Community leaders: Health care ‘failing’ marginalized groups

As the state opens up vaccine registration to residents aged 65 and older this week, gaps in vaccine equity and access leave community members and activists concerned about roll-out for marginalized and under-served communities.

From an English-only vaccine appointment website that requires computer literacy skills and personal technology to navigate alone, to a lack of vaccine education and skepticism, to the finite allotment of vaccines, barriers to entry abound. The issues are systemic, historic, and concrete. They span histories of medical abuse in the Black community and the literal difficulties of signing up for a vaccine online. And community organizers are looking for solutions.

“There’s no equity in this process,” said Tekisha Everette, executive director of Health Equity Solutions, a health policy nonprofit in Connecticut. “All we’re doing is reinforcing the same systems that created the inequalities you saw before. We saw this in testing and we learned nothing.”

Vaccinations of the state’s Black and Latino populations already lags behind that of white residents, mirroring a similar trend seen in other parts of the country. As of Feb. 3, white adults accounted for 59.7 percent of total vaccines administered to those in the 75+ bracket in Connecticut, with just 2.3 percent going to Hispanics and 1.9 percent going to Black elders, a state press release read. These same groups that are receiving significantly less vaccine are the ones that face disproportionately higher hospitalization and death rates due to COVID.

They’re also the people that also make up a large part of the front-line and essential workers, said Crystal Emery, founder and CEO of URU, The Right To Be, a non-profit that takes on social justice issues through media campaigns.

While data is limited and may not be entirely accurate, clear disparities exist, state officials have said.

Currently, the state is working to distribute roughly 10 percent of its excess vaccine each week to specifically target areas that are demarcated as high on the CDC’s Social Vulnerability Index (SVI) scale, according to Maura Fitzgerald, who is running COVID Communications for the CT Department of Public Health.

“That’s a high priority for the state,” Fitzgerald said.

Lost in translation

Misinformation about the vaccination process, from fears of deportation to concerns about cost, could also cause issues for vaccine roll-out in immigrant communities where English is a second language.

Fitzgerald said the state has been clear that they will not be turning over any personally identifiable information to other government entities. “Our goal is to get shots in people’s arms and immigration status is not a deterrent.”

This message has been echoed in recent weeks by the Department of Homeland Security who stated that they encourage “all individuals, regardless of immigration status, to receive the COVID-19 vaccine once eligible under local distribution guidelines.”

But Katia Daley, health care campaign organizer for Connecticut Students for a Dream, is more skeptical.

“This information is not going to get to the community,” she said of bureaucratic attempts to assuage fears for undocumented people. “Of course you’re going to be afraid of putting your information there because you don’t want repercussions.” Instead, she suggested community organizers were the best harbingers of that information.

Daley has family members who are undocumented, and anticipates having to help them through the sign-up process with the oft-unwieldy federal Vaccine Administration Management System (VAMS), which is only available in English. Translation in medical settings is a wellknown duty for children of immigrants, who often bear the brunt of mediating stressful medical communications.

“It’s so prevalent in our community that we honestly even have a meme about it,” said Jonathan Gonzalez-Cruz, a community organizer who often translates for his mother in medical settings.

To help remedy these gaps, Fitzgerald said the state has implemented and will continue expanding a 2-1-1 Vaccine Appointment Assist Line to help people contact specialists who can virtually connect with a language line interpreter. These interpreters are then able to provide translation services in more than 240 languages, according to Fitzgerald. The state also plans to include Spanish subtitles on its VAMS sign-up video and have been doing outreach with community based organizations to help with vaccine education.

“This is one of the major limitations of VAMS that’s been a frustration for us, is it is only in English” said Josh Geballe, chief operating officer in the office of the governor, during a Feb. 8 press briefing. “A lot of our large providers are doing direct outreach and have multi-lingual support to people who would prefer not to interact in English.”

Heavy reliance on community-based organizations

“We already knew there were huge health disparities in our state,” said Jill Zorn, senior policy officer at the Universal Health Care Foundation of Connecticut. “It’s just so obvious that our health system is failing people so badly.”

Instead, community leaders said that the work to get marginalized, under-served populations vaccinated will have to be done by local organizers. Community partnerships and bringing “everyone to the table” where decisions are being made is key to equitable distribution, Zorn said. And community leaders emphasized that education by trusted voices would be essential.

For URU that means highly visual media campaigns on buses and in churches, and training 12 new community organizers. For Health Equity Solutions that means hosting faith-based and education-based sessions where they can dispel vaccination myths.

“We don’t have systems that are in place that can really help people and be really successful in getting an appointment and to getting to the vaccine,” Everette said.

Both Everette and Emery voiced concern about the equity issues in the way phases are structured during roll-out. Emery pointed out that life expectancy for Black people is lower than that of white people, and that current age ranges for phases don’t include Black elders in the same way it does whites. Everette suggested that vaccines be prioritized for communities with the highest rates of COVID spread and deaths.

“This is a war with COVID-19, but at the same time, the biggest war, the deadliest disease in America, is racism,” Emery said.

The combination means communities of color are “just getting slaughtered.”

“This is very complicated, difficult work,” she said.

Language accessibility for non-English speakers

The state does not plan to pivot away from VAMS in upcoming phases, which suggests current language barriers could persist, potentially putting non-native English speakers at a disadvantage.

Zorn said the state phone line seems to have improved access to scheduling, but Everette has heard that there are “enormously long” wait times that could deter or prevent people from signing up.

And even with language help, the site itself, despite improvements, is still hard to use.

Bob Fishman and his wife recently signed up to get vaccinated in the next phase and found it difficult to navigate. “If it’s not easy for us and we’re English speakers, I can’t imagine how complicated it is for people whose language is not English,” Fishman, the executive director of the Connecticut Immigrant and Refugee Coalition, said.

Community-based organizations like the Integrated Refugee and Immigrant Services (IRIS), a refugee resettlement agency in New Haven, have already been through this education campaign once with COVID testing, and are now gearing up again for the vaccination process. Immigrants and refugees have been hit especially hard by COVID, from both a health and economic standpoint, and getting them vaccinated is one of the agency’s focuses.

Earlier in the pandemic, IRIS found success ramping up COVID testing in immigrant and refugee communities by hosting testing sites at their weekly food bank, where clients were more comfortable, and where they were already congregating. IRIS is seeking approval to be a vaccination site.

“When it comes to vaccines, this is a whole, new uncharted territory for all of us,” said Ann O’Brien, director of community engagement at IRIS. “We’ll do whatever it takes.”