Welcome to this training entitled Insights from Undocumented Communities in Rome, in which I'm going to discuss some consideration developed through research conducted into the ethnography of disengagement project. In order to translate my experience as a researcher to insight for policy practices, I would like to start from some of the results that emerged from this research. Across Europe, the effect of COVID-19 have been deeply race, class, and gender. The ongoing pandemic has exposed and exacerbated pre-existing inequalities for those who were already living a condition of insecurity and suffered most the consequences of the pandemic. The housing and working condition represent an additional risk factor for COVID-19 infection. In particular, for refugees and asylum seekers, people on the move and undocumented individuals. Furthermore, undocumented individuals often experience precariousness and difficulties in accessing public services, legal services. We analyzed vaccine and the vaccination campaign for racialized and illegalized people. Analyzing vaccine and the vaccination campaign in Italy provides three points to be considered. Looking at the margins, undocumented migrants inhibit the margin of the Italian state. Pre-existing experience of inequalities and stigmatization intersected with effect and struggle of the COVID-19 pandemic. Looking in the margins means questioning on the pandemic and these consequences have been experienced by people. Secondly, questioning the linearity of the causes of the vaccine hesitancy. Migrants have also been considered hard to reach and vaccine hesitancy by policymakers who have recently been incorporated in attempts to promote inclusivity within COVID-19 response. As well as observing the coexistence of pushes for inclusion, for vaccination and the structural exclusion that migrant people experience. The ethnographic approach makes it possible to question the linearity concept of hesitancy on the basis of attitudes and experiences of vaccination amongst racialized groups. Really seeking new perspective for reasoning on trust and mistrust in the health system. It is estimated that undocumented people in Italy are between 500,000 and 600,000, and they face several barriers in accessing health care, and that's significantly reduce their visit to health services during the pandemic. In Italy during the first month of the vaccination campaign, access to the COVID-19 vaccine was precluded to those not in possession of a national insurance number. As a consequence, regardless of comorbidities and aid factors in several region, undocumented individuals such as migrants and the homeless have largely been excluded from accessing vaccines. The most common reason for rejecting the vaccine was perception that the side effects could be dangerous. These was related but to the fact that many people need to work and are paid daily and they do not want to get sick, and with respect to the alarmist news about AstraZeneca. Additionally, orders were concerned by the fact that the vaccine was developed in a short period of time, without proper protocols. Some people perceived themselves to be a part of an unsafe scientific experiment. Hesitancy was also linked to preconception that the vaccine presented more risk than contracting the COVID-19 virus. Feeling of frustration and coercion where exacerbated by having a limited choice about which vaccine to take because they are targeted as hard to reach. The vaccine consider it as the most effective for highly mobile groups was the single dose, Johnson & Johnson, because it terribly did not require a second dose. However, research has found that the J&J vaccine has a lower effectiveness than the other and at the end it would require a second dose to cover the variants. Our research allies does undocumented individuals face structural barriers in accessing public health services. This obstacle existed well before the current health crisis. The main obstacle are directly in accessing services for fear of being reported to the police because of illegal situation. Bureaucratic obstacle and insufficient institutional communication on how to access health services. During the first month of the vaccination campaign in several regions in Italy, undocumented migrants lacking a national insurance number were unable to register on the platform, and so unable to access a vaccination. Vaccines obtained outside Europe for Philippines, Indonesia, Turkey, Russia, China were often not recognized as valid by the Italian authorities. Migrants were, thus trapped in a paradoxical situation. The lack of a digital COVID certificate, and at the same time, the impossibility of vaccination for medical reasons since people were already vaccinated. COVID-19 vaccination were often perceived in relation to job continuity. In the previous month a digital COVID certificate or Green Pass was mandatory for any form of employment. Despite of the lack of legal contract, benefit social protection, and they'll cover it, employers of undocumented people who work in extremely precarious and the illegal condition often require a Green Pass for job continuity. Green Pass certifications seems to have become more urgent than the regularization of work condition of undocumented employees. This not only help normalize illegal and precarious employment, it also shifts responsibility on the individual worker fitting already exploitative condition. In this sense, Green Pass certification is perceived as an instrument of coercion and blackmail in the hand of employers, further enhancing vulnerabilities of undocumented workers. Moreover, very often undocumented person who had been vaccinated did not receive a green pass immediately. This research showed that for undocumented migrants, it is governance of COVID-19 rather than fear of contracting virus, which has become central to their lives. Thus even among undocumented person who had accepted a vaccine, this was not indicative of trust in the Italian health care system. What does this finding suggest for policy making? This finding provides insight relevant for action in the field of health of undocumented individuals. Their operationalization should be prioritized given the long-term nature of the ongoing pandemic and continuous introduction of new policies. First of all, it's important to reason in term of equity and not just of equality in order to take into account social determinants of when people started living in such economic condition. Public health services should be proactive and build a relationship with individuals and community. This should also be done outside the pandemic emergency, ensuring continuity of care and relationship. Regarding the vaccination campaign for COVID-19, bureaucratic reform are necessary. Vaccination booking system should be accessible also in the absence of a national insurance number. Then to provide more health information, Green Pass certification should be issued immediately after vaccination through simple and widely accessible procedure. Furthermore, it is important to discuss how to proceed with those who have already been vaccinated with a vaccine not recognized in Europe. There is a need to develop tailoring communication strategy with an equitable approach, and it is important to incorporate the migrant-state relationship into health messages. To do this, policymakers and health practitioners should be proactive and establish strong collaboration with migrant-led trusted organization, and engage civic infrastructure to improve access to public services and implement effective communication strategy about access to public health care. It is essential to communicate through social media and produce informative material in a range of different languages. Some final consideration: It is necessary to go beyond a single debate on vaccine hesitancy to consider the structural elements that infer people's choice and understand how to address health issues. Not all in terms of accessibility and affordability, but also in terms of advocacy and fundamental rights. At the same times, the implementation of health policies and information needs to take into account the legal and socio-economic contexts in which they are introduced. Failing to consider and address systematic vulnerabilities to which marginalized groups are exposed, foster deep mistrust in institution and public services carry a risk for increasing exclusion and discrimination. Recognizing the preexisting vulnerabilities and inequalities of undocumented individuals and people on the move are unanswered by the pandemic the regularization of the legal status, living and working situations should be a priority in view of the ongoing health crisis. Access to firm of social protection should be guaranteed, and then correct, regardless of legal status and across the whole country. Strong, effective, and easily accessible complaint mechanism should be reinforced in the event of arrangement, violence, and discrimination. In conclusion, implementing migration elaborate policies that focus on social protection and reducing the inequality faced by undocumented individual and people on the move should be considered as a key public health measure in tackling the COVID-19 pandemic and it's deep, socio-economic consequences.
