Note: this story was first publication by Clarissa Donnelly-DeRoven for North Carolina Health News on November 1, 2021. TCB republishes this story through a partnership with the Solutions Journalism Network.
by Clarissa Donnelly-DeRoven
When the vaccine began to roll out in North Carolina, the rate of Latin Americans getting the vaccine lagged behind other groups. In March, just 2.5 percent of all vaccines given were given to Hispanic residents, even though the group represents nearly 10% of the state’s population and has been disproportionately affected by the virus.
But now Latino residents are being vaccinated at a higher rate than the non-Latino population, according to the most recent data from the state’s Department of Health and Human Services. Statewide, 67 percent of Hispanic residents 12 and older are vaccinated, a rate 10 percent higher than that of the non-Hispanic population of North Carolina.
At the COVID-19 Latino Working Group meeting on October 25. Yazmin Garcia Rico, the director of Latinx and Hispanic policy and strategy at the North Carolina Department of Health and Human Services, explained that of North Carolina’s 9.8% of Latino residents, 8.7% had been vaccinated – a significant achievement, given that a quarter of North Carolina’s Hispanic population is under the age of 12 and therefore not yet eligible to be vaccinated.
So how did we get here?
In almost all age categories, the vaccination rate among Latinx residents of North Carolina is higher than that of the non-Hispanic population. Graphic courtesy of the North Carolina Department of Health and Human Services COVID-19 Vaccine Dashboard.
“Lots of collaboration,” Garcia Rico said with a tired laugh. “It is difficult to list them all and mention them all. ”
The department used familiar tactics to reach residents: bilingual ads on TV, radio and social media, virtual town halls, posting on Facebook Live. But he also did something more creative. A DHHS project, called Healthier Together, paid for community health workers in each of North Carolina’s 100 counties to get the message out. These field workers built on their existing relationships, in this case their relationships with Latino residents, to improve the group’s access to both vaccine information and the vaccine itself.
Garcia Rico, and others in the field, give much of the credit for the group’s high immunization rate to these community health workers.
“We launched the initiative to support organizations on the ground that were already doing a lot of work,” said Garcia Rico. By tapping into existing community networks and providing local people already in a position of trust with money and logistical support to help residents learn about vaccines and schedule appointments, the agency was able to avoid waste time and duplicate resources – in short, to get more vaccines in more arms faster.
In addition, nearly half of community health workers are bilingual, which Garcia Rico says is essential.
“A regular interpreter will just interpret from provider to patient, but community health workers have more knowledge,” she said. They can provide concerned residents – who may already know and trust them – more information before and after the shot, and connect them to other services.
Norma Martí is co-leader of the Latinx Hispanic Community Intervention Team, a project of North Carolina Community Engagement Alliance funded by the National Institute of Health. One of the group’s ultimate goals is to improve vaccine equity in the state. Martí worked closely with DHHS throughout the pandemic to distribute supplies and information to the state’s Latino community.
“Getting the message out was probably the hardest thing because with social media people get all this shitty misinformation,” Martí said. Part of the challenge is also that much of North Carolina’s Latin American community lives in rural areas. Hispanic residents make up between 16 and 23 percent of the population in Duplin, Sampson, Lee, Greene and Montgomery counties.
“The first thing the secretary [Mandy Cohen] made us do it – I mean, I was there for a week – and she says to me: “We have to identify people to help us spread the word,” Martí recalls.
In June 2020, the DHHS announced it would award $ 100,000 each to five different organizations that have worked closely with Latino residents in different parts of the state. This project, in many ways, laid the foundation for the partnership with community health workers.
While about a quarter of North Carolina’s Hispanic population live in the counties of Mecklenburg and Wake, many Latinx residents of the state live in rural counties. In Duplin County, for example, 23 percent of residents are Hispanic. Map created by the Carolina Population Center at UNC Chapel Hill.
“It’s not like [the organizations] weren’t already doing outreach, ”Martí said, but she believes paying these organizations and community health workers for their work and resources has helped“ invigorate ”the work.
“They were paid. They weren’t volunteers. They were paid – which is probably the first time any of us have ever had a community health worker program that was paid for in real money, ”she said.
The NIH approved funding for Martí’s group, the North Carolina Community Engagement Alliance, in the winter of 2021. She and the other leaders toured the state, making sure every region was represented, and brought together 10 Latin Carolinians from the North. They began to strategize on how best to reach people in different parts of the state.
“Their position was, ‘We have to talk about the myths. We have to make mythbusters, ”said Martí. “Everything I’ve done in public health, you don’t mention the bullshit that is being said, because then you just reinforce it. And the community team said, ‘No. We have to face it directly. People hear that, and you have to tell them, ‘No, that’s not right.’ ‘”
Martí and the other leaders said okay, and they all got to work. Over the past year, the group has created animated myth-busting videos in English, Spanish, and Zapotec, an indigenous language spoken in Mexico. They seem to have been effective and the group is working on creating a Mayan language version.
Martí believes that general barriers to care may help explain why there was a delay in early vaccination by Latino residents.
“We do not have access, as a people, to health systems,” she said. “Latinos are the least insured in the state. According to the Census Bureau, approximately 31 percent of Latino residents in North Carolina do not have health insurance.
A video created by members of the Latinx Hispanic Community Response Team, a project of North Carolina Community Engagement Alliance, to help debunk myths about the COVID-19 vaccine.
“When we heard about vaccines, we thought, ‘Well, it’s not for us because we don’t have health insurance and we don’t have money. “Because every time you go to the hospital you end up with a bill for $ 1,000, $ 2,000, $ 3,000, $ 4,000,” Martí said.
“It took a long time for these community health workers to get into these communities to spread the word, to regain confidence. ”
Both Martí and Garcia Rico have said there is no valid reason why the vaccination rate for Hispanic residents looks as good as it is today. It is the result of a lot of work and a lot of investments that have accumulated over the months.
“I really, really think in my heart that it was this combination of collaboration,” said Martí. “We were all at the table, letting everyone talk to each other. “