Seniors in Los Angeles County are now eligible to receive the COVID-19 vaccine, but when the news broke last week, Louida Miller did not book an appointment to get immunized.
“For some seniors, there weren’t any hesitations, but with me, there are,” said the 75-year-old Inglewood resident. “I will not take the vaccine as of now.”
Miller doubts that she will change her mind in the future. With health problems such as chronic kidney disease and an irregular heartbeat, she’s concerned about the effect the vaccine will have on her already ailing body. Previous subpar health care experiences and an awareness of historic medical racism have only heightened her misgivings about the coronavirus vaccine.
“It’s a trust issue,” she said.
As a Black woman, Miller is far from alone in her reluctance to get vaccinated. A Pew Research Center survey published in December found that just 42 percent of Black Americans plan to get immunized against COVID-19, making them the group least likely to do so. Moreover, a recent Kaiser Health News analysis found that, in the 16 states that track such data by race, Black Americans are underrepresented among vaccine takers.
Individuals from other marginalized groups are also experiencing vaccine hesitancy. A five-month UC Berkeley study of nearly 1,100 farmworkers found that only about half of this group, which is highly undocumented and Latinx, said they would likely get immunized. Similar patterns have been identified with the flu vaccine, with 49 percent of whites receiving their shots during the 2018-19 flu season and just 37 percent of Hispanics, 38 percent of Native Americans, 39 percent of African Americans and 44 percent of Asian Americans doing the same.
Since people of color are contracting coronavirus at disproportionately high rates — the Latinx infection rate is more than twice that of whites in L.A. County — experts say it’s crucial for them to get inoculated to stop the spread. That’s especially the case for seniors of color, a group that’s even more vulnerable to developing serious complications from COVID-19 infections than their younger counterparts. Health advocates in California contend that offering vaccines in a variety of settings, enlisting trusted community groups to conduct outreach, and launching culturally-relevant public education campaigns can boost vaccine rates among Black and brown seniors.
Breaking access barriers
To make the vaccine rollout equitable, leaders at the city, county and state level in California must consider primary barriers to access, according to Vickie Mays, director of the Bridging Research Innovation, Training and Education Center for Minority Health Disparities at UC Los Angeles. For seniors of color, transportation might prove to be a hurdle if vaccination centers aren’t spread evenly throughout cities and counties.
“When you have a grandmother who is wheelchair bound and doesn’t have access to a car, getting out to health appointments is very difficult,” Mays said. “So, could you do a better job with the rollout if you had smaller … places where the person is not traveling to the health care center but instead staying in their neighborhood? Should you have mobile vans that are going around and setting up vaccinations? It’s really thinking about how we deliver care.”
Public health officials could set up vaccine sites in areas that do not have enough medical offices, or where the facilities are underutilized, she added.
The idea is to bring the vaccine to the people rather than the inverse, a goal that sounds progressive but is not a new concept. The polio vaccine was administered in schools in the 1950s to make it widely accessible to children, the group most prone to that disease. Los Angeles Unified School District Superintendent Austin Beutner is proposing that schools be used as COVID-19 vaccine distribution sites to make the shots widely available to all community members.
“If schools have cafeterias or the capacity, for example, to have an ultra-cold freezer, then, yes, that would be a great place to do this rollout,” Mays said. “There are lots of approaches and innovation that we need to be thinking about.”
An educational approach is vital to the vaccine rollout’s success, according to Richard Carpiano, professor of public policy and sociology at UC Riverside. He said the state will need to counteract misinformation campaigns spread by anti-vaccine activists and tap trusted community leaders to encourage seniors of color to get immunized. A general ad campaign may not be effective.
“We have to be thinking about culturally appropriate and community-centered kinds of promotion and outreach,” he said. “That means relying on local community leaders, relying on the local community-based organizations that are trusted within communities to do outreach, to set up websites.”
Carpiano urged state officials to be sensitive about their outreach to undocumented immigrants, who may be wary about showing up at a public agency to receive the vaccine. Having faced government surveillance and raids, this group may be more likely to go to a trusted community clinic or even a mobile clinic than a public health agency to get vaccinated.
Recognizing past inequities
No matter their immigration status, people of color may hesitate to get the vaccine because they’ve had bad experiences in health care settings previously, Carpiano said. If a person received poor treatment, faced stereotypes when getting health care, or generally had an unpleasant visit, they’re unlikely to want to interact with a doctor to get immunized.
Miller is a case in point. She said that she has been undiagnosed and misdiagnosed by doctors in the past, and those experiences chipped away at her confidence in medicine. She also recalled the Tuskegee experiment, a four-decade long government study of the effects of syphilis on hundreds of Black Alabama men who did not consent to be research subjects.
“There have been too many experiments on Black blood,” Miller said, adding that a Black woman’s involvement in developing Moderna’s COVID-19 vaccine has not allayed her fears.
Stephanie Franco, community advocacy manager of the California Pan-Ethnic Health Network in Oakland, said that elders of color are old enough to remember terrible injustices in health care — from forced sterilizations in California to garden-variety medical racism.
“Our health care system has been filled with so many oppressive forces of patriarchy, colonialism and capitalism,” Franco said. “So, there’s this huge feeling against the vaccine, and it trickles down to seniors of color because there’s a lot of intergenerational trauma that is being activated in light of COVID-19. A lot of people are just not willing to trust Western medicine.”
While community-based and grassroot organizations can’t necessarily convince seniors of color to sign up for the vaccine, they can meet these elders where they are, Franco said. That includes reaching out to seniors who aren’t computer literate or who speak languages other than English. To remove barriers to access, she added, it’s important for public health agencies to communicate well, so people aren’t confused about immunization processes and protocols.
To that end, the state of California announced the launch of My Turn on Jan. 26, a new system that will track vaccination data and help residents find out when they’re eligible for the vaccine and make appointments to do so. But to use the system, Californians need digital know-how, which many seniors lack.
“There’s just not enough culturally and linguistically competent information to share with our community members who want to get the vaccine,” Franco said.
She would like the public to be able to access information about the vaccine in their preferred language and medium. State officials also need to listen to community groups that are serving the state’s most marginalized residents, Franco added. Even if they don’t agree on approaches, state officials and grassroots organizations share a mutual goal.
“I think the biggest question to ask ourselves is: How can we bring health to the community?” Franco said.