Vaccine nationalism? Why Jordan includes refugees in rollout.

Even after he received the text notification, Mohsen Ibrahim could not believe he would get a COVID-19 vaccine.

“I expect a country to vaccinate its own citizens first. It’s their right,” says Mr. Ibrahim, a 65-year-old Syrian farmer, while waiting for his shot at a health clinic in the Zaatari refugee camp in northern Jordan.

A wide smile creases his face from beneath the mask.

“But I am so glad Jordan sees it differently.”

At a time when countries wrangle over vaccine orders, deliveries, and distribution within their own borders, the resource-poor kingdom of Jordan is taking a different tack – vaccinating the most vulnerable, no matter their country of origin.

Seeing the common good as dependent on the good of everyone, Jordan is emerging as the antithesis – and perhaps an antidote – to so-called vaccine nationalism.

For months, Tedros Adhanom Ghebreyesus, head of the World Health Organization, has urged national leaders to embrace a collective response to the pandemic at the global level, saying an equitable distribution of limited vaccine resources was in each country’s national interest. He warned a month ago that the world was on the brink of “catastrophic moral failure” by not sharing vaccines more fairly.

Jordanian officials say their refugee outreach is part of Jordan’s wider strategy to seek out and inoculate the most vulnerable across the country – to support the entire population.

The country is a long way off from securing enough doses to vaccinate the majority of its 10.5 million population. Yet refugees are among the first to be vaccinated.

Zaatari’s rugged conditions

The first confirmed refugee in the world to receive the COVID-19 vaccination was a Zaatari resident last month.

“We are very grateful for the Jordanian government for targeting refugees, particularly inside the camps, where population density is high and social distancing is difficult,” says UNHCR Jordan spokesperson Mohamed Al-Taher.

Here in the Zaatari refugee camp, population 80,000, life is basic: residents hail donkey-led carriages as taxis, dust storms are a near-daily occurrence, and eight years after being driven out of Syria by war, the vast majority still live in prefabricated trailer homes.

Yet it is precisely these rugged conditions that led officials to make Zaatari home to the first COVID-19 vaccination unit in a refugee camp in the world.

The Jordanian government and The U.N. Refugee Agency (UNHCR) opened the vaccination unit in this camp this week after nearly a month of transporting elderly and vulnerable residents to the nearby town of Mafraq for inoculation. It cuts down the transport time from a one-hour round trip to a few minutes.

Like the dozens of vaccination units opening up across the country, a team of Health Ministry nurses and a physician receive patients, browse their medical history, and ask them a series of questions before they administer the shot.

A handful of freshly inoculated Syrians sit in a socially distanced waiting room, sipping water as nurses monitor them before finally placing them on a bus to drop them off at their home.

“Is that it?” Asha Hariri eagerly asks the nurse walking her to the waiting area shortly after receiving her second vaccine dose. “Am I protected now?”

The 70-year-old, who has health challenges, says she had spent a “year in fear” riding out the pandemic in Zaatari. Only after both she and her 72-year-old husband received their second doses this week, she says, did the “fog” begin to lift.

Limited resources

As of last week, 120 camp residents had received both doses of the vaccine, a further 80 received their first dose, as part of the initial batch of 2,000 Zaatari residents categorized by Jordan’s Health Ministry as first-tier recipients.

The unit will receive 50 camp residents a day. Dozens of other refugees are being inoculated daily in regular vaccination units in towns and villages across the country, where the vast majority of refugees live.

Although the numbers seem modest, Jordan’s limitations make them remarkable.

Resource-poor and mired in an economic crisis that predates the pandemic, Jordan has yet to receive full shipment of the 3 million doses of the COVID-19 vaccine it purchased – enough to vaccinate 15% of its population.

And vaccinating its refugee population is no small task; Jordan is home to 660,000 registered Syrian refugees and an estimated 1 million Syrians in total. It also hosts 70,000 Iraqis, and tens of thousands of Yemenis, Sudanese, and Somalis, among others.

The well-being of refugees is not only a moral issue, but a national health challenge.

Warning of a “lost generation,” U.N. High Commissioner for Refugees Filippo Grandi has urged the international community to follow Jordan’s suit and include refugees in their vaccination plans. Lebanon has vowed that it, too, will be vaccinating refugees.

Noting Jordan is “proving how it should be done if we are to keep everyone safe,” Mr. Grandi says richer nations must help refugee host countries gain greater access to vaccines to ensure their pandemic recovery.  

A dose of dignity

Despite near-universal mask-wearing, refugee camps like Zaatari are risky because they are crowded. Prefabricated “caravan” trailers measuring 20 feet by 6 feet often house several people from multiple generations in what amounts to a single room.

Self-isolation was a dilemma for Khudewy al-Nabulsi, an artist who shares a caravan with his wife, seven children, and two grandchildren.

Refusing to go out and mix with other camp residents, he spent much of the last year in his trailer, producing paintings and designer greeting cards for customers remotely.

When he didn’t feel his best, Mr. Nabulsi would isolate himself in a corner of the family’s trailer, separated by a curtain, for days at a time.

“I have been waiting so long for this day,” he says, waiting for his turn for his first vaccine dose. “I am not just happy, I am extremely excited – a more normal life is around the corner.”

He described feeling emotional at being among the first in the country to be inoculated.

“Being told as a refugee that your life is worth just as much as a citizen is the highest form of dignity,” Mr. Nabulsi says as his name is called.

“A little mercy”

Mr. Ibrahim, the former farmer, shares two caravans among his seven children and five grandchildren. Just last week, a close friend, a Syrian schoolteacher, died suddenly of COVID-19 complications.

As nurses start to roll up his right sleeve, Mr. Ibrahim is jovial, joking with the nurses, but then turns philosophical afterward.

“After war and being displaced, we do not think about diseases often,” he says. “We just move on.”

Meanwhile, resentment from Jordanians is hard to find, if you find it at all.

Laith Aamer, a lawyer, is still waiting anxiously for his 70-year-old mother to have her turn to receive the vaccination. He and his family recovered from COVID-19 three weeks ago. But he says he harbors no ill will toward Syrians who got the vaccine before his family.

“When we say may God protect everyone from this virus, we mean everyone,” he says.

“People try to discriminate by nationality, ethnicity, class, or religion, but this pandemic proves that all our fates are tied together, from the very poorest to the very richest. ... We should all offer each other a little mercy.”