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The Vaccination Gap Among Hispanic Communities Reflects Barriers to Access

Barriers to vaccine access faced in many Hispanic communities — alongside the structural limitations communities of color generally face — stand in the way of higher vaccination rates, even as the vaccine becomes more widely available, according to public health experts and community health organizers.

March 29, 2021 / 04:03 PM IST
Representative image: Reuters

Representative image: Reuters

Hispanic people across the United States continue to be especially underrepresented among those vaccinated, according to a New York Times analysis of state-reported race and ethnicity information. The Hispanic share of the vaccinated population is less than the Hispanic general population in all states with large Hispanic communities.

Barriers to vaccine access faced in many Hispanic communities — alongside the structural limitations communities of color generally face — stand in the way of higher vaccination rates, even as the vaccine becomes more widely available, according to public health experts and community health organizers.

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There is limited access to the digital tools needed to secure an appointment, for instance, especially among those who are older and live in immigrant communities.

“Our folks don’t have emails, they don’t have computers at home,” said James Rudyk, executive director of the Northwest Side Housing Center in Chicago, which runs vaccine clinics in Belmont Cragin, a largely Hispanic neighborhood. “They have smartphones, but they are not navigating registration systems that want you to fill out pages and pages of information.”

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A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

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There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

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Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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And often information about vaccine eligibility and registration is only readily available in English.

“People didn’t even know that there was a vaccine when we talked to them,” said Gilda Pedraza, the executive director of the Latino Community Fund in Atlanta, which called hundreds of older Hispanic people in late February to organize a vaccine clinic, before the state health department had posted eligibility information in Spanish.

Counties across the United States with significant Hispanic populations are more likely to face technology and language barriers, as well as cost barriers to pursuing health care, and are less likely to have insurance.

Vaccine clinic organizers also report that Hispanic members of their communities, many of them uninsured, are unaware that the vaccine is free for all and have expressed concern about its cost. Some, especially essential workers with limited or no time off, say that they can’t miss work to get a shot or can’t afford to miss a day if they have side effects from the vaccine.

And while the Biden administration has stated that getting a vaccine will not affect a person’s immigration status, community health workers say this is still a major concern for immigrant families.

“Yesterday I received two calls from people who are in the process of trying to regularize their situation, and they were saying, ‘We would rather not have our vaccine, because what if they find out that we got it and it affects our immigration process?’ ” Pedraza said. “And I said, ‘You might not live to see your immigration process if you don’t get your vaccine.’ ”

A trusted health care provider who shares information about the vaccine can alleviate some of these barriers, according to public health experts. But Hispanic people are less likely to have an existing relationship with a health care provider. And counties with significant Hispanic populations are less likely to have dependable or regular access to health care.

Community health advocates who live and work in the neighborhoods they are helping to vaccinate are taking on some of this responsibility and sharing critical information about the vaccine.

“We had a nearly 20% no-show rate initially for our first day of second doses and we got that down to less than 2% with phone calls,” Rudyk said. “Lots of people thought one dose was enough.”

And while concerns about vaccine safety often come up, advocates say that talking through these fears, even if it takes time, helps people decide to get immunized.

“Seeing people like you, speaking like you, it is critical,” Pedraza said. “It is what changes behavior.”

States that partner with community-based organizations are administering the vaccine more equitably than others, said Rita Carreón, vice president of health at UnidosUS, a civil rights organization for Hispanic communities.

In the states included in The Times’ analysis, the gap between the Hispanic share of the general population and the vaccinated population has declined slightly since the start of the month. Widening eligibility for the vaccine in some states may be contributing to the narrowing gap, but public health experts say that barriers to access still play an outsized role in the disparity.

Federal efforts to close the vaccination gap for Hispanic Americans through community health centers, while limited in size, are having some success. While the Hispanic share of the U.S. population is about 18%, Hispanic people made up more than a quarter of those nationwide who received their first dose at a community health center, according to an analysis of federal data by the Kaiser Family Foundation.

METHODOLOGY:

The Times gathered race and Hispanic origin data for vaccinated people from state websites March 19 and March 20.

Race and ethnicity information is missing from a significant number of vaccination records across states, by as much as a third in some states. Subsequently, The Times removed from its analysis vaccination records with unknown or unreported race or ethnicity data. The Times excluded the District of Columbia as the ethnicity was unknown for half of its vaccinations.

States also vary in whether they include nonresidents among those vaccinated. States may or may not include people vaccinated by a federal program for long-term care facilities. The Times used population data from the 2019 American Community Survey. While some states include Hispanic people among racial categories, others report ethnicity separately. Total population figures were adjusted based on the method of race and ethnicity reporting in each state.

Surgo Ventures provided county-level data from its COVID-19 Vaccine Coverage Index, which identifies potential barriers to vaccine access. Indicators are based on the proportion of households that report various barriers, as follows. For the “access to information” indicator: no internet connection, no smartphone or limited spoken English; for the “health care cost barrier” indicator: no health insurance or not seeking care because of costs; for the “access to routine medical care” indicator: not making regular medical visits; and for the “regular doctor” indicator: no personal doctor or medical home.

(Authors: Amy Schoenfeld Walker, Lauren Leatherby and Yuriria Avila)/(c.2021 The New York Times Company)
New York Times

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