LOS ANGELES – Loretta Hsueh, 31, knew her parents were at high risk for COVID-19. The elderly Taiwanese immigrants had chronic health problems and managed a grocery store in Riverside, California, where many of the employees and customers were also immigrants or people of color. For nearly a year, they washed their hands and wore masks and hoped for the best.
After COVID-19 vaccinations began in December, Hsueh assumed the local government would ensure all grocery store workers would be contacted about getting the vaccine. When that didn’t happen, Hsueh suggested her parents call the one phone number listed on the county’s vaccination website to get help. The worker who answered the phone didn’t speak Mandarin and said he couldn’t help them get an appointment.
As the couple’s oldest daughter, Hsueh took over, clicking through pages of information before she was able to secure her parents’ appointments. Her parents’ neighbors asked if she would do the same for them. Then other family members requested help. Soon, Hsueh was making vaccine appointments for her parents’ co-workers, all of whom are not fully English-proficient.
“We know that people with limited English proficiency are going to have difficulty navigating something that is in English. That is a no-brainer,” said Hsueh, a post-doctoral researcher in Oakland who studies health care systems and has made about 15 vaccination appoints for her parents and their friends in recent weeks.
More than two months after the first coronavirus vaccine shots were distributed in the USA, many states and local governments provide limited vaccine information in languages other than English. Language and cultural barriers have made it difficult for many people of color, immigrants and non-English speaking communities to get a COVID-19 vaccine.
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Experts said more targeted outreach – including door knocking, visits to front-line workers at their place of employment, streamlined registration sites and language translation services at vaccination sites – is needed to overcome misinformation and educate communities that long have been plagued by racial injustices in the USA.
Many states and federal leaders have yet to come up with adequate plans to address inequalities in the vaccine rollout, even after they saw similar disparities when coronavirus testing began nearly a year ago and white Americans disproportionately had greater access to tests, said Dr. Georges Benjamin, executive director of the American Public Health Association, a trade group based in Washington.
“This is the largest vaccine effort in the history of the world. They didn’t plan and they started too late and they didn’t pay attention to the lessons we learned from testing,” said Benjamin, former secretary of the Maryland Department of Health and Mental Hygiene.
Nonprofit groups have stepped in to fill service gaps, distributing vaccines and making the case person by person that everyone must be vaccinated for the safety of all. More government staffing and funding are needed to make a difference, experts said.
Latino, Black, Native and Pacific Islander Americans are dying of COVID-19 at much higher rates than white Americans. Discrimination, limited health care access, inequalities in education and income and other factors have made many immigrant groups and communities of color particularly vulnerable to the spread of COVID-19, according to the Centers for Disease Control and Prevention.
“What we are hearing from the ground is a lot more needs to be done,” said Eva A. Millona, CEO of the Massachusetts Immigrant & Refugee Advocacy Coalition. “This is imperative. This is a health crisis for all of us.”
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Many states do not provide adequate language assistance
Millions of Americans speak a language other than English at home, including more than 150 Native American languages spoken by 350,000 people, according to the U.S. Census Bureau. Language barriers can represent an even more significant challenge in metropolitan areas with high concentrations of immigrants, such as New York City, where 31% of the population speaks a language other than English at home, according to census data.
On New York state’s main COVID-19 page, users have to scroll through various graphics to get to the bottom of the page, where they can click on “language access” to find other languages. If people don’t know to scroll down or they can’t read English, they might not have much success. Translations are provided in Bengali, Chinese, Haitian Creole, Korean, Russian and Spanish.
State Assembly member Yuh-Line Niou, a Democrat who represents New York City’s Chinatown neighborhood, said a lack of language access at vaccination sites is a problem for her constituents.
“They are all calling me asking me, ‘How do I get this vaccine? What’s going on?’ Then they will ask me, ‘Hey, can you translate this site for me?’” Niou said.
In some cases, her staff members have signed people up to be vaccinated, then driven them to a vaccination site and back home. Niou, who introduced legislation that would require the state to translate pandemic information for non-English speakers, said essential workers, who disproportionately are people of color and immigrants, should have been granted access to vaccines weeks ago.
In Arizona, health officials launched a Spanish-language vaccine registration website only last week. Arizona is about 32% Hispanic, according to census data.
“It was frustrating to see that we did not have a bilingual online registration in place,” said Tomás León, interim CEO for Equality Health Foundation, a nonprofit group based in Phoenix. “That should have been something that was prioritized and ready to go.”
Only 8% of the people who have been vaccinated in Arizona are Latino, though 29% of those who have died are Latino, according to state data.
León said he’s troubled by signs that fewer Latinos are getting tested for the coronavirus since the vaccination rollout began, suggesting a false sense of security building among people who are not getting vaccinated. Across the nation, testing in recent weeks has hit the lowest level since late December, according to the COVID Tracking Project.
In another troubling sign, life expectancy in the USA dropped by a full year during the first half of 2020: Hispanics lost nearly two years, and Black Americans lost nearly three years, the CDC announced Thursday.
“It’s life and death right now,” León said. “We have to make sure we don’t leave communities of color behind that are struggling and dying at high rates and being hospitalized at high rates.”
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Some struggle to use COVID-19 vaccine registration sites
Even when there is information provided in a variety of languages, people might not know how to access it, said Peter Ng, executive director of Chinatown Service Center, a nonprofit health organization in Los Angeles’ Chinatown neighborhood. The organization runs a mobile testing and vaccination site in Asian-majority neighborhoods in the greater Los Angeles area. It has made outreach calls to vulnerable households to help register them for vaccines and provide translations at vaccination sites.
“The problem is we don’t have enough outreach to the Chinese community,” Ng said.
In Los Angeles, Latinos make up 23% of the total vaccinated population but nearly 49% of the overall population.
In Santa Clara, California, County Supervisor Cindy Chavez said it was clear from the beginning of the pandemic that marginalized communities did not have equal access to coronavirus testing, food banks and unemployment insurance, among other services helping people survive the health and economic crisis. The county is 39% Asian and 25% Latino. About 53% of the population speak a language other than English at home, and about 39% are foreign-born, according to census data.
The county held Facebook Live events a few times a week in different languages and sent bilingual workers door-to-door in the hardest-hit neighborhoods to share vaccine information.
“There’s still a lack of equity and parity and our goal is to figure out how to close that gap,” Chavez said.
Many immigrant communities have been bombarded with misinformation about COVID-19 and the vaccines on social media. Vaccine requirements giving precedence based on age rather than risk factors such as living in a multigenerational home have put immigrant communities at a disadvantage, said George Escobar, chief of programs and services for CASA, an advocacy group for Latino and immigrant people in Maryland, Pennsylvania and Virginia.
Escobar said his organization has met with local and state lawmakers to lobby for more culturally sensitive outreach to help overcome these challenges. He said officials nod their heads and express support, but little has changed.
“There’s still a significant anti-immigrant force, that providing anything to the immigrant community is seen as not worthy,” he said. “There are certain sections of the population that do not believe we are equal, that everyone is entitled to the same benefits.”
Others demand vaccine registration sites that are easy to use.
Nikhil Trivedi, 42, spent many weeks trying to get a vaccine appointment for his 78-year-old mother and 80-year-old father, who both have health complications. They emigrated from India in the 1970s and have no problem with English but had trouble getting an appointment. When they logged on to register, they couldn’t figure out how to use the site.
Trivedi, a director of engineering at a museum in Chicago, said he created Walgreens accounts for his parents and logged in multiple times a day to try to get them appointments. He heard a rumor that if he logged on at midnight, it would be easier to get an appointment, but that didn’t work. And the website interface kept changing.
“It’s been really challenging to get something that should be really easy for my parents,” said Trivedi, whose parents got vaccinated last week. “People with access and means are able to get it, and people without access and means simply aren’t.”
In California, Hsueh’s days are consumed with making sure her immigrant parents are safe. The Riverside County website says it will contact patients when the second dose of vaccine becomes available. Hsueh doesn’t know whether she can trust that, given how frustrating she’s found the vaccine process. She regularly checks the website to see whether any appointments have been announced. Then she checks again.
‘A matter of life or death’
Some officials said they will continue to tweak their vaccine plan until everyone has equal access.
In Harris County, Texas, leaders have sought to make sure COVID-19 vaccine information is available in various languages on official websites, digital ads, billboards and tool kits provided to clinics and community partners.
A first-come, first-serve vaccine registration process was restructured after officials realized it contributed to inequalities. Instead, officials created a randomized selection system that prioritizes the elderly. Vaccines are distributed to clinics that serve the uninsured and in the 25 hardest-hit ZIP codes in the area.
Despite these efforts, marginalized communities still receive vaccines at low rates, Harris County Judge Lina Hidalgo said.
“It’s the same people who had been hardest hit by the pandemic, they are the same folks who are struggling to access the vaccine or who have vaccine hesitancy,” she said.
In Massachusetts, the initial vaccine rollout consisted of an online portal that was criticized for not being accessible to low-income people or others with limited internet or computer access. State officials created a call center to accommodate those with digital barriers. The state vaccine appointment website offers translations in more than 100 languages, including Bengali and Igbo.
Vaccine distribution has remained out of reach for many Latino and immigrant communities, said state Sen. Sonia Chang-Díaz, a Democrat.
Chang-Díaz said vaccine distribution should have started in communities hit hardest by the virus, including Latino-majority neighborhoods. Chang-Díaz urged Massachusetts Gov. Charlie Baker, a Republican, to create a senior-level position tasked with executing a grassroots vaccine outreach campaign, which would involve phone banks, door knocking and workplace visits.
In Boston, roughly 138 languages are spoken, and 23% of the metropolitan area speaks a language other than English at home.
Without equal access to vaccines, Latino and immigrant communities will continue to experience high death rates, trauma for survivors and their families, economic fallout and learning losses for children, Chang-Díaz said.
“It is not hyperbole to say this is a matter of life and death,” she said.