Refugee access to COVID-19 vaccines in Lebanon

Lebanon is currently experiencing multiple unprecedented crises—political, infrastructural, and economic. The Beirut port explosion, in August, 2020, damaged 36% of health facilities.¹ The Lebanese pound has lost 90% of its value, pushing more than half of the population into poverty.¹ Complicating its desperate plight, Lebanon hosts the largest refugee population per capita in the world.² The COVID-19 pandemic has exacerbated this situation, leaving an ill-equipped health-care system overwhelmed.¹ Given that the country struggles to care for its own citizens, the individuals who are most vulnerable, such as refugees, are at a heightened risk, particularly given the historical neglect of refugee populations in Lebanon's routine vaccination efforts.³ Amid Lebanon's crises, the risk of failing to ensure equitable access to the COVID-19 vaccine for its 1·7 million refugees represents an impending public health crisis.

In Lebanon, refugees make up approximately 30% of the population.² Refugees live in high-density camps with scarce access to clean water, sanitation, and hygiene services, which leaves these individuals highly vulnerable during an infectious disease outbreak. According to the non-profit organisation Anera, public health interventions have been scarce across refugee camps since the beginning of the COVID-19 pandemic. Consequently, COVID-19 deaths were elevated among Syrian and Palestinian refugees in Lebanon, with a fatality rate that is four times and three times the national average, respectively.⁴

The Lebanese Ministry of Public Health prepared a National Deployment and Vaccination Plan (NDVP) for COVID-19 vaccines, which aims to vaccinate 80% of its total population, including non-citizens.² However, the acquired number of doses thus far—including those from COVID-19 Vaccines Global Access (COVAX)—is only sufficient to vaccinate 2 million people.² Although the NDVP commits to vaccinating refugees, routine immunisation rates among refugees in Lebanon have historically been alarmingly low compared with the native population. Only 12·5% of Syrian refugee children in Lebanon are fully immunised through routine vaccination services.³ Given that Lebanon does not have enough doses to vaccinate its own citizens, international support is needed to ensure that refugees in Lebanon receive the COVID-19 vaccine.

Access to vaccinations by the most vulnerable is critical in curtailing the spread of COVID-19. While Lebanon struggles to address its economic and political crises, it is untenable for Lebanon to solely provide vaccinations for its refugee communities. Thus, international aid organisations must step in to ensure that those most at risk of COVID-19 are prioritised in vaccinations. Without international efforts to ensure equitable access, vaccine distribution in Lebanon risks becoming another crisis and a catastrophic moral failure.

We declare no competing interests.