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As an undocumented construction worker living outside Miami, Miguel is constantly challenged to prove that he exists. Police hassle him for an ID he doesn’t have. Without one, he can’t open a bank account or fill a prescription.
And now, it means he can’t get vaccinated against the coronavirus.
After a handful of out-of-towners made headlines for flying into Florida to get vaccinated, the state announced a crackdown on “vaccine tourism” in January. To get a shot, residents would now have to submit documents verifying that they lived there.
Requiring proof of identification can help ensure that scarce doses go to the people who need them most, government officials and providers say, and help reduce racial and income disparities in a vaccination campaign that has so far disproportionately reached white and affluent people.
Sometimes, though, those rules are keeping out the very people they aim to protect.
Miguel, who asked that his last name be omitted out of concern over his immigration status, has lived in Florida for more than 30 years since arriving from Colombia. But without documentation, the 68-year-old told BuzzFeed News that he’s been turned away from a vaccination site twice, even though his age qualifies him for a shot.
Miguel is one of a number of vaccine-eligible people who have been turned away from vaccination sites that deem them unable to prove identity or residency. In some cases, BuzzFeed News has found, eligible people are rejected even when they show up with documents that fit the site’s stated rules, highlighting a patchwork of inconsistent and sometimes arbitrary policies across vaccination centers. While officials have imposed ID requirements with the stated intent of making vaccine distribution more equitable, they have also created barriers for many in high-risk populations, including undocumented immigrants, older adults who don’t drive, and people experiencing homelessness.
In response to the incidents described in this story, Walgreens, Albertsons, and the Los Angeles County health department said they were reviewing their vaccination policies to make sure people who qualify aren’t turned away.
“We require IDs for things like vaccines because there’s just an assumption: ‘Well, everyone must have one,’” said Kat Calvin, founder of Spread the Vote, a nonprofit focused on helping people obtain government-issued photo IDs and getting them to the polls. Up to 11% of adults in the US — or more than 21 million people of voting age — lack such an ID, according to a 2006 report from the Brennan Center for Justice. Older adults, people of color, and people with low incomes were less likely to have one, the survey found. “We have a huge ID crisis in this country, and it affects everything,” Calvin added.
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As more people become eligible for vaccines, health officials are grappling with how to cut down on line-jumping while getting shots to those at the highest risk of severe symptoms — a dilemma complicated by the country’s fragmented healthcare system. Those with the time and resources to insist on being served stand to be protected against a deadly virus. The rest are in danger of being left behind.
When Florida initially opened its vaccine appointment system to adults 65 and older, it didn’t make residency a requirement. People from all over the world — Argentina, Mexico, New York, Canada — hopped on planes to the Sunshine State. “Already vaccinated!!” a Mexican TV host tweeted in Spanish from Miami. “Thanks #usa what a shame my country couldn’t grant me that security!!!”
Floridians erupted. Watching out-of-towners appear to cut the line felt like yet another insult to older adults navigating a dysfunctional rollout, fighting for slots on Eventbrite and sleeping in their cars while waiting their turn.
On Jan. 21, the state unveiled a list of documents that people would have to present to prove their residency. While Gov. Ron DeSantis said at the time that people who live there during the winter were eligible, he added, “To just kind of come in from another country or whatever, we don’t support that, and we’re not going to allow that.”
It was one of the first and clearest instances of the struggle to balance two seemingly opposing forces: the desire to distribute the vaccine far and wide, and the need to prioritize precious doses for those who need it most.
As the vaccine rollout has ramped up, New Mexicans have been traveling to Texas for shots, and Georgians to Alabama. These states and others — including Arizona, Colorado, Iowa, Minnesota, and Nevada — say they won’t turn away visitors.
Meanwhile, Kentucky, Maine, Mississippi, New Hampshire, New York, North Carolina, Oklahoma, and Washington, along with Florida, have taken the opposite tack, reserving shots for those who live or work there. The Centers for Disease Control and Prevention has told states that they can decide to restrict vaccinations to residents “as long as the policy is intended to promote public health aims, such as reaching priority populations and promoting equity.”
At a vaccination center in Washington Heights, a Latinx-majority neighborhood in New York City, suburbanites were getting appointments, according to the City, a local news outlet. The story led the center to reserve all new slots for city residents, with 60% going to residents of Washington Heights, Inwood, Northern and Central Harlem, and the South Bronx.
And in Philadelphia, the Black Doctors COVID-19 Consortium recently announced that to get vaccinated, people under 75 would have to show they live in a zip code where hospitalizations and deaths were among the highest in the city.
“The number of individuals with no health conditions who have never set foot in Black neighborhoods [coming to get vaccines] in the past month has been unconscionable,” the group’s founder told reporters in February.
The cost of keeping out vaccine tourists, though, is potentially excluding those without state-issued IDs or proof of residency, such as people who are unhoused or were recently incarcerated.
In Florida, immigration advocates questioned whether a residency requirement was a proportional response. Should a state of 21 million people, including an estimated 775,000 undocumented immigrants, craft a policy to turn away outsiders? More than 80,000 out-of-staters have gotten vaccinated in the state so far, though that includes people who live in Florida part time and have permanent addresses elsewhere.
“In the great scope of things, I think it’s statistically insignificant to worry about these narrative cases of people flying in and getting vaccinated,” said Thomas Kennedy, the Florida coordinator for United We Dream, an immigrant youth-led advocacy group. “That doesn’t merit enacting these restrictions that carve out big portions of our most vulnerable and exposed populations from vaccination.”
Florida does not require proof that someone is a US citizen or permanent resident, just that they live in the state. Acceptable documents include gas bills, mortgage and rental agreements, and bank statements.
Miguel, the day laborer outside Miami, doesn’t have any of those forms. He moves homes often, he said, and currently lives in a three-bedroom house with four roommates. His name isn’t on any utility bills or rental agreements.
After a severe bout of COVID-19 landed Miguel in the hospital last fall, he hopes to stave off another infection. But many others in the Latinx community are wary of the vaccine, said Oscar Londoño of WeCount, an advocacy group for migrant workers and others who make low wages in South Florida. Throwing proof of residency into the equation, he said, doesn’t make it easier to persuade people who might be distrustful of the government and medical establishment.
Adonia Simpson, a family defense attorney for Americans for Immigrant Justice, a Miami-based nonprofit law firm, is worried that eligibility policies advertised as based on “proof of U.S. residency” — a phrase that she recently spotted in a local hospital’s social media post — might mislead some people into thinking the requirement is tied to immigration status. “We have a lot of concerns that people who may be eligible may deem themselves not eligible because of that messaging,” Simpson said.
The Department of Homeland Security has affirmed that everyone should have vaccine access “regardless of immigration status.” Several states explicitly say on their websites that status is not a hurdle to getting vaccinated.
Those policies, however, are not always followed by those who are handing out the doses. Even though Texas does not have a residency requirement, Abraham Diaz told a local radio station that his father was turned away from a clinic at the University of Texas Rio Grande Valley for showing up to his appointment without paperwork. “[Dad] said that [the health worker] told him in front of everybody, ‘You don't have a social, so we can’t help you at all. And it’s only for US citizens,’” Diaz said. The university later apologized.
In High Point, North Carolina, Laura Zambrano Duran, 85, was unable to get a vaccine at her local Walgreens pharmacy because an employee said she needed a North Carolina ID, even though the state hadn’t yet tightened its residency guidance. In October 2019, she had flown from Colombia into the US for a six-month family visit that she had to extend indefinitely when the pandemic hit. Only when she scheduled an appointment at another site, a hospital, did she learn that her Colombian passport was enough to confirm she met the age requirement.
Phil Caruso, a Walgreens spokesperson, said that the company’s stores ask for ID to confirm that a person is vaccine-eligible and that, unless specifically required by a jurisdiction, they do not deny individuals who lack ID. Regarding Duran’s case, he said, “We are reviewing our procedures with the store to avoid this from occurring again.”
Rene Trujillo was eager for his mother to celebrate turning 88 with the ultimate birthday present: getting vaccinated. So last month, Trujillo and his wife, who live in Seattle, booked an appointment online for his mother at a Vons pharmacy near her home in Bakersfield, California.
The pharmacy’s registration website was light on instructions, simply stating that she ought to bring a “photo ID verifying age requirement.” Trujillo’s mother, a US citizen, has lived in California for more than a dozen years but does not have a driver’s license. So to be safe, Trujillo said, she showed up with an armful of documents: an ID from Florida, where she used to live, her passport, and her Social Security and Medicare cards. (Disclosure: Trujillo is a relative of one of the authors of this story.)
Upon arrival, a Vons staffer told her that she needed a California ID, refused to look at her other documents, and turned her away, Trujillo said.
“She’s been in this country for 55 years, been a citizen for 50 years, and she feels like, if this is the kind of treatment she’s getting, what are other people receiving?” Trujillo said of his mother, who declined to be interviewed. “She’s unwilling to go through this process of a potential humiliation again.”
Andrew Whelan, a spokesperson for Albertsons, Vons’ parent company, said that its practice is to accept documents that verify a person’s eligibility as defined by the local health department and that the “incident as described does not reflect how we expect our policies to be applied.” He said that the company was contacting its pharmacies in the Bakersfield area to ensure they were aware of these policies.
Even in a state with a vaccine rollout “based on eligibility irrespective of residency or immigration status,” Californians have encountered unexpected hurdles at local sites.
In Sacramento County, Emily Jones, a 33-year-old caregiver for her brother, showed up to her appointment at a Safeway in Elk Grove with three letters of approval — from the local health department, the in-home care agency her family works with, and her mother, who is technically her employer. Though the pharmacy’s website listed such letters as proof of eligibility, Jones said, the employee at the vaccine station would only accept a W-2 or a pay stub, neither of which she has because her mother pays her by personal check.
Bewildered, Jones tried a different Safeway in the same county. She walked out with her first dose within the hour. Whelan, the spokesperson for Albertsons (which also owns Safeway), said the company was also circling back with pharmacies in the Sacramento area to make sure they are following local guidelines.
In Los Angeles County, Bri, who asked that their last name not be published to protect their privacy, had to argue with staff at a county-run vaccination center to compel them to give their father the Pfizer vaccine last month.
Because he had lost his driver’s license, Bri’s father, a 65-year-old Mexican American man who lives in a multigenerational household, brought his Medicare card and a utility bill to his first appointment, both of which are on the county’s list of acceptable documents to prove age and residency. (The county has since updated its rules to require people 65 and older to also bring a photo ID.) But a nurse, supervisor, and the site director initially refused to give him the shot because he didn’t have a photo ID.
“I just kept telling [the supervisor], ‘Show me that he is required to provide that,’” Bri told BuzzFeed News.
The site director eventually agreed. But three weeks later, when their father returned for his second dose, staff tried to deny him again — even though he had his vaccination record card and a photo ID from an old job, the two documents the county requires for the second appointment. This time, workers at the vaccine site claimed that he needed a government-issued ID with his birthdate, according to Bri.
In response to questions from BuzzFeed News, the county’s public health department confirmed that ID cards only need to have the person’s name and photo. The department says it requires a photo ID for the second dose because ineligible people have tried to game the system with fraudulent or forged vaccine cards.
The county health department doesn’t track how many people are turned away, but it said those who are eligible and have appointments, like Bri’s father, represent “a relatively small number” of people who are denied and that staffers “may have been confused.” The agency said it would follow up with workers “to make sure they understand when a photo ID is needed and when it is not required.”
Bri said, “I understand the concern around somebody taking something that isn’t theirs, but at some point we all need to get vaccinated anyways, so why are you giving these old people a hard time?”
COVID-19 vaccine shortages across the US have ignited a fundamental urge: to get to the front of the line.
“I don’t know how we solve this problem, this very American idea that you just jump in the car and drive to solve your problem,” said Nancy Berlinger of the Hastings Center, an independent bioethics research institute. “It may be left over from almost a year ago, when people were running to Target to buy out all the toilet paper: ‘I need 12 jumbo packs, and I don’t care about the 11 people behind me.’ No, there’s going to be a dose for everyone.”
Vaccine distribution is in the hands of a myriad sources, some of which have only come online during the Biden administration: private insurers, sites run by local and state public health departments, pharmacies, community health centers, FEMA-staffed mass vaccination sites. No single one of these providers can easily identify and contact everyone who’s eligible.
Instead, health departments, private employers, and advocacy organizations must each figure out their own solutions for getting vaccines to the people with high rates of comorbidities.
In Santa Cruz County, California, a hospital partnered with a group of agricultural producers to organize a vaccination clinic specifically for farmworkers. Growers handed over lists with names of their employees and then told the workers when and where to show up. All the laborers had to do was say their name and birthdate. “We did 1,300 farm workers in two days with five days’, six days’ notice,” said Thomas Am Rhein, cochair of the Santa Cruz County Farm Bureau's COVID task force.
In Los Angeles County, where everyone 65 and older currently qualifies for the vaccine, providers have been advised to accept self-declarations that a person experiencing homelessness meets the age requirement if they lack ID, the health department told BuzzFeed News. It acknowledged that “many residents in this group may not possess identification.”
People should be given as many options as possible to prove their eligibility, advocates say. Kelly Orians, co–executive director of a nonprofit called the First 72+, which helps formerly incarcerated people transition back into society, said vaccine providers could allow witnesses to attest to a person’s identity or have them sign an affidavit to affirm their eligibility. This system would be similar to how provisional ballots are given to people whose voter registration status is uncertain to ensure no one is turned away.
For now, Miguel is continuing to work on-site with construction crews in Florida while waiting for a vaccine.
With the advocacy group WeCount, he’s lobbying for Miami-Dade County to adopt a municipal ID card that would allow residents to access local services, from using the library to getting the vaccine, regardless of immigration status. The idea has been floated before, most recently in 2019, but the vaccine residency requirement “created a sense of urgency to bring this back,” said Eileen Higgins, a county commissioner who is working on the measure. In the meantime, all Miguel can do is try to avoid ending up in the hospital again.
“If we don't get vaccinated, the contagion will keep spreading,” he said in Spanish. “It’s hard. And the authorities have known about this for a while. So I don’t know why they won’t give us some form of ID. As workers, we need it.” ●
Ken Bensinger contributed reporting to this story.
This post has been updated with Los Angeles County's new documentation requirements for people 65 and older to get a vaccine.