By Beth Howard
For weeks, the Latinx day workers who gathered each day at the Home Depot in Baltimore, Maryland, promised that they would get a COVID-19 vaccine. “We would make appointments for them, but they just wouldn’t show up,” says Alejandra Flores-Miller, one of a small team of community health workers employed by Johns Hopkins School of Medicine to promote vaccination among the Latinx community.
So the determined group shifted strategies — they brought the vaccines to the workers. “On the first day there with our mobile clinic, we vaccinated 50 people,” Flores-Miller says.
The community health workers have also canvassed restaurants, bars, barbershops, and laundromats, distributing flyers and sometimes even people directly to the vaccination site — the gym of Sacred Heart of Jesus Catholic Church, which sits in a predominantly Latinx community. “Trust comes from them seeing that we are of their community,” says Flores-Miller.
The result of all that legwork: Since February, more than 5,000 members of the city’s Latinx population have received a COVID-19 vaccine.
In similar efforts around the country, community organizations, health departments, and academic medical centers are taking on one of the biggest challenges of the pandemic response: vaccinating Latinos, who are often disproportionately affected by the disease. These initiatives have had to overcome barriers common to Latinx communities — fear of deportation among the undocumented, concern about having to pay for the shot, and inability to take time off from work or duties as parents and caregivers to get vaccinated.
Now, new research from the Kaiser Family Foundation shows that many of these efforts are paying off. Unlike earlier in the vaccine rollout, similar proportions of Hispanic (73%), Black (70%), and White (70%) populations report having received at least one dose of a COVID-19 vaccine.
Here are three programs that have made a difference.
Baltimore, MD — Johns Hopkins University School of Medicine
Latinos make up only about 5% of Baltimore’s population, according to infectious disease specialist Kathleen Page, MD, an associate professor of medicine at Johns Hopkins and head of the vaccine effort. “But at one point, half of people in ICU beds were Spanish-speaking,” she says.
To turn things around, Page used organizational strategies she already had in her back pocket. In 2008, she’d assembled a team of health care personnel to address the AIDS epidemic. Last year she was able to pivot their efforts to COVID-19, starting with testing in tents set up in Sacred Heart’s parking lot. The group also launched a Spanish-language hotline to get the word out.
In the early days, as many as 40% of tests the team administered were positive. So health care workers doubled down on contact tracing and responded quickly to those who tested positive so they could begin isolating, including in quarantine hotels.
“Once the vaccines became available, we switched to vaccination at the same site,” Page says. “We became known as the place to go if you speak Spanish.”
The group has relied on community partners, including the Mayor’s Office of Immigrant Affairs and the Esperanza Center, a Catholic charity that provides legal and other services to immigrants. At the same time, the National Institutes of Health provided funding to produce vaccine-related educational materials in Spanish. “A lot of people have stepped up to the plate,” Page says.
The effort got a boost when local journalist Pedro Palomino took up the cause last March. Every Friday since then, Page and the head of the mayor’s office have appeared on his Facebook video show “Tu Doctor y Tu Municipalidad,” where they explain things like how the vaccines work and take viewers’ questions.
The team has had to tweak its tactics over time to boost vaccinations. “We used to say no IDs are needed to get a vaccine but bring something with your name on it,” says Ben Bigelow, a former medic and third-year medical student at Johns Hopkins, who has taken a break from his training to help lead the COVID-19 response. “But even that hindered some people from coming. Now we strictly say, ‘No ID needed.’”
The work seems to be paying off. Despite the rise of the Delta variant, “We’ve seen an enormous decline in cases in this community,” Page says.
Charlottesville, VA — University of Virginia School of Medicine
As soon as COVID-19 appeared, Max Luna, MD, associate professor of cardiovascular medicine at University of Virginia (UVA) School of Medicine in Charlottesville, knew that his community’s Latinx population would encounter roadblocks to getting tested. “We saw many institutions saying, ‘We’re happy to give you a COVID test for free. We just need your primary care physician to refer you,’” he says. “But 50% or more of Latinos don’t have a primary care physician.”
That was just one of the challenges Luna faced when addressing the COVID-19 pandemic. Fortunately, eight years ago he had helped to form UVA’s Latino Health Initiative, which offers multiple health programs for Latinos in a five-county region around the city, and could rely on this infrastructure to test, and later vaccinate, Latinos.
Between November 2020 and March 2021, the group and community partners, including the Blue Ridge Health District and UVA Health, the University’s affiliated health system, paved the way for the vaccines, first through a series of educational messages on Spanish social media and flyers distributed to stores, restaurants, and churches and then through focus groups to fine-tune their messaging.
“From these groups, we designed an approach that emphasized respect,” Luna says. “We never start or end a conversation with a community group or an individual without saying that getting the vaccine is a personal decision.”
When health care workers promoting the vaccines encounter skeptics, says Luna, “We focus more on the convenience, like ‘We’re here to make it easy for you to get vaccinated before your employer requires it and makes it hard for you to come back to work.’”
The organization also crafted videos designed to build trust, gave talks at migrant work camps, and regularly appeared on a local radio show, “Latinx Power Cville,” to push the vaccine’s benefits.
When the organization was invited to meetings on health equity with UVA health leaders, scores of the system’s health care workers signed up to help with the vaccine rollout. “We had so much support and interest,” Luna says. “They’d say, ‘It’s the experience of a lifetime to help deliver this life-changing product.’”
The effort has been staggeringly successful. The team has given around 10,000 COVID-19 tests and fully vaccinated more than 70% of the local Latinx population.
CASA – Mid-Atlantic Region
As a promotora (health promoter) with CASA, a Latinx and immigrant advocacy group serving the mid-Atlantic region, Cindy Escobar is used to hearing wild theories about COVID-19 vaccines. Recently, one of the women she encouraged to get a vaccine said she was worried about having a chip in her arm that would allow the government to track her movement.
“I said, ‘Why would they put a chip in you?’” recalls Escobar, who is based in Hyattsville, Maryland. “‘If they wanted to locate us, they could do it through our phones. Cell phones have chips and you always have a cell phone in your pocket.’ She said, ‘Oh yeah, that’s true.’” The next day, the woman showed up for her first shot.
Promotoras are CASA’s secret weapons in the quest to vaccinate Latinos in the areas it serves. These trained volunteers frequent places like farmers markets and shopping malls in Latinx communities, striking up friendly conversations and gently prodding people to get COVID-19 vaccines.
“It’s not an outsider coming in. It’s someone from within their community,” says Michelle LaRue, MD, CASA’s senior manager of health and social services. “And the majority are women. We know that women tend to be the caregivers, the ones who push everyone else to get medical attention.”
When the pandemic hit, CASA was ready to face the challenge. “Like a lot of other organizations and health departments, we shifted gears immediately,” says LaRue. Since then, the group has administered around 10,000 COVID-19 vaccines.
It wasn’t easy at first. “Access to vaccines was a big barrier,” says La Rue. “It took a while for us to convince people that the [Latinx] community wanted to get vaccinated.”
Once the vaccines became available, the organization benefitted from its presence in Latinx neighborhoods. “We put our offices where communities live and work to better serve them,” LaRue says. “So oftentimes, people come walking over because they live in the immediate area.” Being able to offer vaccines in-house helped eliminate cultural and linguistic hurdles.
LaRue also chalks up the organization’s vaccination success to being one of the first clinics in the region to offer shots in the evenings and on weekends. “Our communities don’t have the luxury of paid sick leave,” she explains. “Many people are afraid of how they may react to the vaccine, and our Friday afternoon clinics allow those who have the weekend off to recover from any side effects.”
CASA has promised to keep the jabs coming so long as there’s a need. Says LaRue, “We’re not planning on stopping until there are no [unvaccinated] arms left.”