AUSTIN, TEXAS — Peter Astrán, a single father living in Austin with his two sons, has been trying unsuccessfully to get the COVID-19 vaccine since January.
Astrán, who qualifies because he is 67 years old, has been calling around to clinics and vaccination sites multiple times a week with no luck. Getting vaccinated would not wildly change his behavior, but he would worry less when he rides the bus and goes to the grocery store, he said.
Astrán is not alone in his struggle to get the vaccine.
Travis County, where the Texas capital city is located, offers one stark example of a national vaccine rollout that’s been uneven for communities of color.
A new analysis by the USA TODAY network shows that only 22% of people vaccinated in the county have been Latinos, even though Census data show they made up one-third of the 1.2 million residents in 2019.
The analysis also examined ZIP-code-level data through the end of February for 20 large Texas counties. It showed that ZIP codes with white, non-Latino residents in the majority had vaccination rates 1.3 times higher than other ZIP codes on average. No Latino-majority ZIP code had a higher vaccination rate than white-majority ZIP codes, according to the analysis.
In Travis County, white-majority ZIP codes had average vaccination rates 1.7 times higher than ZIP codes where people of color were in the majority. The disparity was most pronounced in ZIP codes with a Latino majority, and Travis County’s gap for Latinos was bigger than in all but three other large Texas counties: Cameron, Harris and Dallas.
Latino residents face a unique set of challenges when they try to get to the coronavirus vaccine. Places where Latinos live often lack adequate health care facilities. Language barriers and poor internet access make it hard for non-native speakers of English to navigate Austin’s online system for booking appointments and checking wait lists.
An additional disadvantage: Early vaccination efforts focused heavily on residents 65 or older and those who live in nursing homes. Only 5% of Latino residents are old enough to qualify, compared with 9% of non-Latino Black people and 13% of non-Latino white residents. To ensure a similar percentage of Austin-area Latinos were eligible as white residents based on age, the state would have to lower the age cutoff for Latinos to 55.
And even that would not be enough to address the disproportionate risks Latinos face from COVID-19. The coronavirus death rate among Latinos younger than 55 is triple that of non-Latino whites in Texas.
The CDC reports that 500,000 people nationwide, including 91,000 Latino people, have been killed by COVID-19, according to counts of death certificates that lag other data sources. Travis County officials have reported more than 770 deaths, about half of whom were Latino residents.
Paul Saldaña, co-founder and coordinator of the Austin Latino Coalition, pointed out that this gap in life expectancy can be attributed to a lifelong lack of access to health care and other social services that goes far beyond this vaccine. Neighborhoods east of Interstate 35, where the majority of Latino residents live, lack adequate pharmacies, grocery stores, transportation and medical facilities, all of which impact residents’ health outcomes, he said.
Jill Ramirez, left, and Ma Isabel Lopez, right, look over sign-up sheets from a list of people that they will help register to take the COVID-19 vaccine at the Latino Healthcare Forum office in East Austin on Monday, March 1, 2021. Most of the people who signed up are unable to get online themselves. (Photo: Ricardo Brazziell)
Jill Ramirez, the CEO of the Latino Healthcare Forum, also pointed out that, culturally, Latinos are much less likely to put their elderly relatives in long-term care facilities. Instead, elderly parents often move in with their children or other relatives. The emphasis on getting vaccines to nursing homes overlooks older people of color who are vulnerable to the virus and living in multigenerational homes, Ramirez said.
A Centers for Disease Control and Prevention analyses of outbreaks in Latino communities around the U.S. found significant risks to the elderly in multigenerational homes. There simply are more people with potential COVID-19 exposures from school or jobs living together, a limited ability to isolate someone who is sick and no direct access to testing, like is found in many nursing homes.
The demand for vaccines far outstrips supply, and organizers in Austin’s Latino community are focused on breaking down the digital divide that prevents elderly people and people without access to technology from signing up for shots.
“Austin Public Health decided to use a very technology-heavy way of getting people vaccinated,” Ramirez said. “Given how the process was set up, we knew there was going to be barriers to our community accessing the vaccine.”
Ramirez said that the city’s vaccination portal is difficult to navigate, especially for those without access to newer phones and broadband internet. In majority-Latino ZIP codes in Travis County, 18% of households do not have internet. In majority-white ZIP codes, that figure is just 5%.
The registration system requires both digital and English fluency, two qualities that do not describe a lot of the people Ramirez’s organization serves.
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“It’s really tough to get a vaccine appointment and, because of that, people who are able to get vaccine appointments will generally be people who have the time and technological resources to continually refresh pages and track down those appointments,” said Spencer Fox, the associate director of the COVID-19 modeling consortium at the University of Texas. “People who don’t have high speed internet might be less likely to get appointments.”
Fox also pointed out that with the scarcity of vaccine appointments and the uncertainty in how the vaccine will be distributed, it can be difficult to schedule an appointment with more than a few days notice. This makes it challenging for people who cannot take time off work or do not have reliable transportation to get to the vaccine appointment with little warning.
Saldaña said the difficulties with the vaccine portal mimic those that his organization found with the city’s testing portal earlier in the pandemic. As early as October, Saldaña said he and other community leaders approached the city and asked for the vaccine distribution system to work differently from the testing structure. He was disappointed when that didn’t happen.
“The system that’s being used to try and get people access to the vaccine is not working. The technology aspect of it is not functioning and it’s failing our people,” he said. “The system was set up to fail poor Black and brown old people. This should not be an epiphany for any of the city council members. Our communities experienced the same exact thing last March trying to get a COVID test.”
Austin city council member Vanessa Fuentes, who took her seat in January, said she has been working hard to address inequities in the vaccine distribution system. Fuentesis co-sponsoring a resolution
that, among other things, calls on the city to use funding from the most recent federal stimulus package to prioritize mobile testing and vaccination programs.
“As a newly elected policy maker I am tasked with learning and navigating a new system and ensuring that system fully addresses the needs of my community,” she said. “And it’s not working, which is why I am bringing forth this policy directive to the city manager.”
Officials at Austin Public Health are working to resolve issues that make the local online vaccine portal difficult to navigate, a spokesperson said. This includes improving the website and login page and launching a new queuing system in late February. Now, instead of users fighting over the same time slots and receiving errors or having to click next for hours, users are put into a virtual queue to streamline the process. Each week, appointments are now released on Mondays to give people more warning before their appointments, with additional appointments made available on Thursdays.
The department is also working with community and faith based organizations, employers, health care providers, public health agencies and policy makers to get the vaccine to communities of color. This includes establishing vaccine distribution sites in places that are the hardest hit by the virus and having Capital Metro offer free transportation through the Vaccine Access Program.
“Getting these hard-to-reach communities vaccinated is essential,” a spokesperson for Public Health wrote in an email. “Our hope is that as we continue to refine these processes and systems and vaccine distribution ramps up nationally over the next several months, access to the vaccine becomes much easier and everyone who wants a vaccine can get one.”
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Susana Almanza, the director of the local environmental and social justice group PODER, said that her organization is one of those that has worked with Austin Public Health to make vaccine appointments for eligible folks in East Austin. Since mid-January, PODER has used a phone tree and word of mouth system to register over 1,600 people for vaccine appointments, the majority of them Black and Latino.
“That would never have happened unless the grassroots community was able to partner with the city’s health department,” she said. “Our elders are the most important people. They carry a lot of the wisdom and knowledge and, when we lose that, we lose so much. And that’s why we’re doing this.”
Almanza said the city has to do a better job bringing vaccination sites to East Austin and making them accessible to people who live there. The city opened a vaccine location at the Delco Center in East Austin in mid-January where Almanza got vaccinated on Jan. 21, which is a start she said.
Ramirez said some people in Austin’s Latino communities are avoiding the vaccine because of longstanding fear and mistrust of health care institutions. However, research shows that vaccine hesitancy exists across racial and ethnic groups.
Four national surveys by the Pew Research Center since May 2020 suggest that Latinos actually trust vaccination more than some groups.
Asked whether they plan to get vaccinated or already have had a shot, the percentage of Hispanic people answering “yes” was consistently higher than for non-Hispanic whites and non-Hispanic Blacks. About 70% said of Latinos said they favored the vaccine as of late February. Only Asians voiced greater support: More than 90% said they would seek vaccination or had been vaccinated.
Political affiliation is also a factor in who wants to be vaccinated, according to findings published by the Kaiser Family Foundation COVID-19 Vaccine Monitor in February. The poll showed that 28% of Republicans said they will “definitely not” get vaccinated and another 10% will do so “only if required.” Among Democrats surveyed, only 2% said they would definitely not get the shot and 4% said they would only do so if it is required.
That national survey also found that Blacks and Latinos worry more than whites do about side effects and whether the clinical trials included enough people like them. Health experts reassure the public about the vaccine’s safety for all race and ethnic groups, noting concerted efforts were made to recruit a diverse pool of study participants. Latinos were overrepresented in the late-stage clinical trials of the Pfizer and Moderna vaccines. They are 18% of the U.S. population but made up 26% and 20% of participants in the vaccine trials.
Ramirez said she attributes the vaccine hesitancy among some Latinos to the government’s and medical establishment’s long history of mistreating people of color and immigrants, such as the mass sterilization of Latina women in Southern California. Factors including documentation status and previous negative experiences with a medical provider can also contribute to this trend.
Latinos, particularly non-citizens, are less likely to have health insurance, which can mean they have reduced access to medical providers. Even though such coverage is not required for the vaccine, those connections have helped many people navigate their options to schedule a shot.
“There’s mistrust about medical practices, so there are some real reasons that people don’t want to take the vaccine because of the experiences they have had in the past,” Ramirez said. “There’s so much misinformation about COVID. In our office, we do a lot of work with people who speak Spanish primarily, and a lot of people have told us they’re not going to take it because of what they’ve seen on the internet and social media.”
Ramirez and Saldaña both said Austin Public Health should launch a comprehensive bilingual public awareness campaign to educate the community about how the vaccine works and why it is safe.
“The only way you can change hearts and minds is educating people, giving them information in a way that makes sense to them,” Ramirez said. “When there’s a void, misinformation really takes root.”
Neighborhood to neighborhood
State vaccination data by ZIP code obtained by the Statesman does not show the demographics of who received a shot and where, just the ZIP codes that recipients report as being their home.
The analysis focused on Texas’ 20 most populous counties, which have 832 ZIP codes with significant residential populations. In the 239 ZIPs where Latinos make up a majority, about 11% of residents have received at least one shot, according to the USA TODAY Network’s analysis. In the 317 ZIP codes where most residents are white, about 15% of the population has received a dose — a figure that’s 1.3 times higher.
In Travis County, white-majority ZIP codes have vaccination rates 2.1 times higher than Latino-majority ZIPs. Only three of the 20 most populous counties in Texas had a bigger gap.
Latino vaccination rates in Travis County trail the rates for non-Latino whites. (Photo: Ricardo Brazziell)
The biggest difference was found in Cameron County, a 90% Latino resident county in the southernmost tip of Texas. In the county’s 17 ZIP codes that are majority Latino, the vaccination rate is 19%. The only ZIP code that is majority white, which encompasses the popular resort and retirement destination of South Padre Island, has a vaccination rate more than four times higher at 86%.
One of the smallest gaps was found at the other end of Padre Island, about 100 miles away.
In Nueces County, which is anchored by Corpus Christi, the vaccination rate averaged 21% in white-majority ZIP codes and 18% in Latino-majority ones. Yet, gaps persist even there.
In a Latino-majority ZIP code of Corpus Christi where 12% of residents are 65 or older, the vaccination rate is just 6%. Meanwhile, just across the channel in the homes of North Beach, at least one dose has been received by 60% of residents. There, 72% of residents are white and 43% are 65 or older.
In the 20 Texas counties reviewed by USA Today, none had a higher average vaccination rate in Latino-majority ZIP codes than those with white majorities. The analysis excluded the ZIP codes for the U.S. Army’s Fort Bliss because state data fails to count vaccines administered to service members by the Army.
Ramirez said the city of Austin needs to think outside the box about how to get vaccines to underserved communities.
“Recognizing that we have an infrastructure set up in place that is unequal already and you cannot use that infrastructure to distribute the vaccine. You have to look outside that infrastructure to deliver that vaccine,” she said. “We know the vaccine is what’s going to get us out of this pandemic and we have to have as many people as possible get it so we can control this virus.”
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