Nota del Editor: WHRO publico esta historia en Español el 18 de diciembre. Puedes encontrar esa historia  aquí. Alan Rodriguez Espinoza de  VPM tradujo la histora de inglés a español.

While COVID-19 vaccines are not yet available to the general public, Virginia health officials are confronting the fact that some residents will face greater barriers than others to get vaccinated. 

Over the summer, local health districts placed special attention on Latinos and other non-English speaking immigrant groups when rolling out COVID-19 testing. Teams prioritized the recruiting of bilingual contact tracers and investigators, and they conducted testing events in neighborhoods and communities with particularly high concentrations of Latino residents.

The special focus was a response to health data that showed Latinos as one of the highest-risk populations --  at one point making up over 40% of COVID-19 cases in Virginia, despite only making up 9% of the state’s population.

The statistic was driven in part by outbreaks at chicken processing plants, especially those in Accomack County.

Now, local health departments have a blueprint to focus their vaccination efforts on those most impacted.

“Now we have a whole system in place to try and reach out to everyone and hopefully help them get the care that they need,” said Karen Carle, a bilingual public health nurse with the Richmond City Health District.

Once the vaccine becomes available for the general public, Carle says Richmond will see vaccination events similar to the testing events that began over the summer, placing close emphasis on marginalized communities that have been disproportionately exposed to COVID-19.

She adds that local health departments will work closely with small clinics, medical providers and trusted community leaders who can spread awareness of the benefits of the vaccine. 

“We're working hard trying to recruit Spanish speakers to come help, and we're getting a pretty good response,” Carle said. “But some of the problems that we're seeing is there's a certain reticence to get the vaccination. There's still a lot of misunderstanding and mistrust, and that's one of the big barriers we're going to have to overcome.”

Addressing Historical Trauma And Mistrust

Some data suggest that trust of the vaccine is increasing among Latinos. In a survey last month,  71% of Latinos nationwide said they would take a vaccine if it were free and determined safe by health professionals, an increase from 60% in September.

Still, that leaves significant portions of the population that say they will not seek the vaccine. Latinos forgoing vaccinations is not unprecedented. According to the CDC,  only 38% of Latinos got the flu vaccine last year -- the lowest of all racial and ethnic groups.

Medical experts say Latinos have voiced some of the same concerns held in the general population. These include fears of side effects, and a concern that the vaccine was developed too quickly.

Carle quickly dispels those concerns. She explains that the COVID-19 vaccine was developed at a record-pace in part because scientists and medical experts had already done much of legwork for two previous public health scares -- SARS in 2002 and MERS in 2012. 

“They worked on vaccines for both of those infections… And we didn't end up needing a vaccine, but they did a lot of work that served as the basis for this COVID vaccine. So we didn't go into it completely blind,” Carle said.

However, many of the concerns held by Latinos and others in non-white communities are rooted in deeper traumas. Shanteny Jackson, a community health worker with the RCHD, says many are cautious of taking a government-sponsored vaccine given the current political climate.

“The community is very watchful at this point and kind of hesitant. They know that there's a  history of discrimination in terms of who gets what… And so they want to make sure that it's going to benefit them and their loved ones, before they embark in taking the vaccine,” she says. 

In the case of undocumented immigrants, experts tell VPM fears of being detained by immigration authorities have been shown to deter undocumented families from seeking medical assistance. Carle assures them the information they provide when getting vaccinated will be kept private and will not be shared with immigration authorities.

“They will probably have to show some form of ID and give their name, address and phone number. But that's a safety issue in case there's a vaccine recall or in case someone has a bad reaction or something we need to be able to get a hold of them,” she said.

Dr. Sergio Rimola with the Virginia Latino Advisory Board adds that people’s information shared through the state’s contact tracing mobile app, COVIDWISE, is also kept confidential and not shared with authorities.

In addition, the Department of Homeland Security has said immigrants seeking citizenship  will not be considered a public charge for getting the COVID-19 vaccine or any other medical treatments related to the virus, so it won’t impact citizenship applications.

Breaking Down Systemic Barriers

Health officials say access to information about the vaccine in various languages will be key to immunization efforts. Despite the pandemic’s clear and overwhelming impact on Latinos,  Virginia lagged early on with providing language access to non-English speakers. 

While Spanish has been the language in highest demand, other ones like Arabic and Chinese are also needed. Jackson says language access is not just a matter of meeting government regulation or checking boxes; rather, it’s an integral part of building trust in the vaccination process.

“It's important to give that level of support. It makes it much more impactful, and it makes it much more well received by the client or the person,” she said.

Even among Latinos, experts say the state will have to increase its effort in reaching speakers of indigenous non-Spanish languages. Rimola says this is especially urgent given the prominence of these languages among essential workers.

“A lot of the migrant workers, for example, are coming from Guatemala, and they speak Mayan languages. They don't speak Spanish very well, so it is important to have some information in those languages,” he said.

Carle adds that while vaccines are so far only available to healthcare workers and residents of long term care facilities, the  CDC has proposed that essential workers be next in line. According to the U.S. Bureau of Labor Statistics,  five out of six Latinos work outside the home, and many in essential jobs like manufacturing and agriculture. 

Furthermore, Carle reiterates that COVID-19 vaccines will be free of charge, addressing another major concern for Latinos -- cost. Several studies have found that Latinos are uninsured  at the highest rate, especially those who are  foreign-born. 

“The government has guaranteed that all of these vaccines, the COVID vaccines, will be available for free. And we will still continue to see undocumented people and they will still get the vaccine for free,” she says.

Jackson says many immigrant patients often express interest in resorting to traditional home remedies, as opposed to seeking a vaccine. She says they can sometimes be discouraged by a medical system that’s culturally unfamiliar, highlighting the need for cultural competence in the state’s vaccination efforts.

In an effort to tackle these cultural and language barriers, Jackson says the RCHD is setting up conversation sessions at several resource centers where community members can voice their concerns and bring up questions.

“We want people to make informed decisions. We don't want to force them into anything. We want to have dialogues where we hear your concerns and we talk about the issues,” Jackson said. 

Turning To Trusted Community Leaders

Cecilia Barbosa, the chair of the health committee of the Virginia Latino Advisory Board, says government and private resources will rely on local community groups and nonprofits to serve as “a bridge” to the community.

“They're really the key to connecting these resources to the people who need them,” she said. “There has been quite a bit of distrust of institutions of government institutions, and so that gap is an important one to reduce, and hopefully to eliminate.”

The Sacred Heart Center has been one of the most active in linking Richmond Latinos to information and resources during the pandemic. In a  radio show broadcast in November, SHC leadership asked doctor Felipe Lobelo questions about the flu vaccine ahead of a vaccination event hosted by the center that weekend.

During the show, Lobelo walks Spanish-speaking listeners through the differences between symptoms of the flu and of COVID-19, and he presses the importance of the vaccine. He also fact-checks myths of the flu vaccine that are frequent among Latinos.

“The flu vaccine cannot give you the flu, because the genetic material inside the vaccine is a dead virus. It cannot be replicated, so it is impossible to catch the flu from the vaccine,” he said in Spanish.

The COVID-19 vaccine takes  a different approach and does not insert an inactive virus -- or a virus at all -- into the user. Still, the logic holds: the COVID-19 vaccine cannot give someone COVID-19.

Churches such as Vida Nueva Para las Naciones in Southside Richmond have also helped Latinos get tested, find food and even raise money when in need. Pastor Diego Fernandez says even more outlandish myths about the vaccine are not uncommon in the community.

“We hear that this vaccine will be used to insert chips in people, or that it’ll be used to control the population. There’s many conspiracy theories,” Fernandez said in Spanish. “There’s too much misinformation, and this information is not true.”

Fernandez personally vouches for the vaccine, calling it a “tremendous help,” and he calls on members of his community to trust medical experts, who he says are “educated, capable and knowledgeable.” 

“As leaders, when we communicate a message poorly, when we give the wrong message, it can have bad consequences, even deadly. This is a very delicate subject where we must be very responsible,” Fernandez said.

Barbosa credits the many organizations, foundations and members of the community that have come together in solidarity with the city’s Latino population. She says  over $1 million has been raised in the Richmond community to address their needs.

“I think we are really starting to connect our communities, and as difficult as COVID-19 is, sometimes there's some positive things that come out, and I think that this is something that's truly positive,” she said.