A few weeks ago, the US Centers for Disease Control and Prevention (CDC) released a startling report: minorities in the US—particularly Latinos—were getting vaccinated at disproportionately lower rates compared to Whites despite suffering higher rates of infection and death from Covid-19.
During the first months vaccinations were available, Latinos in the US received about 11.5% of the vaccinations, while Non-Hispanic whites, on the other hand, got over 60% of the vaccines—at least when the report had access to racial and ethnic data. Vaccine administrators only collected it about half the time, possibly skewing the data.
Overcoming these vaccination disparities are key to ending the pandemic. But that’s not happening yet, says Maria Teresa Kumar, the president and chief executive officer of Voto Latino, a Latino political organization. “None of it is going okay,” she says.
The first step of overcoming a problem is understanding why it exists. In the case of the Latino community, it’s a combination of historical distrust in the US federal government, poor messaging about the vaccine, and tight-knit community culture that weighs information from trusted peers above all else. “There is so much trust to build,” says Parinda Khatri, the chief clinical officer of Cherokee Health Services in Tennessee. Though that will look different for every minority community, learning how to address individual needs is key to tailoring vaccination campaigns to different groups.
The US government’s rocky relationship with Latinos
For much of the 20th century, the US federal government paid little attention to Latinos or people of Hispanic descent. The result was that these communities weren’t always included in federal aid or resources for decades.
Latinos, a term that broadly encompasses anyone who identifies as Hispanic, Latino, or Spanish, wasn’t an official category in the US Census until 1980. Even today, response rates by Latinos on the US Census are low due to fears that reporting—particularly among immigrants who are undocumented—could attract unwelcome attention from authorities.
And this same undercounting has persisted during the pandemic. As Covid-19 cases rose in March and April, there was no federal mandate to collect data on race or ethnicity among people who tested positive. It was up to states to gather and report these data to their health departments. Only last June did the Trump administration begin requiring all states collect age, gender, race, and ethnicity data.
That’s still not a guarantee all cases among Latinos will be recorded properly—sometimes, people are unwilling or anxious to disclose demographic information about themselves. “Public health officials may not be keeping track of Latino populations as a whole, let alone undocumented populations,” says Kumar. Typically, she says, when surveys and healthcare providers begin asking about race and ethnicity on surveys, “participants may not tell you.”
Former president Donald Trump only made tensions with much of the Latino community worse, says Nancy Berlinger, a scholar at the Hastings Center, a non-profit bioethics research organization. Aside from referring to Mexicans as “rapists” and “drug traffickers,” Trump’s administration tightened restrictions on legal immigration pathways from certain countries, increased deportations and ICE raids, and began building a physical wall between Mexico and the US.
These intimidation tactics have left legal and undocumented immigrants, many of whom are Latino, afraid of dealing with authorities, Berlinger says. Previous research has shown a direct tie between mistrust of the government and vaccine hesitation. “Those who do not trust the government…sometimes extend their distrust of government to distrust of vaccines, as well as towards the people and systems that deliver them,” Heidi Larson, an anthropologist and the founding director of the Vaccine Confidence Project, wrote in 2018 in the journal Nature Human Behaviour.
Of course, there are exceptions; Latinos, like any demographic, are not a monolithic group. In the 2020 presidential election, roughly 32% of Latinos voted for Trump—likely due to other values, like conservatism, entrepreneurialism, or faith, an increase of 4% from 2016, particularly in Florida and along the Texas-Mexico border.
But another factor besides governmental distrust that leads to vaccine hesitancy in the Latino community: misinformation and rumors spreading through close networks of families and friends.
Vaccine misinformation is rampant online. But of all the rumors on social media that are spread in English, “it’s twice as bad in Spanish,” claims Kumar. This misinformation, she says, disproportionately affects non-native English speakers.
It’s hard to counter these rumors for two reasons. First, they’re often found on encrypted social media networks. Many people with families spread across several countries—like many immigrants in the US—use WhatsApp to communicate. It uses WiFi, which can be cheaper than international texting. It’s also end-to-end encrypted, which is appealing for privacy, but makes it harder to monitor misinformation. It’s impossible for regulators, for example, to flag or ban the spread of vaccine misinformation, like Facebook and Twitter have stated they will do. WhatsApp, which is owned by Facebook, has limited the number of messages users can forward to one another in an effort to limit the spread of misinformation, but it’s not clear this is working
Second, these messages are coming directly from family and friends. And in the Latino population, these ties—and the anecdotal stories that can come from them—carry significant weight.
Kumar says that her mother has told her stories of people who have gotten the Covid-19 vaccine and still gotten sick—which is possible, if someone had contracted Covid-19 the few days before or after getting vaccinated. She’s also seen stories on nightly news discussing handfuls of cases of dangerous adverse reactions. Though these may be true stories, they distort the perception of the vaccine’s danger.
What would be better would be information in Spanish about the science and safety of vaccines. But that’s less common, or fails to reach everyone. “They’re not getting the right information because there’s no central force of communication to them,” Kumar says. A poll from the CDC found that about 20% of Latinos were likely not or definitely not going to get the vaccine. A similar poll from Kumar’s organization Voto Latino found roughly 47% of Latinos said they would refuse a Covid-19 vaccine, or still were unsure if they’d get it. Responses came from over 1,000 individuals who voted in the 2020 election from Arizona, Florida, Georgia, Nevada, North Carolina, Pennsylvania, Texas, and Wisconsin.
The only way out of vaccine hesitancy is through building trust between healthcare providers and Latino communities.
Khatri, who works to vaccinate diverse populations in Tennessee, says that they’ve had great success working with promatoras, community leaders in the Latino community. These individuals are people who work with healthcare providers to get the medical information they need to deliver, and then go out into the world where people actually are. It’s a mode of communication that builds on the strength of community ties. “We’ve always had those relationships,” she says. “We’ve been working with them for 10 or 15 years.”
Trust built with promatoras has been vital for getting through the earlier phases of the pandemic. Doctors would even request certain well-respected promatoras talk about testing, or demonstrate how the process worked to show that it was safe.
At the moment, there’s not strong data to suggest how well these small efforts are working. All Khatri has are personal accounts of how promatoras can make a difference among people still unsure about the vaccination process. These individuals have been with the group of hospitals and clinics for years—they have a reputation for having the community’s best interest at heart.
“There is so much trust built up,” Parinda says. Though the road ahead can feel long, it has to start somewhere. At this point, efforts to reach the Latino community isn’t just about the end of the current pandemic—it’s about easing the burden of future pandemics, too.