West News Wire: It felt nice after a long week of assisting 125 low-income Latino immigrants in finding their way to a mass vaccination station. But we also realized that at that rate, protecting everyone in danger would take years.
Covid-19 has disproportionately affected Latino immigrants. Low-income Latinos have been laboring to keep the economy moving and food on the table, allowing others to shelter at home, whether in metropolitan settings (from Los Angeles to Boston), in California farm land, or in Nebraska chicken factories. The toll on Latino immigrant populations has been quite severe, with more than three times the number of fatalities per capita as a result of a mix of occupational exposures and congested living circumstances owing to low-wage labor.
Despite the tremendous burden of disease represented by these high death rates, we are concerned that Latino immigrants may be overlooked in the vaccination rollout for a variety of reasons.
First, current vaccination priority algorithms, particularly those based on age, are inequitable. Almost 90% of white fatalities have been in persons over 65, whereas CDC data clearly show that more than one-third of Covid-19 deaths in Latinos and African Americans have occurred in those younger than 65. And, while cramped living quarters have likely aided in the fast spread of Covid-19 in immigrant groups, living in a crowded dwelling does not automatically qualify people for the vaccination.
As for essential workers, it’s one thing for a hospital employee to prove they are a healthcare worker, but another thing entirely for a day laborer getting paid in cash to show proof of occupation. Finally, while people all over the country are struggling with poorly designed websites and busy call centers, these approaches are particularly insurmountable for low-income Latino workers who lack the digital skills, language capabilities and time to overcome these barriers.
As data becomes available showing the disparities in vaccination rates, much of the media attention has focused on the problem of vaccine hesitancy among some minority groups, rather than the problem of unequal vaccine access. We think that’s a mistake.
Vaccine hesitancy is very real, especially among communities of color. Many Latino immigrants mistrust the healthcare system, in part because of a history of health system abuse in their countries of origin. The current rumor that the Covid vaccine results in infertility resonates strongly with Puerto Ricans and others who recall or were told about the infamous sterilization of women without informed consent in Puerto Rico between 1930 and 1970. Among undocumented immigrants, the fear of deportation and family separation is often front and center, and can dissuade many, including those in mixed-status families, to avoid seeking healthcare.
According to a recent Kaiser Family Foundation survey, about a third of Latinos say they will not get the vaccine or will do so only if required by work. But 70% want the vaccine. Among them, about 40% say they will get is as soon as it’s available to them, and the rest want to get it, but after they see how it goes with others.
Easy access is the best way to overcome hesitancy. In the Latino immigrant community, word of mouth is key and there is no more “trusted messenger” than your friend or family. So, let’s get the vaccine to those who are eager to get it, and let them encourage their friends and family to get vaccinated as well.
To be clear, we are not advocating for race or ethnic based prioritization of vaccine groups. We are simply asking that we follow the data by adopting an “age or place” approach to vaccine implementation. We know where the Covid-19 hotspots are. And it should come as no surprise, given Covid-19 disparities and segregated housing history in this country, that many hotspots are in high-density Latino, African American or Native American areas.
This is where we need to go to vaccinate. Working with trusted community organizations and leaders, easily accessible (ideally walk-up) vaccine clinics should be set up in heavily hit neighborhoods. Partnering with high-penetration pharmacies is also a good idea to facilitate access.
This will take some work, flexibility and investment. There is a long tradition of successful outreach by bilingual and bicultural healthcare workers (also known as promotors) to low-income Latino immigrants, but they need to be expanded and supported in this work. Vaccine messaging, in Spanish, needs to say loud and clear that the vaccine is available to everyone, regardless of immigration or health insurance status, and that their information is protected and will never be shared with Ice. Doctors who speak Spanish can be credible sources of information and debunk the many myths about the vaccine. Bilingual hotlines should be available for people with questions and concerns. Among the fears we hear, immigrants without a doctor tell us they worry about experiencing a side-effect to the vaccine and having no one to turn to.
All this can be done. Many groups did this successfully to expand access to Covid testing, and we can learn from that.
The Biden administration’s plan to distribute vaccine to community health centers and safety net hospitals is sound. But states need to ensure that their vaccine implementation algorithms do not disadvantage Latino immigrants. Moreover, outreach and access strategies need to be critically examined before attributing disparities to vaccine hesitancy.
Continuing the current approach is not only unjust and unfair to Latino immigrants; it makes no public health sense: high transmission rates in communities with low rates of vaccination will only increase the pressure on the virus to mutate and perhaps reduce the vaccine’s effectiveness.