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Hearts and Minds

Educating Latinos about vaccines is a challenge

By Alexander Estrada

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In the dizzying madness of this last year, Latino communities throughout the United States have been disproportionately affected by the coronavirus pandemic and its consequences.
The problem is structural as well as practical. Latinos were 3.1 times more likely than non-Latino whites to be hospitalized, and 2.3 times more likely to die from COVID-19 infection, noted the Center for Disease Control in mid-March, while Latinos have accounted for only 7% of people fully vaccinated nationwide. These disparities reveal not only how the pandemic has amplified existing health inequities for Latinos, but also the patchwork nature of local, state, and federal efforts to reach our country’s hardest hit communities.

In Texas, where Latinos are about 40% of the population, they constitute 48.8% of the state’s total deaths from the coronavirus and are only 20% of vaccinations so far. The pervasive underinsurance of low-income and especially undocumented Latinos, the uneven distributions of personal protective equipment (PPE) and testing, a widespread lack of bilingual and community-centric resources about the virus, conflict between state and federal officials, and the glaring digital divide in access to technology are some proximate causes. But beneath these hurdles is the insidious legacy of inequity in healthcare, which has inculcated fear and distrust within Latino communities of government programs, from federal efforts at mitigation to public health measures at the neighborhood level, even in the state capital of Austin.

“My ZIP code has the largest Latino population in all of Travis County. We have consistently had the highest number of positive COVID-19 cases. But if you look at a map of vaccine distributions, where we have over 50,000 residents, probably less than a thousand people have received the vaccine,” said Paul Saldaña, coordinator and leader of the Austin Latino Coalition. “This is what we’re experiencing in Austin, a city that prides itself on being liberal and progressive. Latinos across the country are going through the same thing.”

Few public health agencies nationwide have successfully implemented culturally relevant and bilingual programs that reach Latino communities on their own terms. The responsibility of implementing education and prevention campaigns has been taken up by organizations such as the Austin Latino Coalition, a volunteer network comprised of seventeen of the city’s long-standing organizations who feel their communities have been neglected by both elected officials and the infrastructure of public health. Between May and December of 2020, the Coalition provided over 18,000 families in the Austin area with masks, hand sanitizer, and other essential items.
“We have to be creative and innovative, but sadly we have unmasked the historic inequities that our communities have been subjected to. We ended up doing what we have been raised to do,” said Saldaña. “When we see people in our community, family members or friends, who need assistance, we are there unequivocally to lift them up and provide support because we are used to fending for ourselves.”

Trust, once betrayed, rarely returns. In a UnidosUS Latino Survey on Health Priorities conducted last October, 28% of Latinos reported they were unlikely to get the vaccine when it became available to them, while more than a third of Latinas said they were unlikely to get vaccinated as compared to 22% of Latino men in the sample. Among the reasons listed by respondents were fears of long-term health or side effects, the perceived cost, belief that it will be ineffective, and general distrust of the government. There is also uncertainty and misinformation surround the varieties of vaccines, and which are most effective or suspicious. These educational, historical, and cultural challenges, together with the ongoing economic and public policy hurdles, are greater than the sum of their parts.

“The only way you can change hearts and minds is educating people, giving them information in a way that makes sense to them,” said Jill Ramirez, CEO of the Latino Healthcare Forum, to the Austin-American Statesman. “When there’s a void, misinformation really takes root.”

One difficulty is that data on race and ethnicity continues to undifferentiated and vague at the federal level. While the transition to the Biden administration and the national rollout of vaccines have helped to build greater trust among Latino political and community leaders, available statistics about cases, mortality rates, and vaccinations at national and state levels evinces the need for a radically different and well-coordinated approach to the hardest hit, even as light has begun to appear at the end of the coronavirus tunnel. Many in the Latino community have been emphatic in highlighting local government and public health obstinacies such as in language and technology barriers, lack of access in low-income communities to medical facilities and testing, and fear of deportation at testing and vaccination sites.

Undocumented immigrants have faced inordinate difficulties in navigating a rapidly changing health landscape that is often broadcasted in English and devoid of cultural relevancy. Limited hours at testing and vaccination sites, for example, makes access a challenge for those working early in the morning until late at night. The looming fear of deportation, exacerbated by former President Trump, has given rise to a false dilemma for some: risk disease or risk deportation? While television networks such as Telemundo and Univision began last year to broadcast information and guidelines about the pandemic in Spanish, much more needs to be done at city and state levels in terms of bilingual communication and messaging. One solution is to place testing sites in familiar and trusted institutions, such as schools, churches, and community centers.

According to Saldaña, cities should meaningfully coordinate with community groups like the Austin Latino Coalition if public health organizations hope to overcome the terror of trust and enact justice in their distribution of vaccines, testing, and PPE. “What works best is the old fashion way—word of mouth,” he said. “They’re going to go to those trusted resources who are in the community, or they’re going to go to the prometoras who they already have a relationship with.”
The Biden Administration has taken an decisive step toward rectifying these structural and informational inequities through the creation of a COVID-19 Health Equity Task Force within the Department of Health and Human Services, which brings together twelve members from diverse backgrounds, racial, and ethnic groups to take lead in addressing the public health disparities revealed by the pandemic.

It is chaired by Dr. Marcella Nunez-Smith, associate dean for health equity research at the Yale School of Medicine, and has a few Latinos on board. One is Dr. Octavio Martinez, a native Texan, who is the Executive Director of the Hogg Foundation for Mental Health at The University of Texas at Austin. Another is Mayra Alvarez, President of The Children’s Partnership, an advocacy organization working on child health equity. According the White House press briefing from February, the mission of the task force is to ensure the “equitable allocation of COVID-19 resources and relief funds, effective outreach and communication to underserved and minority populations, and improving cultural proficiency within the Federal Government.”

This task force, when thinking about Latino communities across the nation through in-depth study and analysis, must build upon the work already begun by community organizers to identify communication strategies that can resonate with and improve trust among Latinos in the vaccine roll-out process. This includes finding not only the most effective conduits to transmit this information in neighborhoods, towns, and cities, but also means blending data and good sense to differentiate the messaging among Latinos, be it by age, gender, location, or ethnicity, to ensure that the community is not treated as a monolith. Recognizing that some of the most vulnerable communities have been suffused with misinformation about vaccines that can be refuted through bilingual and culturally relevant communication strategies is key to this endeavor.

While the pandemic has disrupted our society in many unexpected ways, the crises facing the most vulnerable communities are hauntingly familiar. The last year has illuminated the fissures of our nation, the long-untended cracks of healthcare equity and social justice through which many more Latinos will slip unless we reckon with radical change. Distrust in one facet of the government contributes to distrust elsewhere. Absent a new ethos of cultural competency and empathy in public health and government, at all levels, the promise of normalcy will remain distant and vague.

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