Access barriers have created a Hispanic vaccination gap.
Margarita Salas Crespo, a senior adviser to the Nevada Governor’s Office, knew that the process of getting the state’s Hispanic population vaccinated for Covid-19 would be challenging before it had even begun.
Hispanics in Nevada had already suffered disproportionately from the virus: They are more likely to test positive for Covid-19 than any other ethnic or racial group in the state and have experienced high levels of unemployment as the state’s tourism-reliant economy was shut down.
They were also the least likely to to get a Covid-19 test due to inadequate access and outreach, a trend Salas Crespo and others worried might be replicated when it came time to vaccinate.
“I think it really did give us a sense that it was going to be a little bit tough for the vaccination rollout,” Salas Crespo said. “The state of Nevada and also our local governments started thinking that we’re going to have to really target the Spanish-speaking community to ensure that they’re getting the information that they need.”
Those concerns have since been borne out, as data shows clear disparities in vaccination rates between Hispanics and other racial and ethnic groups, both in Nevada and nationwide.
As of April 7, just 15 percent of Hispanics in Nevada have received one dose of the vaccine as compared to 29 percent of non-Hispanic white people, according to a Kaiser Family Foundation (KFF) analysis of data from 41 states that track the race and ethnicity of people being vaccinated. Nationally, it’s 16 percent of Hispanics compared to 29 percent of white people.
“Those are disparities that we’ve seen since we began tracking the data and they’re persisting over time,” Samantha Artiga, vice president and director of the racial equity and health policy program at KFF, said.
So what’s driving the disparity? The answer, experts say, is twofold: initial vaccine hesitancy and a lack of access.
“I think a lot of this reflects increased access barriers that are associated with underlying inequities,” Artiga said.
Some Hispanics were initially hesitant to receive the vaccine
A small, but significant proportion of Hispanics were initially hesitant to receive a Covid-19 vaccine.
According to a January KFF survey, 7 in 10 Hispanic adults were willing to get the vaccine, but only a quarter said they would do so as soon as possible; almost half said they would wait and see how others were reacting to the vaccine before they got it themselves.
The greatest skeptics were younger Hispanics under the age of 50, who were less trusting of vaccine information from political sources, such as state government officials, President Joe Biden, and his chief medical adviser Dr. Anthony Fauci.
Now that broad swaths of the population are being immunized, willingness to get the vaccine has been increasing across racial and ethnic groups, Artiga said. At this point, there isn’t a meaningful difference in the willingness of Hispanics and the non-Hispanic white population.
But among those who were or are now still skeptical of the vaccine, experts say misinformation on social media has played a pivotal role in shaping their views. Non-native English speakers who might not turn to vetted sources of information, such as newspapers and announcements from government officials, have been especially vulnerable as false rumors about the vaccine have circulated largely unchecked on platforms including Facebook.
“As in any other community, there is a lot of fake news — the really ludicrous idea that you are being implanted with a microchip, [or] that the vaccine will give you the actual disease or will kill you,” said Julián Escutia Rodríguez, consul at the Mexican consulate in Las Vegas who has been advising state and local policymakers on the vaccine rollout in the Hispanic community.
Policymakers and public health groups in some states have consequently made concerted efforts to run counter-messaging on social media, in both English and Spanish. The Nevada government has created two Spanish-language campaigns — “Está en tus manos,” which translates to “It’s in your hands,” and “Seguir adelante,” meaning “Go ahead” — to educate people about the vaccine, how they can get it, and why they should continue to practice social distancing and wear masks even after they are inoculated.
Private groups have also stepped up to amplify that messaging. The Culinary Workers Union has held several bilingual virtual town halls with doctors, health care professionals and others to answer workers’ questions about the vaccine. Their aim is not just to communicate that the vaccine is a public health imperative, but that it’s also an economic one.
“A lot of jobs were completely gone because of the pandemic,” said Geoconda Argüello-Kline, secretary-treasurer for the Culinary Workers Union, the largest union in Nevada that represents around 30,000 Hispanic workers. “We need to bring back Las Vegas. If more people get protection, that’s the only way we’re going to go back to the way things were, little by little.”
Those messaging campaigns, and the simple fact that more time has passed and millions of people have now gotten the vaccine safely, have helped decrease some of that initial vaccine hesitancy.
Hispanics continue to face barriers to accessing vaccines
While most Hispanics are now willing to get the vaccine, they continue to face barriers to accessing it. This is due to underlying inequities in the health care system, fears about potential immigration consequences, and limited English and technology skills.
As of 2019, non-elderly Hispanics were more than twice as likely as their white counterparts to be uninsured. Coverage rates have likely only declined during the pandemic as Hispanics have suffered disproportionately from high unemployment and may have lost their employer-sponsored coverage.
That means that they may have more concerns about the cost of the vaccine. And although it’s supposed to be available for free, some people have reported being erroneously billed for it.
Hispanics are also more likely to report difficulty traveling to a health care facility because they may rely on public transportation or not be able to take time off work. In Nevada, public health officials have set up vaccination sites near where Hispanics live and work, including in a number of major hotels along the Las Vegas Strip, in order to address this. Other states have allocated more vaccine doses to hard-hit, heavily Hispanic areas.
The Biden administration has also sought to meet Hispanics where many of them already get their medical care by setting up vaccination clinics at nearly 1,500 community health centers nationwide. A March KFF report found that over a quarter of people who had received their first shot from community health centers were Hispanic, suggesting that they were doing a better job of penetrating the community compared to other health care facilities.
“That really reflects the longstanding role those centers have played as sources of care for low income populations, people of color and particularly the Hispanic population,” Artiga told me. “They already have an established trusted relationship with the population, they know the barriers that they potentially face to getting care or a vaccination and they know how to address those barriers.”
For recent Hispanic immigrants, language barriers have also posed an obstacle to accessing health care, which has historically made them more likely to experience adverse health outcomes than fluent English speakers. Absent Spanish-language information campaigns, they might not know how to sign up for the vaccine, or that they are even eligible as non-US citizens.
Salas Crespo said that one of her office’s immediate priorities in planning the vaccine rollout was setting up statewide toll-free phone lines so people could talk to someone in Spanish or another language and be guided through the registration process or learn where they can get the vaccine.
For those living in the US without authorization, the fear that seeking medical care could lead to their deportation also serves as a deterrent. That fear only ramped up under former President Donald Trump, who publicly derided Mexicans and sought to clamp down on unauthorized immigration from Mexico and Central America.
Nevada’s government has sought to allay those concerns by assuring people that they are not sharing data about immigration status with the federal government, including immigration enforcement agencies, and that they can bring any kind of photo ID, such as a consular ID, to get their vaccine.
The Mexican consulate in Las Vegas has also been holding vaccine clinics on its premises. “Opening the consulate of Mexico for the administration of vaccines is a very symbolic gesture because people feel they trust us,” Escutia Rodríguez said. “They feel confident coming here. They feel at ease. It doesn’t matter where you come from, if you’re undocumented or not.”
Some Hispanics might not have adequate internet access to be able to register for the vaccine and confirm appointments. “We cannot make the assumption that everybody has access to internet,” Carlos E. Rodríguez-Díaz, a professor at the Milken Institute School of Public Health at George Washington University, said. “We have a significant amount of people in Latino communities in the United States that do not have access to that technology, nor may know how to use it, even if they have access.”
Rodríguez-Díaz said that the states that acknowledged these kinds of disparities early in the vaccine rollout have fared better in vaccinating Hispanics. But there is only so much public officials can do in a period of months to overcome longstanding barriers to accessing health care.
“We all know that access to health care is not equitable at all throughout the country and this global pandemic just really highlighted how bad it really was,” Salas Crespo said. “I hope it will change how we do things.”
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