Chatham vaccine providers work to ensure vaccine equity for Hispanic residents

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When Chatham Hospital’s Jesus Ruiz became the first person — and first Latino — in the county to get vaccinated on Dec. 16, UNC Health made its stance clear: vaccine equity and access would be top priority.

“It’s very important to get the coronavirus vaccines,” Ruiz said in a Spanish-language video Chatham Hospital shared on Facebook a week later. “In part it’s another weapon against this virus that unfortunately has devastated our community, so I recommend that everyone get vaccinated when the vaccine becomes available to all of us.”

But about two and a half months into its vaccination campaign, UNC’s Chatham clinic hasn’t quite vaccinated as many Latino residents in Chatham as many had hoped — and neither have some other Chatham-based vaccine providers, who have also made equity a key piece of their vaccination campaigns. 

According to North Carolina’s vaccination dashboard, just over 3% of all Chatham residents who received their first vaccine doses identified as Hispanic as of March 2. Not all received their shots inside Chatham. Statewide, about 2.64% of first-dosed residents have identified as Hispanic.

The dashboard also reports that about 5.4% of Chatham’s Hispanic population has received a first-dose vaccination. About 12% of the county’s total population is Hispanic.

“We know that there is inequity in who is receiving the vaccine,” Chatham Hospital’s chief medical officer, Dr. Andrew Hannapel, told the News + Record. “Latino, Indigenous and Black people are not receiving vaccines in the same proportion to their representation in the general population.”

Rates vary from provider to provider. As of Feb. 28, about 2.15% of the UNC Chatham clinic’s first doses have been administered to Hispanic residents, including teachers. Nearly 2.9% of residents identified as “other,” meaning they chose not to fill out their demographic data or they ticked the “other” box.

A week ago, Hannapel had told the News + Record that UNC’s Chatham clinic had administered 1.57% of first doses to Hispanic residents, while nine days earlier, about 1.33% of clinic’s first doses had been administered to Hispanic residents.

Most of the clinic’s first doses have gone to white residents — nearly 90% — and that’s a problem, Hannapel said.

“We realize we’re coming up short,” he said, adding, “and we’re trying to figure out ways” to expand the Chatham clinic’s reach.

A larger portion of the Chatham County Public Health Department’s first doses have gone to Hispanic residents inside and outside of the county as of March 1. According to CCPHD Communications Specialist Zach Horner, about 4.5% of the department’s first doses had been administered to Hispanic residents — or 145 first doses out of 3,222.

Last Friday and Monday, CCPHD administered 5.7% of 368 first doses to eligible Latino school and child care workers in Group 3. Not all live in Chatham.

Up until last week, that percentage had been shrinking as the department received larger dose allocations and vaccinated more residents. About three weeks earlier, Chatham County Public Health Director Mike Zelek told the News + Record that 4.2% of the department’s first doses had been administered to Hispanic residents. In a Feb. 19 press release, the department reported that 3.8% of its first doses had gone to Latinos.

'It's a young community'

Compared to the county’s overall Latino population, these numbers may seem disproportionate. Yet when they were compiled, a large portion of Latinos hadn't yet become eligible to receive the vaccine.

"We have been making intentional efforts to reach Chatham’s Latinx community," Zelek told the News + Record Wednesday. "... Childcare workers and teachers recently became eligible, and it is likely the Hispanic/Latinx population is more represented in this group than in Group 2."

Just a week ago, only frontline health care workers, adults aged 65 and older as well as nursing home residents and staff could get vaccinated in Chatham. That pool grew in Chatham last Friday when the health department administered shots to school staff and daycare workers over 45 for the first time.

Alirio Estevez, 51, received his first dose last Friday. He teaches ESL at Siler City Elementary School and told the News + Record last Monday that he wanted to set an example for his community.

“There are some misgivings, some misinformation in the community, especially some people in the Latino community,” he said. “... So if I can get it at the school and they can see that teachers are getting it, they would be less reluctant to get the vaccine.”

Johnny Alvarado, 52, told the News + Record last Tuesday that he planned to get vaccinated as soon as he could. He teaches AP Spanish Literature at Jordan-Matthews High School.

“The vaccine protects you,” he said in Spanish, adding, “Originally, I’m from Costa Rica. I don’t believe in what anti-vaxxers believe. I’ve taken all the vaccines on the planet. It seems to me that science is preponderant, and if there is a vaccine, then I’m going to take it.”

But before Wednesday, Chatham’s biggest eligible group by far had been adults aged 65 and older; at about a quarter of Chatham’s population, they number about 19,000, and over half of the health department’s first doses have gone to seniors. According to Zelek, Hispanic residents account for a tiny fraction of that population — about 2.4%.

“(That’s) in line with the percentage of first doses of vaccine administered to (Hispanic) adults ages 65 and older by the Public Health Department to date,” Zelek told the News + Record on Feb. 1, when 2.4% of their first doses had gone to Latino residents 65 and older. As of Monday, that percentage has increased to 2.7%, or 53 first doses.

Chatham’s Hispanic community is young. According to Horner, around 40% of Chatham’s Hispanic population is under the age of 18 — something UNC journalism professor and Pittsboro resident Paul Cuadros emphasized in a virtual talk he gave last September about the pandemic’s impact on the Hispanic community.

According to Census data, Cuadros said at the time, the median ages for Siler City’s white and Black communities had been around 56 and 43 respectively; for Latinos, who comprise the majority of Siler City, it was 23 — and probably 26 by now, he estimated.

“(This community is) in their prime childbearing years, and they’re having children now,” Cuadros said during the talk. “... You can’t go to Siler City on a weekend and not encounter a christening, not encounter a baby shower, not encounter a wedding. It’s a young community. It’s a thriving community, and it’s just — kids.”

On Tuesday, Gov. Roy Cooper announced that all frontline essential workers in Group 3 will be eligible to get vaccinated beginning Wednesday. As such, providers say they anticipate that the Latino population's share of vaccinations may begin to increase.

"We expect a high number of individuals in the Hispanic/Latinx population to become eligible in the frontline essential workers category in Group 3," Zelek added, "which becomes eligible today.”

‘We’re not completely off’

These vaccine statistics didn’t surprise Executive Director Ilana Dubester of the Hispanic Liaison, which serves Hispanic residents across four counties, including Chatham.

“I mean, we’re not completely off in terms of percentages,” she said, “and at the same time, I think because of the limitations of how to access the vaccines right now … there’s still some lack of information to the community in Spanish about the vaccines and how to make appointments.”

Many Latino residents in Chatham also face several barriers to vaccine access, she added; beyond the language barrier, many have struggled with little digital know-how, especially as the pandemic has forced more traditionally in-person events and activities online.

“The whole online appointment is difficult for people, and I think more and more, there’s some phone numbers available that are not widely distributed yet,” Dubester said, adding, “People have access to phones, but don’t have access to ‘online’ to fill out forms and things like that.”

Dubester cited UNC Health’s “complicated” My UNC Chart system as an example. In the past, the Hispanic Liaison has helped clients create My UNC Chart accounts for various reasons.

“Sometimes we have to go all the way back to setting up an email account for them because they don’t have one,” she said, “and then (we need to) show them how to use email on their phone and install it on their phone before we can ever create a UNC MyChart.”

All Chatham vaccine providers offer both online and call-in scheduling, but most providers — including the CCPHD, Chatham Hospital and Piedmont Health — have told the News + Record that they prefer patients to schedule online or that online scheduling is more “efficient.”

“People will call and they’ll find out it’s not answered as quickly as they want to because we’re getting approximately 3,000 calls a day,” Piedmont’s CEO Brian Toomey said. “There can be a phone number, but people should understand that that’s probably going to be the least likely connection.”

It’s not just external barriers to access. Dubester and her staff have also dealt with some vaccine hesitancy among their clients, including their older clients.

“It was hard to get to the bottom of why exactly other than ‘No, I’m just not getting it,’” she said, adding, “People are afraid of health consequences. There’s always the rumor (that) somebody got really sick or somebody dies, and (that) makes people feel unsafe about investing.”

To address these concerns, the Hispanic Liaison has sought to educate their clients about the vaccines and the county’s distribution process through online flyers, links and Facebook Live videos.

“With the system being online at first, a lot of online people signed up, so there’s a waiting list,” she said. “So part of what we’re trying to do is make sure that our community knows about it and accesses it and reaches out to us if they’re facing any kind of barriers that we can help them overcome.”

‘More needs to be done’

They’re not the only ones. Chatham vaccine providers have been working to build trust and ensure equitable vaccine distribution, especially as North Carolina opens up vaccines to more and more people.

At UNC Health’s Chatham clinic, Hannapel said they’re “well aware” of the problems the digital divide poses for historically marginalized communities and many seniors.

“It’s an absolute problem,” he said, adding, “We have a large number of people fielding calls, but even with that — the phone calls and the online — UNC would prefer online, because it can be done by that person. They make the appointment they want when the appointment becomes available.”

But not everyone has online access, he added, nor do all have the time to keep circling back to check on available appointments since UNC Health doesn’t offer a waitlist. That’s why UNC Health is working to send out people into the community and help them register, Hannapel said; he also added he’d like to explore the possibility of creating a waitlist.

Most Chatham vaccine providers also offer Spanish-language assistance. UNC Health’s online scheduling system is available in both English and Spanish; Spanish interpreters are available, too, for Spanish-speaking residents who call UNC’s central line. The CCPHD’s online Vaccination Information Tool, which allows residents to get on the department’s waiting list, is available in English and Spanish; the department also has bilingual staff members who can answer calls.

Likewise, Piedmont Health Services’ Chatham locations employ bilingual staff. Siler City Pharmacy, Chatham’s newest vaccine provider, employs a full-time Spanish translator, and Walgreens also offers call-in scheduling in both languages.

Save Walgreens, most Chatham providers also don’t require residents to present government-issued ID or health insurance to get vaccinated; most, if not all, Chatham providers have told the News + Record that undocumented immigrants may freely get vaccinated.

“We don’t want this to be exclusionary,” Hannapel said. “If someone’s over 65 and they’re undocumented … they’re still at risk, and if we can prevent that person from getting serious a coronavirus hospitalization, then it just makes so much sense for public health. Going beyond the moral and ethical argument of why that’s the right thing to do, it protects everybody. This is the reason why we’re not asking for ID.”

Many have also been trying to reach out directly to Hispanic residents and the community organizations that serve them.

In early February, Hannapel said, UNC Health began “diverting” some of their doses to Piedmont Health Services.

“We were not getting to our Black and Hispanic/Latino community and Piedmont Health has (that) community that goes to their clinic,” he added. “I think they’re trusted within the community.”

According to spokesperson Debra Markley, around half of Piedmont’s 48,000 patients across seven counties are Hispanic. Speaking from her own observations, Markley told the News + Record that many of their eligible Hispanic patients in Moncure have been getting vaccinated.

“It’s very important for us — especially with the equity issues that have gone on — that we want to vaccinate our patients first,” she said. “I mean, if you look at who we serve, we serve a lot of different people, different ethnic groups.”

The CCPHD, UNC Health and Piedmont Health Services also partnered with the Hispanic Liaison on Feb. 20 to lead a Spanish-language vaccine webinar, which was broadcasted via Facebook Live on the Liaison’s page.

For about 45 minutes, the CCPHD’s Nellie Benitez, UNC’s Dr. Michael Herce and Piedmont’s Alejandra Hernandez answered questions from Dubester and viewers about the vaccines and the distribution process. About 20 people watched live — and one was Sandra Eugenia Flores Crispin, a Siler City resident originally from Guatemala.

Flores Crispin, 43, plans to get vaccinated as soon as she can — though, she added with a laugh, she’ll be among the last group that does since she’s not at high risk and doesn’t work.

“The vaccine is the only thing we have (against COVID-19),” she told the News + Record in Spanish, “and well, we’ve got to take advantage of it.”

She attended the chat to find out more information about vaccines and Chatham’s vaccination process; going in, she said she wanted to know how long vaccine protection might last — and Herce answered her questions.

“You have the access to look for the information, but you don’t actually look for it,” she said, with a laugh. “A lot of people don’t look for it. There (in the webinar) they were going to give it all out, and that’s why I was interested because I also had the option to ask what I couldn’t find anywhere else (in Spanish). … It was a very short time, but it was useful.”

Close to the end of the webinar, the CCPHD opened its COVID info line for two hours that afternoon to allow Spanish-speaking residents to register for the waitlist. According to Horner, six called in.

As more people become eligible for the vaccine, Dubester said she’d like to see more community education and outreach — especially to address any reluctance among the Latino community to get vaccinated.

“We need a more concerted public education campaign,” she said. “The access is so limited right now, but like when it comes time that the access is broader, then we could have, for example, our staff members having their pictures (taken) getting the vaccine.”

All in all, Dubester said she thinks Chatham vaccine providers “are catching up” in their efforts to ensure vaccine equity and access for minority communities.

“They are making efforts. The Facebook Live (event) is one; they also organized an event with an African American church in (Goldston),” she said, “but yes, more needs to be done.”

Reporter Victoria Johnson can be reached at victoria@chathamnr.com.  This story was updated on Wednesday, March 3.

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