of all individuals to receive a dose and prevent possible conflicts leading to harmful relationships between communities and children in street situations if such negative dynamics exist.
Vaccination Centre accessibility
Each country has set up vaccination centres inside hospitals, pharmacies, parking spaces of shopping malls, convention centres, etc. The typical approach is that they are temporarily opened for visitors to visit them either by foot or car and, after a short period, closed if not longer needed. Street-connected children often lead a relatively mobile lifestyle, and it may be difficult for them to get a dose.
For street-connected children, the difficulty may be related to accessibility by location or opening hours, lack of clarity concerning health institutions, discomfort, fear about the treatment, etc. Therefore, vaccination programmes must consider street-connected children and young people’s needs and realities. National vaccination schemes should include mobile medical units that visit remote locations and hard to reach areas. The aim is for these units to be closer to the communities, offering greater flexibility of attention and the same quality of care. Mobile vaccination centres would allow street-connected children to go when they are able and willing to do so.
Misinformation
Street-connected children are not exempt from misinformation about vaccines and the pandemic in general. It is in their best interests to be presented with child-friendly information that gives them answers to their most pressing questions. CSC’ Child-Friendly Covid 19 booklet is an example of a visual and easy-to-understand guide to Covid-19 that presents information in an accessible way for street-connected children to protect themselves and others.
Schools, parents, guardians, and non-governmental institutions in touch with street children should act as trusted sources of information, offering them as much up-to-date information as possible on the latest available efforts to protect them from Covid-19.
Considering the best interests of street-connected children about vaccine coverage is necessary to ensure that all street-connected children have the protection they deserve worldwide. Countries claiming that their vaccination programme has been successful should only do so if it protects street-connected children, who deserve the same protection as any other child.