Note: This story was first published by Clarissa Donnelly-DeRoven for North Carolina Health News on Nov. 1, 2021. TCB is republishing this story through a partnership with the Solutions Journalism Network.

by Clarissa Donnelly-DeRoven

At the beginning of North Carolina’s vaccine rollout, the rate of Latino people getting the shot lagged behind other groups. In March, just 2.5 percent of all vaccines administered were given to Hispanic residents, even though the group accounts for nearly 10 percent of the state’s population and was hit disproportionately hard by the virus.

But now, Latino residents are vaccinated at a higher rate than the non-Latino population, according to the most recent data from the state’s Department of Health and Human Services. Statewide, 67 percent of Hispanic residents 12 and older are vaccinated, a rate 10 percent higher than that of North Carolina’s non-hispanic population. 

At the COVID-19 Latino Task Force meeting on Oct. 25. Yazmin Garcia Rico, the director of Latinx and Hispanic policy and strategy at North Carolina’s Department of Health and Human Services, explained that of North Carolina’s 9.8 percent of Latino residents, 8.7 percent had been vaccinated — a significant feat, considering that a quarter of North Carolina’s Hispanic population is younger than 12, and therefore not eligible to be vaccinated just yet.

So, how’d we get here?

In nearly every age category, the vaccinate rate among North Carolina’s Latinx residents is higher than that of the non-hispanic population. Graph courtesy of the North Carolina Department of Health and Human Service’s COVID-19 Vaccine Dashboard.

“A lot of collaboration,” Garcia Rico said with a tired laugh. “It’s hard to list them all and to mention everyone.” 

Trusted ambassadors

The department used some familiar tactics to reach residents: bilingual ads on TV, radio and social media, virtual town halls, posting on Facebook Live.   But it also did something more creative. A DHHS project, called Healthier Together, paid community health workers in each of North Carolina’s 100 counties to get the message out. Those boots-on-the-ground workers built on their existing relationships, in this case their relationships with Latino residents, to improve the group’s access both to information about the vaccine, and to the jab itself.

Garcia Rico, and others in the field, attribute much of the credit for the group’s high vaccination rate to these community health workers. 

“We started the initiative to support organizations on the ground that were already doing a lot of work,” Garcia Rico said. By tapping into existing community networks and providing local people already in positions of trust with the money and logistical support to help residents learn about vaccines and schedule appointments, the agency was able to avoid wasting time and duplicating resources — in sum, to get more shots into more arms quicker.  

Also, almost half of the community health workers are bilingual, which Garcia Rico says is critical. 

“A regular interpreter is just going to interpret from a provider to a patient, but community health workers have more knowledge,” she said. They can provide apprehensive residents — who perhaps already know and trust them — with more information both before and after the shot, and connect them to other services. 

Getting paid

Norma Martí is the co-leader for the Latinx Hispanic Community Response Team, a project of the North Carolina Community Engagement Alliance funded through the National Institute of Health. One of the group’s end goals is to improve vaccine equity in the state. Martí has worked closely with DHHS throughout the pandemic to distribute supplies and information to the state’s Latino community. 

“Getting the messaging out was probably the hardest thing because with social media, people get all this crappy misinformation,” Martí said. Part of the challenge, also, is that much of North Carolina’s Latino community lives in rural areas. Hispanic residents make up between 16 and 23 percent of the population in Duplin, Sampson, Lee, Greene and Montgomery counties.

“The first thing the Secretary [Mandy Cohen] had us do — I mean, I was there a week — and she’s like, ‘We’ve gotta identify people to help us get the word out,’” Martí remembered. 

In June 2020, DHHS announced it would award $100,000 each to five different organizations that worked closely with Latino residents in different parts of the state. That project, in many ways, laid the groundwork for the partnership with community health workers.

While about a quarter of North Carolina’s Hispanic population lives in Mecklenburg and Wake counties, many of the state’s Latinx residents live in rural counties. In Duplin County, for example, 23 percent of residents are Hispanic. Map created by the Carolina Population Center at UNC Chapel Hill.

“It’s not like [the organizations] weren’t already doing outreach,” Martí said, but she believes that paying these organizations, and the community health workers, for their labor and resources helped “invigorate” the work. 

“They were paid. They were not volunteers. They were paid — which is probably the first time any of us have ever had a community health worker program that was paid actual money,” she said. 

The NIH approved funding for Martí’s group, the North Carolina Community Engagement Alliance, in the winter of 2021. She and the other leaders looked across the state, aiming to ensure each region was represented, and brought 10 Latino North Carolinians together. They began strategizing on how best to reach people in different parts of the state.

“Their position was, ‘We need to talk about the myths. We need to do some mythbusters,’” Martí said. “Everything that I’ve ever done in public health, you don’t mention the crap that’s being said, because then you’re just reinforcing it. And the community team said, ‘No. We’ve got to face it straight on. People are hearing this, and you’ve got to tell them, ‘No, this isn’t right.’’” 

Martí and the other leaders said okay, and they all went to work. Over the last year, the group has created animated myth-busting videos in English, Spanish and Zapoteco, an indigenous language spoken in Mexico. They seem to have been effective, and the group is working on creating a Mayan language version. 

Let everybody talk

Martí believes that general barriers to care can help explain why there was a lag in vaccine uptake at the beginning by Latino residents. 

“We don’t have access, as a people, to health systems,” she said. “Latinos are the least insured in the state.” According to the Census Bureau, about 31 percent of Latino residents in North Carolina do not have health insurance. 

A video created by members of the Latinx Hispanic Community Response Team, a project of the North Carolina Community Engagement Alliance, to help debunk myths about the COVID-19 vaccine.

“When we heard about vaccines, we’re like, ‘Well, it’s not for us because we don’t have no health insurance and we ain’t got no money.’ Because every time you go to a hospital, you’re stuck with $1,000, $2,000, $3,000, $4,000 bill,” Martí said. 

“It took a lot of time for those community health workers to get into those communities to get the word out to, to win the confidence again.” 

Martí and Garcia Rico both said there’s no silver-bullet reason for why the vaccination rate of Hispanic residents looks as good as it does now. It’s the result of lots of work and lots of investment that has built up over the months.

“I do think, really, truly in my heart, it was that combination of collaboration,” Martí said. “We were all at the table, letting everybody talk to each other.”