The uncomfortable truths about visa discrimination and global health conferencesBMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p78 (Published 23 January 2023) Cite this as: BMJ 2023;380:p78
For more than eight weeks, Lindiwe (not her real name) received no response to her application for a travel visa to Canada. A reproductive health advocate for women and girls in Africa, she was one of 883 health professionals from low or middle income countries who had received a scholarship to attend the 24th International AIDS Conference in Montreal in July 2022.
When she finally received a response, just two days before her travel date, her visa was refused by the Canadian government. Although Lindiwe’s scholarship covered all expenses for her stay, including accommodation and daily stipends, they determined she didn’t have sufficient personal funds.
To Lindiwe, it means that Canadian officials didn’t look at her documents, “they just saw an African passport and denied it.”
She says that had they properly reviewed her application they would never have mentioned insufficient funds as a reason for refusal. It was a huge opportunity to attend the largest HIV/AIDS conference in the world, one she had been preparing for for months. “I couldn’t make it and our booth for the exhibition was empty. It was all wasted,” she says.
Lindiwe’s experience mirrors the barriers faced by many health practitioners from low and middle income countries—often the sites of the highest burdens of global health conditions, and therefore at the forefront of discussions and debates about responses—who need to secure travel visas to participate in global health events.1
Visa denials are just one hardship. African health practitioners told The BMJ that in high income nations they encounter harassment at border controls and extreme checks at airports—both in terms of time delays and seemingly higher levels of scrutiny than non-African travellers.
A year of discrimination
That same July, Ugandan researcher Winnie Byanyima, who leads the UN AIDS agency, tweeted5 that she was “almost refused” to be allowed to board her flight at Geneva airport on her way to Canada to attend the same conference that Lindiwe had missed.6 She denounced an “unjust” and “racist” visa situation. Just a few months later, in October 2022, the acting head of Africa Centers for Disease Control (Africa CDC), Ahmed Ogwell, reported “mistreatment”7 at Germany’s Frankfurt airport as he was travelling to the World Health Summit in Berlin.
“It’s shocking that the head of a major global institution such as the Africa CDC would be prevented from exercising reasonable professional duties,” says Jesse Bump, a lecturer on global health policy at the Harvard TH Chan School of Public Health in Boston. “How could you have a conversation about world health without including someone like that?”
Boghuma Kabisen Titanji, a Cameroonian medical doctor and associate professor at Emory University in Atlanta, who was at the International AIDS Conference in Montreal, says that although African researchers and clinicians have a wealth of knowledge and experience, visa denials prevented them from sharing it with the rest of the world. “It’s not only frustrating, it reduces the value of the level of scientific discourse that can happen,” says Titanji.
“It doesn’t make sense to have global health conferences discussing health matters that affect African populations, with no Africans to discuss them,” says Catherine Kyobutungi, executive director of the African Population and Health Research Center, a Nairobi-based non-governmental organisation that works to drive policy action to improve the health and wellbeing of Africans. “The exclusion of Africans from conferences is part of bigger discriminatory practices and a symptom of a broken global health system.”
Bump, a US citizen and scholar of history and political economy of global health, withdrew his attendance from the 7th Global Symposium on Health Systems Research (HSR) in Colombia in October, after he realised that several participating members from low and middle income countries were unable to obtain travel visas to attend the meeting.
“I wanted to make a statement,” he says, “To my colleagues throughout sub-Saharan Africa and other parts of the world where people are similarly excluded, I wanted to say, ‘I see you; I’m aware of your value and centrality in discussions on matters that affect your region.’”
Overcoming the barriers
Petitions and boycotts are one form of action. For instance, Bump and Gitinji Gitahi, chief executive officer of Amref Health Africa, co-sponsored a petition against HSR to “hold its symposium and gathering of its members in countries that have no visa restrictions or agree to expedite processes likely to result in universal permission for HSR members to travel.” The symposium went on, but Bump hopes that the petition will spur his colleagues in high income nations to be aware of the discriminations and encourage them to add their voices to make global health conferences fair and more participatory.
Titanji urges international conference organisers to communicate with government officials in advance in order to help support delegates from low and middle income countries to attend conferences. Michelle Nyah Joseph, a trauma and orthopaedic surgeon at Harvard Medical School in Boston, agrees, adding that organisers need to inform embassies and border departments in advance about attendees, and should be prepared to provide visa support letters and think about travel grants to ease the cost of participation.
In 2021, Joseph and her team established the Equity Research Hub, an initiative that aims to promote equity in global health processes and collaborations. They’re currently developing a “conference equity index”—a set of metrics such as accessibility, costs, grants, scholarships, and diversity in attendees for conferences to measure their level of equity and to identify areas for growth. “With the index ratings we aim to assist conferences in facilitating equity,” Joseph told The BMJ.
But perhaps the biggest shift would be to bring the conferences to the people most involved. Just 4% of global health conferences were held in low income countries, according to a 2021 study on conference equity in global health published in BMJ Global Health.8
“Geographical location is one of the biggest barriers,” says Joseph, who led the study. Several systemic barriers limit the participation of health practitioners from low income nations, including high travel costs, visa restrictions, and lower acceptance rates for research presentations. Joseph says shifting the locations of conferences to visa friendly nations would significantly increase the participation of African health practitioners. “When you switch locations it makes a difference for people on the continent—that’s undeniable,” she says.
Kyobutungi wants to encourage funders to sponsor national and regional health conferences in Africa. Having conferences locally will bring African researchers together, who are more likely to question the impacts and benefits of health research on the African population. “You will have Africans talking about areas that matter to them,” says Kyobutangi. “That’s the fundamental value of science and research.”
Titanji is hopeful. “We’re beginning to see conversations around visa discrimination and people are becoming aware,” she says. “It’s uncomfortable, but it takes discomfort and being uncomfortable about what’s happening to create change.”
Commissioned, not externally peer reviewed
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.