Mauro Ortiz had planned to get the COVID-19 vaccine, but work always got in the way. Plus, the 45-year-old Denver resident, who tows vehicles for a living, had tested positive for the virus twice over the course of the pandemic, but never felt sick. So getting the shot didn’t seem worthwhile.
But during a recent visit to Saint Michael the Archangel Church in Aurora, Ortiz had a change of heart. Towards the end of the Sunday service, Julissa Soto, an independent health equity consultant working to improve vaccination rates among Hispanic Coloradans, stepped up to the microphone.
“COVID is not going away; COVID is like that ex-husband or ex-wife,” Soto joked to the congregation. Which is why, she continued in a more serious tone, we have to protect ourselves. And getting the COVID-19 vaccine is one way to do so.
Her words were enough to convince Ortiz, a father of four, to finally get the shot. After the service, Ortiz rolled up his sleeve at the mobile vaccine clinic Soto had organized in the church parking lot, and received his first dose of the Pfizer vaccine. Through a Spanish-to-English interpreter, Ortiz said hearing Soto say COVID-19 was not going away convinced him to get the shot to protect himself.
Ortiz is one of more than 15,000 Coloradans—98% of whom are Latino, according to Soto—who have gotten inoculated against COVID-19 since last September because of efforts by Soto and others efforts to increase vaccinations among Latinos and immigrants. Yet racial gaps remain: About 48% of Hispanic Coloradans have received at least one dose of the vaccine, compared to more than 82% of white non-Hispanic Coloradans, according to modeled data by the Colorado Department of Public Health and Environment (CDPHE). Data from the Kaiser Family Foundation shows an even bigger gap: Just 42% of Hispanic Coloradans have gotten at least one dose of the shot versus 78% of white non-Hispanics, per Kaiser’s research.
The gap in vaccination rates between Hispanic and non-Hispanic Coloradans “is concerning,” said Irene Aguilar, MD, president of Immunize Colorado, member of the state’s Vaccine Equity Taskforce and former state senator. She worries particularly because of multi-generational households—the “more-likely-to-be-crowded households that exist” among Hispanic Coloradans, she said. That means there’s higher potential for viral spread if a family member becomes infected.
Nearly 18 months after the COVID-19 vaccines first rolled out—and about a year after all Coloradans ages 16 and older became eligible for a shot—what might explain the gap in vaccination rates?
Vaccine hesitancy plays a big role, said Ricardo González-Fisher, MD, manager of the Mexican Consulate of Denver’s Ventanilla de Salud program, which provides health resources, including COVID-19 vaccinations, to Mexican immigrants. A professor in the Metropolitan State University of Denver College of Health and Applied Sciences, González-Fisher believes some of the vaccine hesitancy among Hispanic Coloradans is due to mistrust and misinformation.
“People don’t trust the sources of information that they’re getting,” he said. “They say, ‘Well, we would like someone who understands us and who is like us to come and tell us what’s going on.’” Government officials and health authorities, many of whom are non-Hispanic like Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, aren’t seen as trustworthy, said González-Fisher.
Moreover, the fact that, at first, the vaccine wasn’t readily available to communities of color in Colorado created “a trust issue,” said Charlene Barrientos, community engagement manager at the Colorado School of Public Health. “I think that people were like, ‘Well, what about us?’”
González-Fisher also points to different cultural approaches in medicine as another potential reason for the gap. In the United States and parts of Europe, many physicians follow the bioethical principals of autonomy and shared decision making, meaning patients play a central role in making decisions about their medical care. But in other cultures—including Mexico and other Latin American countries, as well as parts of Asia, Africa and Europe—there is still a relatively paternalistic approach in medicine, meaning the physician is presumed to know best, explained González-Fisher. People from cultures with a more paternalistic approach to medicine may respond better to a provider saying, “you need to get the vaccine right now, just roll up your sleeve” versus a provider explaining what the vaccine was made from and giving them options of when they can receive it, he added.
González-Fisher also points to research published in February that found childhood trauma is linked to vaccine hesitancy. This connection, he said, resonates strongly with what he sees in his work. Nationally, 51% of Hispanic children have experienced at least one adverse childhood experience (defined as a potentially traumatic event, such as abuse, neglect, or living with an adult with a mental illness), compared with 40% of white non-Hispanic children and only 23% of Asian non-Hispanic children.
Another possible factor contributing to the gap: In Colorado, the majority of Hispanics are of Central American and South American descent, where it is typical to only seek health care when you’re very sick, said Aguilar. That means Hispanic Coloradans may not be as apt to go to the doctor’s office to get vaccinated as non-Hispanic Coloradans. Moreover, as The Colorado Sun recently reported, Hispanic residents are more likely than white residents to report being treated poorly within the health care system.
Soto, for her part, attributes the low vaccination rate among Colorado Hispanics to the fact that there aren’t enough “messengers or cultural brokers” educating people on the vaccine. Though Soto is a member of the state’s Health Equity Commission and has partnered with CDPHE to host vaccine clinics, she is also a vocal critic of the state’s efforts to inoculate Hispanic and Latino populations.
The state is “saying that they’re trying, but trying is not enough at this point for my community,” said Soto, who expresses frustration over the pace of the state’s response and believes there has been a lack of cultural awareness and respect when planning and hosting vaccine clinics.
“They have not taken the time to build that trust,” she said. “They’re going to places where they think we are at, instead of asking, walking around, seeing where the community is at.” For example, instead of hosting vaccine clinics at libraries and recreation centers, the state should do outreach in places like meat markets, restaurants and mobile home parks, Soto said.
“We really have been very intentional about going into communities and asking the question: where do we need to be?” said Brandy Emily, health equity branch chief in the CDPHE Division of Disease Control and Public Health Response. Emily pointed to a vaccine clinic the state hosted in April at a live Mexican music concert in Pueblo, as well as upcoming vaccine clinics at Día de los Niños events in Aurora and Pueblo. In a follow-up email, CDPHE spokesperson Gabi Johnston noted that the state, along with Tri-County Health Department, had supported Soto by providing vaccines, vaccinators and testing kits for distribution at all of Soto’s clinics.
Making the vaccine more accessible to Colorado’s Hispanics and Latinos is a central part of Soto’s approach: She’s hosted 50-something vaccine clinics, many of them in non-traditional locations including Mexican restaurants, nightclubs, barber shops, beauty salons, spas, tire shops and churches. Before Soto holds a clinic, she knocks on doors in the surrounding neighborhood to introduce herself to people and let them know why she strongly believes in the vaccine.
“We have to put a lot of work in behind the scenes,” she said. “It takes hours and hours to build that trust, to talk one-on-one with people.”
Part of that trust-building comes from sharing her own experience as an immigrant. “I have my master’s in public health and I speak two languages, but I have never forgotten about where I come from,” said Soto, who arrived in the U.S. 23 years ago as an undocumented immigrant, crossing the U.S.-Mexico border in the trunk of a car. Now a U.S. citizen, Soto frequently shares her backstory at vaccine events as a way to connect and build trust with people.
“I’m still Julissa from the block for them,” she said. “And that helps a whole lot.”
Emily said the state is trying to establish new policies and work with communities of color by relying on “trusted partners and voices.” She describes Soto as one such partner, with an unmatched voice, trust and connections in the Hispanic community. But closing the gap in vaccination rates is “going to take time,” Emily said, “and we know that there’s a lot more work to be done.”
Emily said that even though the state is moving towards an endemic phase of its COVID-19 response, which involves moving many COVID-19 testing and vaccination services back into the traditional health care system, CDPHE is hiring an internal team to continue community-level vaccination and testing work. The state health department will also keep operating its mobile vaccination units.
“We have no intention of backing off or slowing down,” said Emily. “In fact, we intend to ramp up to the extent that we can.” A CDPHE spokesperson added via email that in addition to its ongoing Vaccine Champions for Equity program and vaccine partnership with 9Health:365, the state will soon announce multiple CDC-funded equity-based grants available to community organizations for immunization events and other public health efforts.
Soto, for her part, plans to continue her efforts until Latino Coloradans are vaccinated against the virus at the same rate as white Coloradans.
“That’s called equity,” she said. “I’m making progress, and I’m making noise… I’m not going to stop until I vaccinate the last Latino in Colorado.”