ABSTRACT
This study examines cooperation dynamics among actors in the US-Mexico border region of San Diego-Tijuana in relation to migrant access to healthcare and vaccination in 2020–2021 during the COVID-19 pandemic. It applies the lens of disease diplomacy and multilevel governance to understand the efficacy of partnerships as they relate to the Sustainable Development Goals (SDGs) 3, 10, and 17. The key findings reveal that civil society organisations (CSOs) and non-governmental organisations (NGOs), supported by international bodies, were vital in connecting migrants with healthcare services. On the other hand, state actors played a mixed role, which was differential across the border and which did not figure strongly within partnerships. Despite their crucial role, coordination challenges and institutional barriers for actors from all sectors were prevalent.
During the period studied, discrimination and inequitable access to healthcare indicated shortcomings in formal disease diplomacy, exacerbating inequalities and underscoring the need for inclusive health policies. Signs of a decoupled governance model were evident, wherein national health policies were inconsistently implemented at the local level, particularly on the Mexican side of the border. This led to unequal healthcare access and emphasised the need for integrated governance to bridge policy-practice gaps. To contribute to achieving SDGs 3, 10, and 17, particularly during global health crises, a robust and coordinated approach combining local initiatives with broader support systems is essential. Systemic reforms, formalised cooperation among diverse actors, and inclusive, non-discriminatory health policies are crucial for equitable healthcare access and reducing health disparities for migrants in the region.
