Bertha Garcia has been trying to get an appointment for her COVID-19 vaccine for about a month.
Garcia, who qualifies for the vaccine because of her community work with the Chicano Foundation, said she tried day after day to get an appointment, but couldn’t.
“I tried different dates,” she said. “I tried to do the same date again. They always ask me for my information, but once I put it in it will say there aren’t any more appointments.”
Garcia had heard some people had luck trying to make appointments in the middle of the night, but waking up at midnight just isn’t an option for her.
“I’m going to continue to try,” she said. “The most frustrating thing to me is that I have experience with a computer. I can’t imagine people who don’t have that experience, don’t have anyone to help and keep filling this out to be told they can’t make an appointment.”
Getting an appointment is one of the biggest – but not the only – obstacle that many in marginalized communities have been facing as they try to obtain the coronavirus vaccine.
Although Latinos currently make up 56 percent of coronavirus cases – and in the past have made up even higher percentages of cases – and nearly 44 percent of deaths in the county, more than any other racial or ethnic group, they represent just over 15 percent of vaccinations, according to county data. Only 2 percent of vaccines have gone to Black people, while they make up 5 percent of the county’s population. Latinos and Blacks have the lowest vaccination rates in the county. Only 61.7 people per every 1,000 Black people are being vaccinated and 73.5 per every 1,000 Latinos are being vaccinated. For White people, that number is 154.6 per 1,000 people and for Asians, it is 131.7 per 1,000.
County spokeswoman Sarah Sweeney noted that the county is tied to the state’s tier system for vaccine distribution, which limits who is eligible for the vaccine. Sweeney also said that more than a quarter of people vaccinated declined to provide race or ethnicity data to the county or selected “mixed race.”
Community organizations say the discrepancy is fueled by access and trust issues that Latinos and Blacks face. The technological savviness and time needed to get a vaccine appointment is one barrier. Issues with language access or transportation are others. There’s also distrust – between Black people in the U.S. and medicine – and residual fear from the Trump administration for Latinos.
“We just went through this with testing,” said Nancy Maldonado, CEO of the Chicano Foundation. “It feels like we’ve learned nothing.”
Barriers to Access Are Higher for Latinos and Blacks
Tere Olivas had been trying for two weeks to get a vaccine appointment for her husband, who is 73. Olivas and her husband live in the 92114 ZIP code or the Skyline area, which has had one of the highest COVID rates in the county.
Olivas and her husband have been in a strict lockdown since last March, she said. At 63 years old, she still doesn’t qualify for a vaccine, but once her husband was eligible, she made an effort to get him an appointment. There were roughly a dozen locations they could have gone to, but she couldn’t get an appointment at any of them.
“I would try at 8 at night, at noon, at 10 in the morning,” Olivas said in Spanish. “I kept getting no. There are no appointments, there are no appointments.”
Finally on Wednesday, Olivas and her husband decided to try their luck by simply showing up to a site.
They got lucky.
Although Olivas didn’t have an appointment, volunteers at the vaccination station in Chula Vista were able to help them make one on the spot. Her husband was vaccinated within an hour.
This week, Sharp Health-run vaccine sites opened up 2,000 appointments – a boon for many like Garcia and Olivas who had been struggling to make an appointment.
“The majority of people who have gotten vaccines are White,” said Dr. Rodney Hood, a physician and president of the Multicultural Health Foundation. “It’s open to everyone who is knowledgeable and can get on their phone. It’s a race.”
The county rolled out a program this week that will set aside appointments at vaccination sites in Chula Vista, San Ysidro, National City and Imperial Beach for community groups who have community health workers, or promotoras, working with at-risk communities that have historically had difficulties accessing resources during the pandemic.
“Recognizing the historic inequities in vulnerable populations, outreach and promotion efforts include utilizing the county’s existing network of promotoras and Community Health Workers who have shared backgrounds and experiences with the diverse population in San Diego,” Sweeney, the county spokeswoman, wrote in an e-mail. “Their efforts include, among a wide variety of other things, assisting individuals in scheduling vaccination appointments.”
That’s a start, Maldonado said. Her staff had been trying to assist community members in scheduling appointments and had run into availability issues.
While there have been improvements in accessing appointments, Maldonado said that the weeks missed have an impact, just like they did when testing was rolled out later in certain communities at the beginning of the pandemic.
There are multiple factors that have made vaccine access particularly elusive for elder Latinos, she said.
“One is computer literacy and being computer-savvy,” Maldonado said. “But also having to sit at the computer and hit refresh repeatedly or wait on hold for hours with 211. If you think about Latino families, most of the younger generations are working still, so it’s not like they have people who can spend hours with them helping to get their appointment.”
Transportation presents another barrier even once someone has secured an appointment. Some of the vaccine locations are accessible by public transit, but that doesn’t mean getting there is easy or quick. Plus, some elderly people may be fearful of taking public transportation right now. Many younger generations in Black and Latino communities are essential workers, so there are limited timeframes during which they can give their elder family members a ride.
The highest concentration of vaccination sites is near and around South County, Sweeney said. There are vaccination sites in Imperial Beach, San Ysidro, Chula Vista, National City and southeastern San Diego. A site in Lemon Grove will also be coming online on Feb. 21, she said.
The largest percentage of vaccines – 21.7 percent – have been distributed in the county’s North Central region, which includes areas like La Jolla, Scripps Ranch, Pacific Beach and Point Loma. The South region, which includes hard-hit areas like Chula Vista, National City, Otay Mesa and San Ysidro, makes up 15.1 percent of the total vaccines distributed so far, according to county data.
That’s an improvement, said Hood, “but we still think it is a problem.”
Both the Multicultural Health Foundation and Chicano Federation are working with the county to reach vulnerable communities, but say there still aren’t enough community health workers to truly ensure everyone eligible for a vaccine in those communities has access to it.
The Chicano Federation is getting up to 100 calls some days seeking help scheduling vaccine appointments.
Maldonado also warned that the county should be thinking of how to administer second doses of the vaccine to these communities.
“There will be challenges that come up with making sure people get that second dose,” she said. “We’re already seeing appointments starting to come up for second doses, but most of those come through e-mail, so if you don’t check your e-mail or don’t have an e-mail address, you won’t see it. We need to think that far ahead to make sure those people don’t just get missed completely and that there is some sort of follow-up.”
The Importance of Trust and Information
A long history of abuse and neglect in the U.S. medical system is also keeping some Black people from even wanting the vaccine if they are eligible, Hood said.
According to a countywide survey conducted in December and January by FM3 Research about vaccine attitudes, 36 percent of African-Americans said they were unlikely to take the vaccine. That’s higher than any other race.
“Black issues especially go back to centuries of inhumane treatment in America. People often mention Tuskegee, but that’s just the tip of the iceberg,” said Hood, referring to a public health study in which Black men were injected with syphilis without their knowledge or consent.
In the Latino community, Maldonado said, community health workers have had to dispel misinformation and rumors that can spread quickly.
“People were hearing that there were really intense side effects,” Maldonado said. “There were rumors that there quite a few number of deaths related to the vaccine. A few people had heard it had affected women’s ability to get pregnant. Those kinds of things were already circulated before we really started talking about the vaccine as community health workers. It got way ahead of us.”
Fatima Muñoz, director of research and health promotion for San Ysidro Health, said she’s heard many questions about whether the vaccine is safe and why it was developed so quickly.
“It’s really important that the community can get information from organizations and people that they trust,” Muñoz said.
Both Muñoz and Maldonado said that they’ve seen people’s attitudes toward the vaccine change with increased education about it. Hood also emphasized the importance of trusted messengers within the Black community to educate people about the vaccine.
But trust issues go beyond just information about the vaccine.
One issue that may be deterring immigrants in the community from accessing the vaccine is the fact that some websites ask for people’s Social Security numbers when they try to sign up for an appointment. It’s not actually necessary to provide a Social Security number – you can just enter all zeros – but the question itself raises a red flag for many who fear interactions with the government could trigger immigration enforcement, said Muñoz and Maldonado.
“People don’t know that it isn’t mandatory, so when they see it, it’s a barrier,” Muñoz said.
Lingering fear and distrust Latino immigrants feel from the Trump administration is also playing into efforts to distribute vaccines to the community.
“People want to know who this information is going to be shared with and will it be obvious if they put in all zeros that they don’t have a Social Security number? I know that’s been a deterrent,” Maldonado said.
Although the Department of Homeland Security has indicated it will not be patrolling or monitoring vaccine sites, many Latino immigrants are still nervous about going to them.
“We’re heard many people say, ‘We want to wait until somewhere smaller in my neighborhood opens up,’” Maldonado said.
Indeed, the county vaccine attitude survey also indicated that residents of all races and ethnicities are most comfortable getting the vaccine at their doctor’s office, followed by a pharmacy or a medical clinic in their community. Only 25 percent of survey respondents said they would feel comfortable going to a pop-up vaccination clinic or a library or community center.
“It’s great to have a superstation, but how can we engage our community enough that they will go through the door and get the vaccine?” Muñoz said.
As the county works to increase vaccination sites, Muñoz says it’s critical that community organizations like hers continue to build trust and provide information.
“Every time there is a challenge, we need to recognize it and inform our community,” she said. “Things are getting better – and I’m glad – but we have to do better as a county to really ensure that we can improve trust with our community. It’s not only providing the resources, but also providing the appropriate information in the way our community deserves to get it.”