Maria works as a maid in Pitkin County. From Rifle, she commutes to Aspen where she cleans a handful of houses a day. Two to three stories with a basement, pool tables and gyms. The trunk of her car serves as storage for spray bottles, rags and vacuums. Her grocery bags go in the backseat with her son. When the pandemic hit, she considered stopping work. Like many undocumented people, she can’t afford to get COVID. Rarely does she see a doctor. It’s too expensive. She’ll have to bring her son to translate. It’s all unfamiliar. So, she continues to work. As the world halted in fear of the coronavirus, Maria carried on. For the sake of survival and the hope of prosperity, she carries on.
A grueling winter came and went, and now spring offers an opportunity for a vaccine. The news dominates headlines, but Maria, like many Latinos in the country, is unfamiliar with the nation’s health care system. Maria doesn’t have health insurance. Questions arise. Is it free? Where is it available? Can she get it despite being undocumented?
“I go to houses of people that are high risk,” said Maria, who, in order to conceal her immigration status, requested that her last name not be used. “I wanted to get the vaccine for myself but also for them. I heard from friends that got the vaccine before me that things went well. I also heard a lot of information on the radio. Even the owners of the house I clean encouraged us to get the vaccine. All these people influenced my decision, and it’s given me a sense of security to now have been vaccinated.”
She listens to “La Nueva Mix” on KQSQ-FM 102.5 on her commute to work. On that station, she hears an ad featuring a woman entering a carniceria, which is Spanish for butcher’s shop. The woman mentions that she’s in a hurry as she’s on her way to receive her vaccine. The man at the counter asks her if she is going to take the vaccine. The woman mentions her desire to protect herself and others in her community such as the man at the counter. She doubles down on the safety of the vaccine, even noting that the local priest has received his dose recently.
This ad is a direct result of efforts from concerned professionals, volunteers and community members, making sure that everyone, regardless of identity, can receive a vaccine.
A disparity in the data
Both locally and statewide, vaccines are not being distributed to all communities at a proportionate rate. In particular, Latinos in the region are undervaccinated, which is causing activists and public health professionals to organize in hopes of overcoming systemic barriers.
In Colorado as of May 6, according to data provided by the Colorado Department of Health and Environment, 49% of the state’s white population has received at least one dose of vaccine. The number of recipients falls to 20% for Latinos, who make up 21.5% of the state’s population.
The gap persists and in the local region. State data on vaccinations by county as of May 6 show that in Eagle County, which has the largest Latino population among the three counties making up the Roaring Fork Valley and surrounding environs, 60% of white people have received one dose, compared with 15% of Latinos, who make up 29.6% of Eagle’s population.
Vaccination proportion numbers used in this story are based on U.S. Census Bureau population counts, which include children who are ineligible to receive a vaccine.
It should be noted that 22% of Eagle County residents who have received at least one dose did not report their race or ethnicity — a data gap experienced to some degree across the state that was most pronounced at the beginning of the vaccine rollout.
“Early in the vaccination campaign we had a lot of missing data for race and ethnicity,” said Heath Harmon, director of Eagle County Public Health & Environment. “We have since revised our process and forms to ensure this important data is being collected consistently for everyone receiving vaccinations.”
Since March, Harmon said, the county “has been very intentional about bringing vaccination clinics into the community and decreasing as many barriers as possible.” In that time, roughly 30% of the vaccine supply received by Eagle County Public Health & Environment has been distributed through community-based partners focusing on underserved populations, including Mobile Intercultural Resource Alliance and Voces Unidas.
A racial equity gap in vaccination appears less pronounced in Pitkin and Garfield counties; however, those counties have higher proportions of residents who did not report their race upon being vaccinated, which can skew results. Yet the disparity remains clear.
In Garfield County — which lags its neighbors in terms of overall vaccinations, with 43% of the total population receiving one dose as of May 6 — 36% of white people have received at least their first shot, compared with 21% of Latinos. Just over 28% didn’t report their race. The state’s data show that in Pitkin County, nearly 59% didn’t report their race, but counting only those who did, 26% of white people have received one dose, compared with 11% of Latinos. Overall, 58.3% of Pitkin’s population, which is 85% white, has received at least their first shot.
The percentages listed encompass the entire population, including children ineligible to receive the vaccine, and the Latino population tends to be younger overall than the white population. In 2019, the median age for white people in Eagle County was 41.7, compared with 28.7 for Latinos, according to census data. In Garfield County, the median age of white people is 41.7, compared with 25.2 for Latinos.
The disparity in the vaccine rollout is a roadblock in ensuring equitable recovery from the pandemic. Health offices in each county are aware of the issue and have made strides to mend the gap in vaccinations. Yet, these health offices can be only so agile in tackling this systemic issue, and the effort includes social justice organizations such as Voces Unidas de las Montanas, a nonprofit founded to advocate for Latino communities in 2020, operating in Pitkin, Garfield and Eagle counties.
From January through April, Voces Unidas partnered with the Gov. Jared Polis’ Vaccine Equity Team and the Colorado Department of Public Health and Environment to set up vaccine clinics focused on vaccinating Latinos across three counties.
“There’s this narrative that Latinas and Latinos don’t want to be vaccinated. I hear this all the time,” Alex Sanchez, founder and executive director of Voces Unidas, said last month. “People are having meetings right now within the ecosystem asking why Latinos are not coming to (vaccination) clinics. I think what we have proven with our work in vaccine equity is that it is not enough to just have a clinic. We have to change the ways we are working with our community and we have to be more intentional.”
Public health offices also recognize the need to reach all communities and restructure operations to clear barriers of access and form relationships with those seeking care.
“Unfortunately, like every other inequity, COVID has thrown into contrast where gaps are. Things we could not make a priority, all of a sudden the pandemic really throws contrast onto it,” said Carly Senst, Pitkin County Public Health’s testing and immunizations analyst. “Realizing that this is a pandemic and that people are dying, people are sick, we need to reach all of the population as quickly as possible. … The pandemic really did push us to be better and meet those needs. We’re not there yet, it’s a constantly evolving process, but it’s a big takeaway into the future.”
An equitable response begins with systemic change
The vaccination disparity could be rooted in a variety of factors. For example, the amount of Latino working class people in the county could drive their community’s percentage down due to the inability to request time off from work for a vaccine. And a lack of familiarity with the local health care system could exacerbate the gap.
The question remains: Why is this the case? Better yet: What can be done?
“It isn’t about the vaccine itself, it’s about the system,” Sanchez said. “We have proven through our work that if we reduce barriers and make things accessible, in a language that they understand with intuitive systems with people that look like members of the community, then Latinos and Latinas will come out by the thousands to get vaccinated.”
Even in a vaccine clinic, a mass effort available to all can present cultural barriers. Although free and open to all, large-scale operations are bound to create inequities.
“We also understand the limitation of the mass clinic,” Senst said. “It is ultimately a government-hosted and -funded clinic that does have police presence. It’s just by nature of the large scale that we’re operating on. I do want to note that Pitkin County Health is well aware that that is a barrier and that it’s something (in mass clinics) that is very difficult to overcome just by the nature of what it is.”
Senst said she’s excited for the next phase of the rollout, which involves working with smaller, community-based organizations and health care providers.
“We are working with community health services incredibly closely who are active in outreach to individuals who don’t have access to traditional health care systems,” she said. “They are doing phenomenal work and are going to be a key partner in making sure that we do end up lowering those barriers.”
Working intimately with community members, as Senst suggests, is vital to reaching across ethnic and cultural divides. As the vaccination efforts transition, the results of such change is beginning to show. From April 20 to May 6, the percentage of Latino people getting vaccinated increased more than the percentage of white people receiving their shots. In that time frame in Eagle County, the ranks of vaccinated Latinos grew 8%, compared with 6% for white people. In Garfield County, Latino vaccination numbers increased by 17%, compared with a 7% increase in the vaccination numbers for white people. In Pitkin County, Latino vaccinations increased by 29%, compared with white vaccinations’ 10%.
But despite the two-week percentage growth implying that Latino people are increasing their vaccination numbers at a faster rate, the gap between white and Latino vaccination totals have increased. On April 20, the gap was 27 percentage points when looking at the statewide data. As of May 6, that gap increased to 29 percentage points.
Disparities have broken down along racial lines throughout the pandemic in the United States. According to the Centers for Disease Control and Prevention, the Latino population, compared with the non-Latino white population, holds 1.3 times the number of cases, 3.1 times the number of hospitalizations and 2.3 times the number of deaths stemming from COVID. This data is a result of countless factors, but it is important to note that Latino people and other people of color have underlying conditions that bolster these numbers. Those conditions include socioeconomic status, access to health care and exposure to COVID due to occupation.
From June to August, Voces Unidas gave community members across Pitkin, Garfield and Eagle counties a survey that would gauge people’s awareness of COVID procedure and prevention.
Voces Unidas found that half those surveyed did not know where to go nor what preventive steps to take if they developed COVID symptoms. Due to cultural barriers, many Latinos in the valley were without crucial information regarding the virus. Vaccination efforts are about distribution of information as much as they are about distribution of the vaccine itself.
“When this first started, Garfield County Public Health didn’t have a Facebook page at all,” said Brisa Chavez, WIC lead educator and Hispanic engagement coordinator for Garfield County Public Health. “And we know working with our Latino community that they use Facebook, WhatsApp and YouTube. So, we were able to create a Facebook page for Garfield County Public Health, which we try really hard to keep bilingual and updated with the most current information because it’s sharable.”
Social media is only one aspect of a larger multimedia marketing strategy regarding the vaccine.
“The broader Pitkin County Health strategy is to go through different sources to provide (information),” Senst said. “Social media has played a huge role in acquiring and disseminating (information). We’ve worked with local media partners. La TriColor [a locally based Spanish radio station] has been a fantastic partner that we worked with. Even back in November and December, we were trying to get information out through these trusted community media partners whether they be online, in print or on the radio.”
Grassroots power lies in volunteer dynamism
Voces Unidas’ first vaccine distribution effort came Jan. 30, when nearly 200 people were vaccinated. That same day, more than 550 other community members registered to take the vaccine through them. This was made possible using the power of multimedia, word-of-mouth and especially volunteers.
As of April 24, Voces Unidas had administered 2,209 vaccines via eight mobile clinics spanning from Glenwood Springs to Dillon to El Jebel. With assistance from medical staff, hundreds of volunteers and community members, Voces Unidas looks to continue the push through recovery and beyond. A drive-thru clinic requires 69 volunteers to operate properly. With multiple vaccine clinics hosted, the grassroots power of Voces Unidas is highlighted by the sheer number of volunteers.
“I enjoyed volunteering because half of this whole COVID thing, we’ve been so helpless in it, especially with no face-to-face interaction,” said Angela Koukoulas, a student at Colorado Mesa University in Grand Junction, who helped out at an April clinic in Glenwood Springs. “There’s just not a lot we could do except stay inside. You feel so very passive in helping stop the spread. (The clinic) has been an active way to help, so I was able to be there and interact with people and help with what we’ve waited for for a whole year.”
Volunteers from across the Western Slope gathered April 10 to vaccinate 516 people at a clinic organized by Voces Unidas. At the Glenwood Springs Community Center, volunteers in their fluorescent-green jackets directed traffic, filled out paperwork alongside cars, administered vaccines and managed break times for everyone. Several coolers of tamales and agua fresca had been prepped — over the course of hours — for all the volunteers.
As was the case at all COVID-vaccination clinics, those seeking a poke were not required to present an ID. This fact was made a mantra and point of emphasis for not only Voces Unidas, but also for public health offices across the Roaring Fork Valley.
Near the end of the day, when the line finally slowed down, the clinic had extra vaccines. Volunteers scoured Glenwood retail stores and other popular locations to offer vaccines. Volunteers entered Target, City Market, Maurices, Bed Bath & Beyond, Petco, and many other stores to get the word out over the intercom that if someone wanted a vaccine, they could receive a Moderna dose that day.
‘If we’re not at the table, we’re going to be on the menu’
For Voces Unidas and its fleet of volunteers, vaccination equity is a means to an end in their fight for justice. Equity is not exclusive to vaccinations. Voces Unidas aims to uncover, rediscover and dissect the system in which Latinos in the Roaring Fork Valley exist.
“We need Latinos and Latinas to have a seat at the table,” Sanchez said. “If we’re not at the table, we’re going to be on the menu and our community will be left behind yet again. What we’ve learned as people of color and community members is that if our voice, our visions, our needs and our wants are not at the table with other community leaders shaping the solutions that our local and state government will implement for us, then we get the short end of the stick.”
The vaccination effort spearheaded by Voces Unidas creates a blueprint for other communities in the region to organize. These efforts were not only a reaction to a dire circumstance, but they acted as a foot in health care’s door for Latinos in the region. Through these efforts, community members across three counties have established a model for how to reach all communities in an equitable way.
It’s becoming increasingly clear that vaccination equity is achievable through smaller clinics that build trust and relationships with underserved communities. For example, on April 30, the Colorado Department of Public Health and Environment’s Mobile Vax team hosted pop-up vaccination clinics at Apple Tree Mobile Home Park in New Castle and at Cottonwood Mobile Home Park in Rifle. When health care providers visit communities where they’re comfortable, progress is made toward lowering barriers and welcoming diverse populations.
“We’ve activated and mobilized ourselves in various ways, yet the infrastructure has never taken root until now,” Sanchez said of community activists working for social justice. “Our hope is that we’re just the first — and not the last — nonprofit that you see coming out of the community to be able to serve them in every single corner of the three counties.”
With all efforts focused on vaccinations, it should not be lost that community organizers and activist groups are agents of change, not a replacement of the system itself. Change, this time, takes form in health care, but the very same volunteers and activists will continue to fight for equity across a range of systemic issues.
“We are not the solution. We are not a health care system. We are not a health care provider,” Sanchez said. “We are just a nonprofit made up of Latinas and Latinos who took it upon themselves to say how we can help in this inequitable system. At the end of the day, our primary role as an advocacy organization is to force the ecosystem and hold the ecosystem accountable for doing its job. Their entire mission is to vaccinate people and give health care to people, and we want to make sure that all of these systems are doing their job in a more equitable way.”
Pitkin County Public Health recognizes the power of making connections through partnerships with community entities, which would have a benefit beyond the pandemic.
“We are working with our community providers to reduce these barriers and encourage engagement with the traditional healthcare system,” Senst said. “We’re hoping that this allows individuals to make a connection with the healthcare system so that going forward, if they were able to have a positive experience with a provider that they met at a tent or clinic site, then it may open a personal connect and put a face to health care because certainly in the United States, that can be difficult to do at times.”
Garfield County echoes such sentiment.
“We’re looking at what other organizations we can partner with so they can also share the information with their families and community,” Chavez said. “We know that our Latinos are looking for those trusted community members to get the word out. So, it’s vital to partner with these agencies, organizations and nonprofits to do the work with and for the community.”
Maria, who was finally vaccinated March 25 through Mountain Family Health Center in Rifle, experiences less of the COVID stress that burdened her and her community’s consciousness for more than a year. From the beginning, she wondered when the turmoil might finally end.
As vaccines roll out at unprecedented rates, the end of the pandemic appears just out of reach. She braces for a return to normalcy. For her and many in her community, the concept of normalcy included cultural hardship. It included a burden of systemic issues left forsaken. But now, with the help of community organizing, in a critical time of need, Maria, her family, her friends and her community are united to redefine what it means to return to normal.
Aspen Journalism data desk editor Laurine Lassalle contributed reporting to this piece.