COVID-19 vaccination: The Latinx experience
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Since the beginning of the COVID-19 pandemic, we have confronted not only the illness and loss of millions of lives, but also the dangerous reality of having a health care system full of moral gaps, inequities and disparities.
This unprecedented and complex situation challenged all of us on many levels. While facing high levels of unexpected fear, uncertainty and distress, the well-known sociocultural and demographic differences became more evident, bringing devastating consequences.
But not everything was negative. The science, as well as the health care workers, were up to the challenge. Altruism, hope, dedication and commitment were transformed into clinical improvements and scientific development. New treatments were discovered, preventive measures were proven critical, and a vaccine was finally available, bringing some light at the end of the tunnel.
However, all these advancements provided more evidence of the health care gap that exists in the U.S. — disparities that principally affect minorities. Differences have resulted from sociodemographic characteristics, cultural backgrounds, literacy and even political beliefs. The population has become divided between those who trust science and the health care system, and those who are skeptical or afraid and refuse to follow preventive measures and recommendations that could save their own lives and the lives of those around them.
Greater infection, lower vaccination rates
In the U.S., the Latinx community represents one of the minorities that have been substantially affected by the COVID-19 pandemic. As a reference, approximately 62 million Latinx people live in the U.S. In fact, one in six adults and one in four children in the U.S. identifies as Latinx, which is the gender-neutral or nonbinary alternative to Latino or Latina.
Data from the CDC reveal that the Latinx population accounts for 24.4% of infections while representing only 18.5% of the U.S. population. These levels are proportionally higher than those seen among Black (11.6%) and white (55.6%) U.S. residents, who represent 12.5% and 60.1% of the overall population, respectively.
Several aspects have accounted for this situation, including misinformation, lack of understanding or trust, socioeconomic status, low health literacy and reduced access to health care. In addition, factors such as migratory status, work conditions and lack of medical insurance have acted as important deterrents to visiting hospitals, getting tested and receiving vaccines. Indeed, although vaccines are currently broadly available, and their effectiveness to reduce deadly disease and safety have been proved, we are still witnessing high levels of disbelief and hesitancy and low compliance in the Latinx group.
Some of the concerns reported by the Latinx community include purported possible harmful effects of the vaccine, such as DNA changes, infertility and cancer, and that vaccines use tracking devices. These unfounded theories are used to justify fear and lack of compliance.
By December, 73.8% of people had been fully vaccinated in the U.S. However, based on vaccine administration data provided by the CDC, only 44.8% of Latinx people have received the full dose. In addition, while 89.1% of those older than 65 years had received the booster, only 58.6% of Latinx vs. 70.4% of non-Hispanic white people had received this required third dose.
This lack of compliance is critical, especially if we take into consideration the increased risks for morbidity and mortality associated with the lack of vaccination. Based on CDC data from October, unvaccinated people have five and 10 times higher risk of testing positive and 14 and 20 times higher risk for death than someone fully vaccinated without and with the booster dose, respectively.
Need for strategies to increase vaccination rates
Many efforts have been dedicated to reducing the hesitancy, mistrust and fear while increasing vaccination compliance in the Latinx community. Health campaigns supported by Latinx institutions and medical societies, educational materials in Spanish, and social media diffusion using influential Latinx representatives are some examples. All of those have focused on providing transparent, truthful, reliable and simple information adapted to the language, health literacy, culture and social background of the Latinx community.
As a result of these efforts, we have seen some improvement in the levels of vaccination. CDC reports show the incidence of full vaccination and booster in the Latinx community have increased to 22.5% and 11%, respectively. While these data demonstrate that initial vaccination hesitancy is slowly being reduced, we are still far away from a reasonable target that will significantly protect the Latinx community.
Omicron has become the predominant variant in the U.S., representing more than 73% of all cases. Although this variant seems to be less aggressive for those fully vaccinated (especially with the booster), it is still very contagious, therefore it is spreading faster in the community. Those not yet fully vaccinated are at high risk for exposure, serious illness and even death. It is not surprising that currently nonvaccinated patients account for the majority of hospital and ICU admissions due to COVID-19.
Knowing that an important number of Latinx residents are not yet fully vaccinated, and understanding the health care gaps and social disparities that affect this group, it is reasonable to assume that the Latinx community will be again disproportionately affected by the new wave of the COVID-19 pandemic. More efforts and resources need to be designated toward continuing educating and empowering the Latinx community to comply with vaccination and other well-proven preventive measures. In addition, medical schools and societies, as well as other related health care institutions, need to become more socially and culturally aware and advocate for a diverse and inclusive health care system that will promote equity and reduce disparities.
References:
- Andrasfay T, et al. Proc Natl Acad Sci USA. 2021;doi:10.1073/pnas.2014746118.
- CDC. COVID-19 Weekly Cases and Deaths per 100,000 Population by Age, Race/Ethnicity, and Sex. https://covid.cdc.gov/covid-data-tracker/#demographicsovertime. Accessed Dec. 24, 2021.
- CDC. Demographic Trends of People Receiving COVID-19 Vaccinations in the United States. https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends. Accessed Dec. 24, 2021.
- Diaz AA, et al. EClinicalMedicine. 2021;doi:10.1016/j.eclinm.2021.100860.
- Galletly CL, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.17049.
- Jimenez ME, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.17074.
- Karout L, et al. Cureus. 2020;doi:10.7759/cureus.10707.
- Khubchandani J, et al. Brain Behav Immun Health. 2021;doi:10.1016/j.bbih.2021.100277.
- Moore KS. Public Health Nurs. 2021;doi:10.1111/phn.12912.
- Niño M, et al. SSM Popul Health. 2021;doi:10.1016/j.ssmph.2020.100717.
- O’Shea BA, et al. Prev Med Rep. 2021;doi:10.1016/j.pmedr.2021.101470.
- Wilder JM. Clin Infect Dis. 2021;doi:10.1093/cid/ciaa959.
For more information:
Miriam Zylberglait Lisigurski, MD, is an internal medicine physician at Aventura Hospital and Medical Center in Aventura, Florida. She can be reached at mzylberg@nova.edu.
Ricardo Correa, MD, EdD, is the endocrinology fellowship program director and director for diversity in graduate medical education at the University of Arizona College of Medicine-Phoenix, Phoenix Veterans Affairs Medical Center, and health equity fellowship director for Creighton University School of Medicine-Phoenix. He is also an Endocrine Today Editorial Board Member. He can be reached at riccorrea20@gmail.com; Twitter: @drricardocorrea; Instagram @ricardocorreamarquez.
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