Covid-19 vaccines: How we can get more to Latino communities

The Covid-19 pandemic has been especially deadly for Latinos in the US. Compared to whites, they have been 30 percent more likely to get infected with the coronavirus — and almost two and a half times as likely to die from it. Now, with three authorized vaccines, there is a chance to start closing these gaps.

But so far, Latinos have also been getting vaccinated at low rates.

The latest numbers this week from the Centers for Disease Control and Prevention show that of the 61 million people who received at least one vaccine dose and whose ethnicity was reported, Latinos made up only 8.5 percent — a ratio far below their share of the overall US population, 18.5 percent.

Over the past few months, vaccine hesitancy among minorities, including Latinos, has received a lot of media coverage. It is certainly part of the reason why few Latinos are getting vaccinated. Some lack trust in the health care system; others worry about sharing personal information with large institutions. My colleagues and I have also found that many are concerned about the cost of vaccination. (The vaccine is free to anyone living in the US but not everyone may realize this.) Others have unfounded but widely accepted misbeliefs about vaccine risks.

But for millions of Latinos, the larger problem is not hesitancy, but access. America’s vaccine delivery system is designed for people who have computers or phones, who speak English, who have their own transportation, who have flexible schedules, and who do not live in fear of being arrested or deported. For those who don’t fit this profile, getting vaccinated can be very difficult.

How can we fix this? We must go where the need is and actively bring vaccination to Latino communities.

I have spent my career bringing care to marginalized groups in this country and all over the world, from people with substance use disorder to those living in remote rural communities. In the US, health care organizations often assume that people have the resources to find and obtain the health care they need. For many, this is true. But for others, including many millions of Latinos, it is not. We need to realize this and adjust our approach accordingly.

For the past year, my colleagues and I have led a local program in Baltimore, Maryland, that has successfully brought Covid-19 testing and support to thousands of Latinos. And last month we began vaccinating people in the community. To ensure that Latinos across the country are properly protected from the virus, we must replicate this approach nationwide as soon as possible.

The burden of Covid-19 in Latino communities makes vaccination there even more urgent

Latinos have been among those who have fared the worst during the pandemic. According to not-yet-published research by me and my colleagues, in many Latino communities, the positivity rate — the percentage of people who test positive for Covid-19 — has been above 30 percent, which is astronomical. (Anything above 5 percent is considered alarming.)

These high case rates have also resulted in a disproportionate number of deaths. The disparities in Covid-19 deaths have been more dire for certain age groups: Through June 2020, among those between age 45 and 54, the death rate for Latinos was six times higher than for whites. For those between 35 and 44, it was eight times higher. And the virus may be killing many more Latinos than these numbers indicate. In 2020, the overall death rate among Latinos was 53 percent higher than in previous years. By comparison, the number of excess deaths was 33 percent higher among Blacks, and 12 percent higher among whites.

There are many reasons for these shocking disparities. Many Latinos work in front-line jobs that cannot be done remotely and thus have a higher risk of exposure. Latinos also have higher rates of poverty and are more likely to live in crowded dwellings that can accelerate the spread of Covid-19. They are less likely to be connected to the media or public health infrastructure and tend to have less access to health insurance and health care. One result of this is that Latinos also have higher rates of chronic health conditions, such as obesity and high blood pressure, which can make Covid-19 more dangerous.

Together, these factors make the lower vaccination rate among Latinos all the more alarming. But this outcome is not inevitable. There are proven ways we can get more Latinos vaccinated and rapidly slow the deaths still happening in so many of these communities.

How we’re helping to get more vaccinations to Latinos in Baltimore

To get as many people in the US vaccinated as quickly as possible, centralized mass vaccination sites have been incredibly helpful. But as effective as this strategy can be, it still misses many people.

In addition to mass vaccination, the federal government should work with state and local public health authorities, as well as large service corps such as the National Guard, to develop a comprehensive effort to hold regular vaccination events in predominantly Latino communities across the country. This work should be done in collaboration with local community-based organizations such as churches and community centers, which have already forged close connections with residents.

In many, if not most, Latino communities, much of the infrastructure for this effort already exists thanks to other pandemic efforts. Local groups across the country are deeply integrated into these locales and have organized other responses such as delivering food, helping people get tested, and providing accurate information about the vaccines.

What these groups often lack, however, are the resources to actually vaccinate people. Vaccination requires medical expertise, protocols for cold chain storage, and community health workers who can perform vaccinations. That’s where the federal and local governments come in. By combining technological expertise with local knowledge and contacts, government and local groups can work together to widely distribute vaccines in Latino communities nationwide — and much more effectively than if either were to try to do it on their own.

This model can work, as we have seen from our work in Baltimore over the past year. Last spring, as several colleagues and I realized that Baltimore’s Latino population had incredibly high rates of Covid-19 compared to other groups, we knew that the community wasn’t getting enough information about how to stay safe, and didn’t have equitable access to testing.

In response, we helped create a Spanish-language Covid-19 hotline there, as well as an open-air testing center at a church in the heart of the city’s Latino community. Initially, we encountered skepticism and mistrust: Who were these strangers in scrubs at their church? But we soon earned people’s trust and they told their family and friends, who told their family and friends. The initiative has tested more than 4,000 people so far.

Last month, we began using the same model for vaccinations. But we needed more assistance, so we collaborated closely with the National Guard, which provided the vaccine doses and logistical support. Working together, we set up a weekly vaccination site in the gym of the Catholic school next to the church. Drawing on the list of patients we’d gathered from testing, we called people who were eligible for vaccination.

We vaccinated 176 people the first day; most of them were low-income Latinos, about 80 percent of whom did not speak English. There is no way to know for sure, but from our conversations with these people and those who have gotten vaccinated at the site since, it seems unlikely that any of them would have been vaccinated any time soon without this effort.

Some of those who were vaccinated had questions or concerns about side effects, but for the most part they were eager to participate. Some were so thankful that they shed tears of gratitude after receiving their shot, and asked how they could refer their friends and family to get vaccinated. For this group, it turned out that the obstacle was not vaccine hesitancy, but lack of access. They simply didn’t know how to connect with the other vaccination processes.

We need to implement a similar plan in Latino communities and neighborhoods across the country, with assistance from the federal and local governments.

And the clock is ticking. With Covid-19 variants gaining speed and threatening to increase transmission and potentially reduce vaccine efficacy, we need to reduce our vulnerability by vaccinating as many people as quickly as possible.

These new variants are most likely to take hold in communities that already have high levels of infection. This means we must do much more to vaccinate everyone — no matter where they were born, how much money they make, or what language they speak. Their lives, and the lives of many others, hang in the balance.

Kathleen Page, an associate professor at the Johns Hopkins University School of Medicine, is an expert on Latino health disparities. Page, who was born and raised in South America, helped create a Spanish-language Covid-19 hotline for immigrants in Baltimore, as well as a testing and vaccination site in the city’s Latino community.

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