Before the vaccination clinic opened its doors at the Farmworker Association of Florida, Teresa was waiting outside. She was first in line for her COVID-19 booster vaccine.
Teresa, who asked to be identified by her first name, moved from Mexico to the United States 15 years ago. Now she works at a nursery in Apopka, about 20 miles from the world-renowned amusement parks and bustling hotels of Orlando. It’s a quiet town of about 54,000 people and is known for its agriculture industry. The conditions are crowded at Teresa’s workplace, which contributed to her decision to get vaccinated against COVID-19 last year.
“We have to take care of each other,” Teresa said.
But it wasn’t an easy decision; she had her doubts.
“I thought it could be a test,” she said. She feared the government was using the public as a trial run. But it didn’t take her long to change her mind after seeing many of her co-workers come down with COVID-19.
After all, she liked the people here. She trusted this place.
They were like her. They were Latinos.
The farmworker association is just one of many community groups fighting for COVID-19 resource equity for Latinos. The quick spread of misinformation, language and cultural barriers, medical accessibility for rural and low-income populations, as well as a historically complicated relationship with the medical system have resulted in a perfect storm for the Latino community, which trailed behind the white population in vaccination rates in 2021.
Latino population now achieving a higher vaccination rate than other racial and ethnic groups.
SPEICAL REPORT: Unequal Shots, how distribution of the COVIID vaccine exposes inequities in Florida’s health system.
Nambi Ndugga, an analyst with the Kaiser Family Foundation’s Racial Equity and Health Policy Program. “Communities of color are more trusting of people who have been in their community for a long time. Building that trust has been crucial for these groups.”
Ndugga is part of the team that collects and analyzes data on COVID-19 vaccinations by race and ethnicity. The information is pulled from both individual states and the Centers for Disease Control and Prevention.
By mid-March 2021, national data showed that 19% of the white population versus 9% of those who identify as Hispanic had received at least one dose of the COVID-19 vaccine. By March of this year, that gap shrunk to 62% and 64%, respectively.
Kaiser’s data indicates that in Florida specifically, 62% of the white population has received at least one dose of the vaccine while 70% of the Hispanic population has.
Ndugga said this can be credited, in part, to the on-the-ground work in communities being done by organizations like the farmworker association.
“When the American Rescue Plan went into place, there were a lot more investments in community health centers, and we saw a dramatic increase in the Hispanic population getting vaccinated,” she said, “They’ve done a much better job of getting that population vaccinated compared to the mass vaccination sites.”
Of course, the Latino community is not a uniform group that can be generalized. Many members of this community have received the vaccine with enthusiasm and little difficulty. But for others, especially the most vulnerable of the Latino population in Florida — rural, low-income residents — more work and trust was required to reach them.
And trust, or the lack of it, was often at the crux of decision-making amid the pandemic for the people of this community.
“Trust,” Vanessa Chee wrote in her research study on factors influencing uptake of the COVID-19 vaccine, “permeates every aspect of the vaccination decision-making process.”
Chee is a public health researcher who studies vaccine misinformation among Black and Hispanic communities. Her study measured the trust Black and Hispanic communities have in COVID-19 vaccinations; she also gathered common threads of misinformation that were most prevalent in these communities.
Among the most common misinformation narratives Chee found were that COVID-19 vaccines made women infertile; the vaccine was made solely for the profit of the pharmaceutical industry; and that COVID-19 vaccines could be used to microchip or track individuals.
Chee concluded that some among the Latino community feel there isn’t enough trusted information available to them to outweigh the risk of being vaccinated.
Chee labels people who delay vaccination as “vaccine-deliberate,” a term she said comes from one of the participants in her study. She clarifies that a “vaccine-deliberate” person isn’t an “anti-vaxxer.” It means people see vaccination as a risk; and until there is enough information to satisfy their concerns, they will wait.
“They want information, reassurance, regarding side-effects–both in the short- and long-term,” she said.
For many, public health initiatives such as COVID-19 vaccinations may feel routine. But there is a history of public health failing the community. In particular, Latina women.
Chee points to one moment in history that illustrates this long history of mistrust.
In the 1950s, two doctors from the mainland United States used poor, under-educated Puerto Rican women as their test subjects to develop the birth control pill. Listen to Chee recount the full history of these contraceptive trials:
Chee said that there’s a permeating hesitancy in the Latino community that they are supposed to trust a system that has historically failed to serve them. In turn, they have to ask themselves:
“What are they not telling me? What information do I need to hunt down? What information do I need to wait for?’
Back at the Farmworker Association of Florida, a steady stream of people began arriving at the vaccination clinic.
The association is an advocacy center for Florida farmworkers. They work to address every issue their community members might have, including health care.
Need a lawyer? They’ll refer you to someone.
Need a stroller? Donations of clothing, baby-care items and household supplies dot the hallways.
Need a COVID-19 vaccine? They have that, too.
The clinic operates during the evening, from 5 p.m. to 8 p.m. so that people can come after work. Pharmaceutical technicians from Walgreens set up in the conference room. Rows of chairs line a cleared-out area, where people can sit and be monitored for 15 minutes after receiving the vaccine.
A few attendees spoke out about their decision to be vaccinated. Only first names were used to protect each person’s privacy.
Irene and Ricardo are middle-aged siblings who don’t live in Apopka but are close enough to commute to the center. Irene said they lack internet access at home, so she couldn’t schedule an appointment online. At the center, her and Ricardo were able to walk in.
Irene said she was initially afraid to get the vaccine, fearing it might make her sick. But in August, her sister was infected with COVID-19, and she and her family were vaccinated.
“We want to follow the president’s advice, too,” she said, referring to President Biden’s zeal for the vaccine.
For Esmina, the decision was a long time coming. She was at the clinic for her first dose, but she was nervous. She worried about the potential side effects she’d heard about.
She said it was hard to make an appointment at other vaccination sites, like Walgreens or Publix. Fortunately, she was familiar with the center, and she saw an event posted on Facebook.
Ana is a nursery worker from nearby Ocoee, about 10 miles south of Apopka. She was getting her second dose of the Pfizer vaccine. Although, she’s the only one in her immediate family to be immunized.
She was worried at first–she thought the vaccine was made too quickly and without the proper diligence. She wanted to wait a bit.
She said her three children, who are 9, 11 and 15 years old, don’t want to get the vaccine.
Ana said her family sees all kinds of misinformation about the COVID-19 vaccine on social media, and they warned her not to get it. Her husband, who has asthma, also refuses to get the vaccine, in fear it will risk his health.
For Ana, the added protections from the vaccine outweighed any risk. But it wasn’t an easy decision, she said.
“My hands were shaking,” Ana said. She remembers getting her first dose.
“In theory, yes, they can get vaccinated; yes, they can get tested,” Xiuhtecutli said. “But many sites are only open during normal work hours.”
He said sometimes this means other things take priority over daily and weekly pandemic precautions.
Ndugga, the Kaiser policy analyst, said there’s been a lot of talk about vaccine hesitancy, but not enough understanding about accessibility. She believes a lot gets missed in that conversation.
And while the national conversation has shifted to whether vaccine holdouts will ever get the vaccine after almost a year of wide availability, Xiuhtecutli said, it’s not that simple for the people he works with.
“Maybe in an urban center, that’s largely true, but in rural areas, accessibility is still an issue,” he said.
But Xiuhtecutli said he has heard all kinds of anxieties and false information. For example, he’s heard that vaccines are a measure of government control or government surveillance. Or even graver, that the vaccines were designed to wipe out the Latino community, and kill them.
“There’s a general mistrust of the U.S. government, and how the vaccine was approved,” he said.
At first, Maria Crim wasn’t sure about getting the COVID-19 vaccine. She lives in Union County, but she originally immigrated from Argentina.
She didn’t doubt the science. In fact, she had a good understanding of medicine, but she still held on to some anxiety.
“I still had my doubts,” she said. “I felt it was a test. That the vaccines were a new thing, and they were testing them on us.”
She said she enjoys being at home and living a calm life with her husband, adult daughter and two young children. But the pandemic shook things up.
In the fall of 2020, her husband fell ill with COVID-19. He was hospitalized and almost died, and for a while, she said, she didn’t know if he would be coming home. Thankfully, he pulled through and is now in good health. But the experience scared her.
Still, when vaccines became available in the spring of 2021, she didn’t jump on the opportunity right away. In August, she finally decided to get vaccinated.
“I prayed about it, and thought, God if this is what you want… put peace in my heart,” she said.
In addition to prayer, she said she and her husband spent time researching and investigating before making the decision to be vaccinated.
Then she decided to help others make theirs.
That’s why a few months back, Crim became a comunicadora, or communicator, who is part of a team of advocates organized by Project Salud, or “Project Health.” The project is run by the Rural Women’s Health Project in Gainesville.
Alejandra Ramos, the coordinator of Project Salud, said the program was born from clients who were passionate about serving their community with credible information.
“We decided to have them connect to people they know, their community,” Ramos said, “We talk to them, to see what they need to know.”
Comunicadora means communicator, and that’s precisely what Crim was tasked to do.
“Essentially, Project Salud sends me the information,” she said, which includes information about events, health services, vaccination clinics and other essential information intended for the Latino community in north central Florida. Crim then sends it to her network of about 60 contacts. The idea is, they might pass it along to others. That way, it might get shared again and again.
“It’s like a chain,” she explains.
But without care, this same network can create the opportunity for misinformation to spread. Crim said she witnessed false information about the vaccine take a foothold in her community once before. It was spreading quickly via a text service called WhatsApp. The speaker introduced herself as Roxana Bruno, an Argentinian biochemist, and claimed the ill effects of the COVID-19 vaccine were 100 times greater than that of other vaccines and that the side effects were worse than the disease itself. The post also incorrectly claimed that the vaccine was being tested on a grand scale without people’s knowledge.
Though the origin of this clip remains unknown because it has been shared so many times, The Poynter Institute reported in 2020 that Bruno was a real person and debunked her claims.
It’s these kinds of falsities that the comunicadoras try to counter with consejos, or tips, provided by Project Salud. These materials come in the form of flyers or audio messages that contain digestible COVID-19 information in Spanish and other Indigenous languages. The materials are also designed to be easily shareable on social media or messaging apps, in the hopes it will catch the same traction as false information.
But misinformation is just a single barrier at play here.
Crim said most people in her network are day laborers or farmworkers. Systemically, low-income, rural, undocumented, and otherwise marginalized Latinos face many barriers to receiving any kind of healthcare.
So Crim doesn’t just forward people’s information and leave it at that. Many Latinos working in the United States have American-born or English-speaking children who help them fill out forms, make appointments and communicate with healthcare providers.
Chee, who is a public health researcher, calls this person the “health agent.” This person is usually a family member who helps facilitate health care for others. But, not everyone has someone like this, which is where communicadoras, like Crim, come in.
Crim says she is happy to help, but it can be frustrating. Sometimes she spends hours on the phone with someone–often a stranger who she has connected with–helping them set up an appointment or fill out paperwork. And even then, there is no guarantee they will go to the appointment, or follow up.
Still, these advocates refuse to give up.
Anna Villagomez, the COVID-19 response manager at the Rural Women’s Health Project, points to inequalities that became apparent at the start of the pandemic.
“At the beginning of the pandemic, there was no information in Spanish, it was all in English,” Villagomez said.
Villagomez said the organization went into overdrive attempting to close that information gap.
“The language barriers are huge,” she said, “If you call somewhere trying to make an appointment, there’s no guarantee someone will speak Spanish, much less an Indigenous language.”
Villagomez, Xiuhtecutli and Crim all echoed a third barrier: religious anxiety surrounding the vaccine.
Several are concerned that the vaccine was manufactured with fetal tissue, said Xiuhtecutli, and that it would be a sin to take the vaccine. The Associated Press has reported that no COVID-19 vaccines have been manufactured with fetal tissue or cells, but fetal cells may have been used in the testing phase.
“Our members are mostly Catholic, and they follow the teachings of the church,” Xiuhtecutli said.
He said although Catholic officials have encouraged vaccinations, some priests of local parishes have not transmitted the message.
Considering the heavy influence of the Catholic church and other Christian denominations on the Latino community, Villagomez said it’s important to gain the trust of the pastor or priest first before appealing to the community at-large.
“They’re the trusted messenger in that community,” she said, “That’s who they are going to trust.”
The University of Florida’s Our Community, Our Health program has also assumed the role of “trusted messenger” to many underserved neighborhoods, including the Latino community, in north central Florida.
The new program, which is operated under HealthStreet, recently launched to bring COVID-19 resources directly into the community.
The initiative will allocate $6 million in the first year to deploy mobile health vehicles, passenger vans retrofitted as small examination rooms capable of temporarily storing vaccines, to practically anywhere. Though they operate mostly in Alachua and neighboring counties, they’re working on expanding into other parts of Florida.
The goal is for these vehicles to serve as education centers as well as mobile vaccination sites, said HealthStreet deputy director Catherine Striley.
It’s also designed to be a space for people to ask questions.
“When people feel hammered,” Striley said, “their opinions harden.”
According to a press release by UF Health, the Our Community, Our Health program will “prioritize migrant farmworkers and LGBTQ, Native American, Hispanic and Black populations.” Though in practice, it will serve anyone seeking its services.
“We pretty much go wherever they’ll let us park,” Striley said.
On a sunny winter morning, two UF vehicles were stationed in a YMCA parking lot in the northern end of Gainesville.
One was a larger vehicle offering anyone a free check-up by a registered nurse. The separate, smaller van, called the Community Health Vehicle, stores the COVID-19 vaccines. The parking lot was sparse, but the staff was alert and ready.
Alex Matisco, a certified nurse assistant, said it’s important for his team to show up.
“People get used to seeing us around, they see we are there to help,” he said, “that we’re
not just strangers coming into their neighborhood.”
Luisa Murphy, the lead community health worker at HealthStreet, stood outside the van, clipboard in hand and sunglasses shielding her eyes from the bright Florida sun.
“In the past year, that’s been our goal, to really reach out to the Hispanic community,” Murphy said “I mean, I myself am Hispanic, I want to take care of our community.”
She said they have been able to overcome the language barrier by bringing in Spanish-speaking volunteers and translating all of their documents. It’s also about just being able to have a conversation.
“One of our goals is to reduce hesitancy,” Murphy said, adding that a lot of misinformation circulates by word of mouth in the community.
It’s paramount to build trust between themselves and the community.
“We go where people gather,” she said. “We don’t wait for them to come to us.”
A part of the work, she said, can be discussing people’s basic needs like food and shelter. Even if it doesn’t relate to healthcare, it is a way to build trust.
Murphy said another key to changing tides was when community health advocates for the Latino community are also of Hispanic heritage: “You need to feel represented, if you meet someone that has the same culture as you, you may be able to make more of a connection.”
Even then, powerful factors–like fear, religious anxieties and misinformation–can perpetuate vaccine hesitancy. Crim, who serves as a communicadora, said it’s important to respect people’s autonomy in making a personal health decision.
“I don’t think I’ve ever really convinced anyone to get the vaccine,” she said, “It has to be their decision, but I will help them.”
Unfortunately, in Crim’s experience, she said many people don’t make the decision to be immunized until the coronavirus has personally affected them or their family.
“It’s a very ugly thing to not have access to medicine,” she said. “There are people who will wait until the last possible moment out of fear; fear because they are undocumented, fear because of bills. I’m not motivated by anything material to do this. I do it for the love of others and of God.”
Crim said she will always try and help anyone who contacts her, and if she can’t, she will find someone who can.
“They put their trust in me,” she said.
Something she knows – now more than ever – holds weight in the Latino community.
How this story was reported
This story was reported over the course of a year using first-person interviews and on-site visits. Public health research and COVID-19 data were also used to inform this reporting.
Many interviews were conducted in Spanish and translated into English for this story. In addition, some last names were withheld from publication by the request of sources to protect their medical privacy.
