On a recent Sunday, Paola Laverde logged on to the computer in her Berkeley apartment and joined dozens of other Latin residents at Zoom in an hour-long conversation about coronavirus vaccines with a UCSF doctor.
Dr. Maria Garcia explained in Spanish how vaccines work, what the benefits are and why it is important to receive them.
Laverde, 57, was happy to see faces like hers. She is eager to receive a vaccine when her turn comes and is curious about which workers will be prioritized. Others asked if they should still wear masks and practice social detachment after receiving the injection, and how to respond to dubious family members who believe false rumors about vaccine problems.
“We know that knowledge is power,” said Laverde, a member of the Latinos Unidos group in Berkeley who co-organized the session. Learning about vaccines is especially important in the Latin community, which represents 39% of California’s population. However, Latinos are disproportionately responsible for 55% of the state’s COVID infections and 46% of deaths.
As vaccine distribution increases locally and throughout California, health officials and advocates hope to reach more residents like Laverde.
They are pressing to ensure that communities of color and other groups – such as those with limited access to the Internet – are not left behind. It is particularly vital that they are achieved, as many are essential workers who face risks at work every day, and others may live in multi-generation families or in more crowded conditions.
However, there is a big problem: it is difficult to know whether people of color are being vaccinated on a par with the incidence of COVID-19 in these communities because the state and most counties have not released information about the racial and ethnic demographics of recipients of vaccine.
This lack of transparency is widespread. On January 22, only 20 states reported some information on the race or ethnicity of the people who received the vaccines, although they were often incomplete, according to an analysis by the Washington Post. California was not on the list. White House officials asked states last week to release more consistent demographic data.
California officials say it is vital that vaccines are distributed equitably and they also want metrics to measure their work. On Wednesday, state officials announced that Blue Shield of California, Oakland’s health insurer, will take over the distribution of the vaccine on behalf of the state. This is expected to incorporate a better way to measure vaccine equity, although details have not yet been announced. Similar problems arose with coronavirus testing early in the pandemic, but the state and counties corrected the problem and provided demographic data – which reflected that, in some areas, the tests were reaching more white residents than black communities hard hit by virus, alerting the use of mobile test sites based in the neighborhood.
Racial and ethnic data on vaccinations can also be more difficult to interpret, at least at the outset, because vaccines are available mainly to certain groups, such as the elderly and health professionals, who may have different demographic characteristics than the general population.
In the bay area of nine counties, only Contra Costa and San Mateo counties provided a breakdown of vaccine recipients by race and ethnicity. However, it is difficult to draw conclusions from local data, which largely reflects who is eligible for the vaccine, because not all providers report the race or ethnicity of the vaccine recipients.
In Contra Costa County, the highest proportions of vaccine doses were for whites (37%), people of various races (16%), people who identify themselves as “others” (16%) and Asians (14%), according to county data. The county is 43% white (not including Hispanics or Latinos), 5.4% multiple race and 18% Asian, according to Census data.
Part of this reflects the demographic composition of health professionals and the elderly. These groups “are” disproportionately white, disproportionately Asian and disproportionately wealthy, “said Contra Costa’s vice health officer, Dr. Ori Tzvieli.
The biggest disparity now is black residents, who are being vaccinated at lower rates, said Tzvieli. There is also some disparity between Latinos, but it is not so great, he said.
“We look at equity in everything we do and, obviously, inequalities have been a big marker of the COVID-19 pandemic,” said Tzvieli. “We saw inequalities in numbers of cases, inequalities in tests. And now, although the data is incomplete, we are seeing inequalities in vaccines as well, and the causes are many ”.
In San Mateo County, the majority of vaccinated people are white (32%) and Asian (24%), according to county data; 12% went to people with different races. The county is 39% white (not including Hispanics and Latinos) and 31% Asian, according to Census data, with 4.5% identifying themselves as multiracial.
The lack of state data is worrying, experts say.
“I am very upset,” said Garcia, assistant professor of medicine at UCSF and co-director of the Multiethnic Health Equity Research Center. “We already know that there are injustices in COVID infection alone. In order to address these inequalities, we need to make sure that we specifically target these same communities for some of the therapies and for the vaccine and for prevention efforts. I find it very difficult to believe that this information is not really available. “
Dr. Sergio Aguilar-Gaxiola, director of the UC Davis Health Disparities Reduction Center, said that while more data is needed, the state has a huge task on its hands.
“I think the state is trying to do the best it can, given the limitations in the supply of vaccine distribution,” said Aguilar-Gaxiola.
Aguilar-Gaxiola is a member of the state COVID-19 vaccine development guidelines committee and “it has been a very intense process to try to be as fair and careful as possible and to try to make our decision-making guided by science and data,” he said. , stressing that he spoke from experience and not on behalf of the commission.
Doctors said they also care about people with language barriers and who have no access to computers or who have little knowledge of computers – such as the elderly and some low-income people – and may lose registration to receive a vaccine.
Vivian Lem, a 69-year-old Japanese American, Franciscan from San Francisco, said she reached a representative on the Sutter Health phone line out of sheer persistence.
She has not yet been lucky to schedule the vaccination, as Sutter is prioritizing patients over 75 for consultations.
Lem said that success can be a matter of “who has it or not”, with the possibility of going online and waiting, sometimes for hours, “really a luxury”.
“It’s terrible. It’s so sad. Everyone is so desperate,” she said. “It’s a life and death thing.”
The non-profit organization On Lok runs a comprehensive care program for the elderly and is the main medical provider for 1,600 elderly people in San Francisco, Alameda and Santa Clara counties.
More than 90% of On Lok participants in federal housing for low-income seniors have given consent to take the vaccine – the result of relationships, trust over time and culturally competent care, said Dr. Ben Lui, director of medical informatics organization.
The average age of participants is 81, and half have dementia, said Liu. Many are people of color and some are non-native English speakers. The consent process involved translating documents into multiple languages and communicating with families – including, in some cases, obtaining consent from these family members – before vaccines were available.
“With the elderly, depending on the support of their families, depending on some of their own abilities, which means that some elderly people are not very tech savvy or have cognitive disabilities, they usually need help in terms of getting this information” said Lui. “It favors those who have resources and family members who can spend time and get information for them.”
Disclosure will also be critical for the black community. Blacks in California are responsible for 4% of coronavirus cases and 7% of COVID-19 deaths, while representing 6% of the population.
Many doctors told The Chronicle that mobile vaccine locations are an important way to address language barriers, digital divisions and other challenges.
In Contra Costa, for example, officials are planning to increase the number of pop-up vaccination sites in underserved areas. They are also planning several mobile vaccination clinics at companies that employ a large number of food distributors and service workers.
UCSF doctors who helped establish community tests in Fruitvale last year are now turning to culturally sensitive and bilingual reach for people of color.
UCSF doctors, including Dr. Alicia Fernandez, are working with groups that have ties to black elderly and Spanish-speaking residents locally and nationally to answer their questions about vaccines. The “COVID-19 Vaccine Speaker’s Bureau” started spontaneously and many question and answer sessions are held at Zoom in the homes of doctors.
Many experts expect to see more people of color get vaccinated as soon as more essential workers can access vaccines.
Earlier this month, state officials said they are considering distributing 20% of the state’s vaccine distribution to counties based on an equity metric that takes into account the zip codes most affected by the virus.
A major obstacle remains the hesitation of the vaccine – the result, in part, of a deep distrust among some people of color in the country’s health system.
“People are sensitive to history,” said Aguilar-Gaxiola. “They know about the abuses that have taken place and there is a deep-seated distrust in some communities about government agencies or other groups. Not just about recommendations like vaccines, but also about providing any (personal) information that can be identifiable. “
Dr. Adrian James, medical director at West Oakland Health, knows this very well. Lately, he starts every conversation with a patient by asking, “Do you have any questions about the COVID-19 vaccine?”
About 70% of their patients say they prefer to wait until others receive the COVID-19 vaccine first. For patients who agree to be immunized, James acts quickly and expects them to spread the word to his friends and family.
“I had a 65-year-old lady today who said she would get the vaccine,” he said. “My question to her was, ‘OK, we have one with your name, when do you want to come in?'”
Tatiana Sanchez, Catherine Ho and Mallory Moench are writers for the San Francisco Chronicle. Email: [email protected], [email protected], [email protected] Twitter: @TatianaYSanchez, @cat_ho, @mallorymoench