MALAGA, CHELAN COUNTY — Teresa Bendito-Zepeda and a few companions went door to door during a summer morning last month, coaxing the farmworkers at this migrant housing complex to a pop-up COVID-19 vaccination clinic in an empty apartment.
They are the Madrinas de Salud, the Godmothers of Health, Bendito-Zepeda says, and they have a simple, yet daunting mission: Help vaccinate as many Latinos in Chelan and Douglas counties as possible.
The Madrinas’ work has taken on a new urgency as the highly contagious delta variant of the coronavirus takes hold in communities across Washington. Delta is estimated to make up more than 90% of new cases and is driving a fifth wave of illness.
And the Latinos the Madrinas serve are the largest ethnic minority in the state — with the lowest vaccination rate among racial and ethnic groups.
“Wherever people are at, we are going,” Bendito-Zepeda said.
Across the state, 43% of Hispanic residents have received at least one dose of a COVID-19 vaccine, compared to 57% of all residents.
In some counties, especially east of the Cascades, the rate is lower. In Adams, where almost two out of every three residents are Hispanic, only 34% of them have received at least one shot; in Franklin, where just more than half of the population is Hispanic, just 32% have received at least one dose. The low vaccination rate mirrors that of both counties’ broader populations.
Latinos historically have faced impediments to health care, including a lack of health insurance, language barriers and fear of deportation that experts say are contributing to elevated exposure to COVID-19. And, like the population at large, Latinos are subjected to vaccine misinformation through social and personal networks.
Calculating the risk for Latinos, nearly 1 million people in Washington, isn’t straightforward, to be sure. Over the course of the pandemic, Hispanic people have accounted for 29% of COVID-19 cases, according to the state Department of Health (DOH), despite only making up 13% of the state’s population. Hospitalizations for the disease are also disproportionately high. But Hispanic people are slightly underrepresented among those who die, at 12%.
Another compounding factor contributing to the risk for Latinos is age. About 25% of the Hispanic population in Washington is under 12 years old, and therefore ineligible for COVID-19 vaccines. In contrast, the percentage of whites and Asians under 12 is 13%. For Black residents, it is 17%.
Dr. Leo Morales, co-director for the Latino Center for Health at the University of Washington, says the age difference is critical.
“Any age is vulnerable if you’re unvaccinated,” he said. “So even though the risk of serious disease and disease transmission is lower among younger people, they are nonetheless vulnerable to COVID unless they are vaccinated. Viruses don’t care what age you are.”
There is real danger for the unvaccinated, whether eligible or not, as the delta variant appears to have begun a rampage across the state.
DOH last week reported 600 hospitalizations statewide — a 20% increase over the previous week. The percentage of positive tests has climbed to 5.5%, up from 2% a month ago. Hospital occupancy is at the highest level seen so far in 2021, DOH said. More than 94% of all cases, deaths and hospitalizations for those 12 and older between February and June have been linked to individuals who were not fully vaccinated.
“It's going to hit the Latino community the hardest because they're the least vaccinated,” Morales said.
Barriers to care
Latinos have long been disadvantaged in the U.S. health-care system, Morales said, and it was no surprise their vaccination rates have lagged.
"Latinos are disconnected from the health-care system for many reasons,” he said. “They don’t have regular health providers, or they may avoid it if they think it threatens their ability to live in this country. And the cost of health care is tremendous. There are also cultural and linguistic barriers that add to their hesitancy.”
The high rates of infection and low rates of vaccination among Latinos illustrate stark inequities here and nationally, said Matias Valenzuela, equity director for Public Health – Seattle & King County.
Latinos work jobs that are deemed essential during the pandemic, he said, which can accelerate the spread of the virus. They also are more likely to live in a multi-generational home than white or Black people, though less likely than Asian or Native American. Multigenerational households were prioritized for vaccination when supply lagged demand.
In King County, infection rates among Latinos are four to five times higher when compared to white residents, said Valenzuela.
"Access to good education, good-paying jobs, good housing, all those kinds of things are essential for people to be able to function and be able to live and make sound decisions," Valenzuela said. "When you are having those things challenged and at the same time dealing with COVID — that is no small thing."
These barriers can be chipped away. Medical Teams International (MTI) helped organize the Chelan County vaccination clinic with Bendito-Zepeda and the Madrinas. The Portland-based humanitarian organization started testing agricultural workers for COVID-19 during the spring of 2020.
Its continuous presence in those communities allowed MTI to more easily run mobile vaccination clinics to reach the largely Latino migrant workers.
"We've become a very trusted name in providing high-quality services and being able to respond quickly to needs both for testing and vaccination," said Leslie Aaron, the Washington COVID-19 program manager for MTI.
Another battle for public health workers and advocates is misinformation relating to vaccines. Morales is aware that, as in other racial groups, there is some hesitancy toward vaccinations among Latino communities because of bad information.
"I don’t know how much religious hesitancy there is, but we do hear about it," he said. "There is apparently a lot of social media that comes from Latin America. Priests that have been speaking out against vaccines."
He is working with other groups to counter the spread of misinformation by organizing online panels in Spanish with religious leaders from both sides of the mountains, which will be broadcast via radio, Univision and Facebook live.
To reach Latinos it is vital they have easy access to COVID-19 vaccines and that those vaccines are provided by other Latinos or Spanish speakers, said Bendito-Zepeda.
“I think that resonates with people,” she said. “I’m here with you and I’m not going to lie to you.”
Anna Zamora-Kapoor, an assistant professor in sociology and medical education and clinical sciences at Washington State University, said repeated nudges for people to embrace vaccination are important.
Latinos are not generally reluctant to be vaccinated and will do so if access is easy and they can ask questions of a Spanish-speaking provider, Zamora-Kapoor said.
“If I had to run a campaign to promote the COVID-19 vaccine, I would say something along the lines of, ‘the best gift for your family is to get vaccinated,’ ” she said. “The idea is to emphasize that the vaccine is protecting not just you, but also your family and those around you, those you love.”
Sick, hesitant, then convinced
María Dolores Herrera, 43, of Spokane, worried about the safety of the vaccines, for herself and her seven kids. She worried about side effects and how those would affect her diabetes.
The absence of information in Spanish and accessible to her only heightened her worries.
"A lot of the times, it feels like doctors don’t really care about us Latinos, so we don’t go unless we really have to," said Herrera, who works cleaning homes.
Herrera and some of her family members contracted COVID-19 in December. They’d only been leaving their home to buy groceries, other essentials, or to work, she said. They still don’t know how they became exposed.
Despite feeling ill, Herrera mustered enough strength to cook and care for her sick family. Every morning she’d wake up to brew enough herbal tea in a pot to last the entire day.
When she became eligible for the vaccine, she weighed her options. Some friends and acquaintances tried to talk her out of it, she said, relaying to her their worries brought on by some “outlandish” theories, including that the vaccine contains a government tracking chip.
"There was just a lack of information overall that probably gave way for stories like that, and it’s still happening," she said.
As she debated getting the vaccine, several Latino organizers encouraged her to get vaccinated and answered all her questions.
But her worries remained, and her family continued to isolate themselves even as the state slowly reopened, she said.
It was only after a family friend of hers got his vaccine and remained healthy — and alive — that Herrera and her family decided to go to a vaccination clinic in June at Spokane Community College.
“I was still fearful, but I thought about how life just needs to continue and we can’t do that living in fear,” she said.
She still struggled with letting her eligible children get the vaccine. But candid conversations with Latino leaders helped her realize it was in the best interests of her children to get vaccinated, too.
Dr. Mabel Bodell, a nephrologist at Confluence Health, who has worked with Bendito-Zepeda, began reaching out to Wenatchee-area Latinos early in the pandemic for testing and other needs arising from infections. She understood that there was going to need to be work done with the community once vaccines were available.
In December, she started the ¡Si! ¡A la vacuna! ("Yes! To the vaccine!") campaign.
“We have to tell a story. We have to really tell them our experiences, and sometimes it takes a couple of times … It takes a lot of effort, once, twice, three times to talk about this and make sure that they do have the right information to make the right decision,” Bodell said.
The efforts appear to be paying off. Bodell said that in March and April of 2020 more than 50% of COVID-19 admissions at Confluence Health’s Wenatchee hospital were Latinos. That number is now between 5% and 8%.