Tensions between universality and equity in the access of racialised immigrants to the SUS in the metropolis of São Paulo during the COVID-19 pandemic

Abstract

Abstract This article presents data from an engaged ethnography conducted on political movements of immigrants in the city of São Paulo between 2020 and 2023. I initially analyse the vaccination campaign against COVID-19 among immigrants living in the peripheries of São Paulo, seeking to demonstrate that undocumented status had a limited effect on difficulties in accessing the right to healthcare, highlighting that even immigrants who had documents - and who were, for all intents and purposes, legally Brazilian - were unable to get vaccinated. Thus, I argue that racialisation processes are more decisive than undocumented status in defining who is eligible to access to that which is considered universal. The second argumentative axis reflects on the guiding paradigms of Brazil’s Unified Health System (SUS), and on the tensions observed in the discourses of certain actors involved in disputes in the field of healthcare, between the principles of universality and equity in the face of demands of certain specific health promotion actions for migrant populations. The paradigms of universality and equity are therefore considered mutually exclusive rather than complementary by these actors.