Thirty-one organizations jointly sent a letter to Governor Polis requesting that the State take immediate steps to reduce barriers and ensure that everyone, regardless of race, ethnicity or immigration status, can access the vaccine for COVID-19.
Below is a copy of the letter:
April 5, 2021
Dear Governor Polis:
Thank you for your work to ensure that Coloradans have access to safe, effective, testing and treatment for vaccines for COVID-19, and also access to the food, housing and economic support they need to feel safe. We, the undersigned, are writing to request that you take immediate steps to reduce barriers and ensure that everyone, regardless of race, ethnicity or immigration status can access the vaccine for COVID-19. Our state’s diversity is a strength, with 22 percent of residents identifying as Hispanic or Latino, 5 percent identifying as Black or African American and 4 percent identifying as Asian. In addition, one in ten Coloradans are immigrants, and one in five children in our state have an immigrant parent. It is also important to note that 10% disabled adult Coloradans (under ADA definition), and 1 in 4 of people with disabilities is Black, 5 in 10 are Hispanic, 3 in 10 are Indigenous, 1 in 10 are Asian (CDC).
Ensuring that everyone has access to and receives vaccines is crucial so that all our communities are safe and healthy. However, an analysis by Kaiser Family Foundation and data provided by CDPHE shows that as of March 31, 2021, many more white Coloradans (72.14 percent) have been vaccinated, while Coloradans with Hispanic ethnicity are very far behind at an alarming rate of only 8 percent, and only 2.46 percent of Blacks and 2.46 percent of Asians. These disparities have existed since Colorado began publishing this data, and is significant cause for concern as the disparities have not been reduced or eliminated. While this data shows the shortcomings of our state’s effort, it is not surprising as this was totally predictable based on the state’s vaccination plan since it’s public appearance back in December. Getting Coloradans vaccinated against COVID-19 as quickly and equitably as possible is part of making sure our health care system works for everyone. While we are encouraged to see that growing numbers of Coloradans are getting access to vaccines, we have grave concerns about the many ways the vaccine rollout continues to perpetuate a system that advantages access for white people and neglects communities of color.
These inequities are the result of centuries of implicit and explicit racist policies and practices embedded in our institutions--from those that have determined what communities people live in, to their legitimate fears about the weaponization of vaccines against communities of color. Established vaccine sites are often located in primarily white communities, with only English-speaking staff, and have appointments that can only be booked online, as a drive-through appointment, during limited hours; these are just a few of the reasons the community members we work with have faced difficulties getting vaccines. We know you recognize these challenges too, and appreciate the clear action that the Governor’s Office and CDPHE are taking to increase education and mitigate vaccine inequity. The Champions for Vaccine Equity program is showing encouraging progress in building vaccine confidence and knowledge in the Hispanic and immigrant communities we work with closely, and the plan to set aside fifteen percent of vaccines for communities with a high density of Coloradans of color and those with limited incomes has a lot of promise.
It is critical that Colorado make a course correction now that all Coloradans are eligible to get the vaccine, and supply has become more available. The White House estimates that the U.S. daily vaccinations will grow from about 1.7 million people a day now, to about 3.3 million doses a day by March 31st.
We also have significant work ahead to overcome the damage done by anti-immigrant federal policies and rhetoric of the last four years, which significantly reduced immigrants’ access to health care and economic support through harmful policies such as the public charge regulation. As the pandemic continues to rage on, both its health effects and economic burden fall most heavily on people of color, including immigrants. Yet, immigrants and their family members fear that if they seek health care, food, housing or other assistance, they could face immigration consequences like deportation, family separation, an inability to adjust status, or that they may subsequently need to pay for these services. These fears undermine access to testing, treatment and vaccination efforts and prolong the health and economic threat facing us all.
With this in mind, we wanted to offer six ways that Colorado can reduce barriers to accessing vaccines for immigrants and people of color and lead the country in vaccine equity metrics. More information about each of these suggestions is provided below.
Educate Coloradans and health and social services providers about vaccine access for immigrants with five key messages.
Share key messages in languages other than English and provide interpreter services at sign up and vaccine clinic sites.
Collaborate with and fund trusted messengers as vaccine ambassadors to overcome fear and other access barriers.
Use information from key stakeholders and data analysis to drive vaccine outreach and distribution efforts.
Ease access to vaccine sites by providing transportation, extended hours, and bringing vaccines where people who are hard to reach live and work.
Develop systems to identify and overcome unanticipated or emerging barriers to vaccine sign ups and clinics.
#1 Educate Coloradans and health and social services providers about vaccine access for immigrants with five key messages.
We applaud our leaders for ensuring that vaccines are available to all free of cost, identification is not required to receive a vaccine in Colorado, and that people’s personal information -- including name, date of birth and contact information-- will only be used for public health purposes and will not be shared for any immigration or law enforcement purposes.
However, we are facing the challenge that we need to encourage access to vaccinations at a time when people in immigrant families are afraid of accessing care. Since COVID-19 began, research continues to document that immigrants and their families are forgoing critical health and economic support programs because of immigration-related concerns. A recent survey of community-based organizations conducted by the Urban Institute found that nearly 70% reported that public charge and other anti-immigrant policies deterred the people they serve from seeking COVID-19 testing and treatment. We strongly suggest that you keep sharing and emphasize the following messages in multilingual vaccine-related materials, and with media and social media, non profit partners, and with health care providers across the state.
Receiving a vaccine is not considered in the public charge test -- even if paid for by Medicaid, CHIP, the health insurance marketplace, or at a community health center-- and will not impact an individual’s or a family member’s immigration status.
Vaccines are free and available to all regardless of health insurance, ability to pay, or immigration status.
Identification -- like a driver’s license or passport - is not required to receive a vaccine.
Personal information provided will not be used for immigration or other law enforcement purposes.
Immigration enforcement activities will not be conducted at or near vaccine distribution sites or clinics.
#2. Share key messages in languages other than English and provide interpreter services at vaccine sign up and vaccine clinic sites.
More than 312,000 or seven percent of people in Colorado are Limited English Proficient (LEP). It is critical that Colorado communicate these messages in the top languages spoken by people who are LEP in Colorado. In May, the U.S. Department of Health and Human Services Office of Civil Rights issued a bulletin that requires all entities that receive HHS-provided federal financial assistance to ensure meaningful access for individuals with limited English proficiency (LEP) during the pandemic. According to the American Community Survey, the top languages spoken by people who are LEP in Colorado were Spanish, Vietnamese, Chinese, African Languages, Russian and Arabic. In addition, providing interpreter services in person or on a language line at vaccine sites, particularly in counties with large numbers of LEP individuals, is critical. The counties where more than 5,000 people who are LEP live are Denver, Adams, Arapahoe, El Paso, Weld, Boulder, Jefferson, Larimer, Eagle, Douglas, Pueblo, and Garfield.
The City of Boston has key information about the status of the virus, the latest news, symptoms, social distancing, the local and national response, masks, information available on its website. It also created a printable booklet with COVID-19 facts and resources in Boston that is available in six additional languages. They also translate a number of brief fact sheets - about emergency food, pandemic EBT, the resiliency fund, and other services available for people regardless of immigration status, into Spanish, the most commonly spoken language other than English.
While CDPHE's website has almost all this information too, the obvious problem is that only a tiny fraction of it is translated into many other languages. The link to "Languages" is even in English, and the following page only offers a sliver of text in other languages. Much of which is already outdated information, and moreover many of those links go to google drive folders with documents also titled in English.
#3. Collaborate with and fund trusted messengers as vaccine ambassadors to overcome fear and other access barriers.
Across the country, worries about side effects and safety are a major reason people are hesitant to seek vaccines for COVID-19. Data is not currently available to gauge immigrants’ concerns about vaccine-related safety, but immigrants may be particularly concerned for a number of reasons. Immigrants are more likely to be employed in jobs that have historically not provided sick leave, and may worry that side effects could interfere with work and result in lost wages, they are also more likely to be uninsured. According to the Kaiser Family Foundation cross the U.S. only 9 percent of non-elderly U.S. citizens are uninsured, yet 25 percent of lawfully present immigrants and 46 percent of people without documentation are uninsured.
One way to address this is to work with trusted messengers who can engage and educate immigrants and their family members and arm them with the facts. These professionals can help bridge public health and community by informing interventions; connecting groups, neighborhoods, or organizations who can help fill in gaps; and helping immunization planners understand historic barriers and challenges to vaccination. Trusted community organizations have made an enormous difference in enrolling Coloradans in health coverage in the last decade. Similar organizations can build trust and help people access vaccines.
This can be accomplished with grantmaking and ongoing communications and coordination with key organizations.
Oregon is providing $45 million in COVID-19 health equity grant funding to 170 community-based orgs, including those that serve immigrants and people of color. North Carolina has partnered with faith leaders to ensure communities of color and underserved communities have access to vaccinations at the state’s mass vaccination clinics, including releasing appointments to Black and Latinx church attendees before opening up registration to the general public.
Tennessee has an African American Health Care Clinician Workgroup, with working members from the NAACP, the Black Nursing Society, and other Black organizations, who are disseminating messaging on the importance of vaccinations and will ultimately help vaccinate Black communities.
#4. Use information from key stakeholders and data analysis to drive vaccine sign ups and distribution.
Colorado should focus on areas where immigrants and people of color live and gaps in vaccine administration remain as it continues to roll out its vaccine access plans. For example, Boulder county health has been collaborating with organizations to determine where vaccination clinics should be located, and making sure that culturally appropriate staff are present and the program responds to specific community needs and preferences. The state and counties can use population-level data about race/ethnicity, socioeconomic status, health status and age to identify priority communities and how to fill in gaps. The Colorado Health Institute also suggests that transparency with the public about historic and existing inequities, activities underway to address them, and progress made on vaccination efforts, is key in closing the gap. This also includes vaccinating people who are immigrants detained for seeking asylum.
States are using hospital and social vulnerability index data to prioritize communities of color in vaccine sign ups and administration; and are developing equity metrics for key counties to meet.
Rhode Island is using its hospitalization, death, and case data to target vaccine distribution by geography. Vaccines will be available in community clinics, pharmacies, and housing sites in communities that have been identified as high risk.
Connecticut is closely tracking vaccine rollout in localities that rank high on the social vulnerability index.
Washington, DC opened its vaccine registration portal to all individuals over the age of 65, data quickly showed that an outsized proportion of appointments was going to wealthier White residents. In response, health officials made more appointments available for residents in parts of the city that were currently securing the fewest vaccine appointments. The city also started making appointments for residents in these high-priority zip codes available a day before other eligible residents could register.
California’s methodology for vaccine allocation will include its “health equity metric” that requires counties with a population of more than 106,000 to meet an equity metric and demonstrate targeted investments to eliminate disparities in COVID transmission.
#5. Ease access vaccine sites by providing transportation, extended hours, and bringing vaccines where people who are hard to reach live and work.
In Colorado, 13 percent of all essential workers are foreign born, and nationwide, nearly half of essential workers nationwide are people of color. These workers often work long hours and may need early morning, evening, or weekend vaccine time to be able to access a vaccine. In addition, transportation is a barrier to receiving health care in Colorado. People may have to rely on family members or mobile clinics to travel to a vaccine clinic. While Health First Colorado (Medicaid) provides transportation to vaccine appointments, the program must actively and effectively advertise and promote this, so their members are encouraged to utilize this critical service. Public health leaders agree that there is also a need to make vaccine sites permanent and consistent so people know where to go and it's not always changing. This is already needed, now when hospitals and the state take over sites previously not run by them, in addition to the highly anticipated need for people to receive vaccine boosters and annual vaccinations to avoid a future COVID pandemic.
Some examples of what other states are doing to increase physical access to vaccines include providing transportation to vaccine appointments through Medicaid (including Medicaid for emergency services), holding mobile sign up events, extended hours at vaccine clinics, and launching mobile vaccination teams that travel to areas high on the social vulnerability index to administer vaccines.
Massachusetts has issued guidance that clarifies that Masshealth can provide transportation to vaccine appointments. Even people who are not usually able to get transportation to medical appointments -- like people who are ineligible for Medicaid because of their immigration status and receive Medicaid for emergency services only -- can access transportation for COVID-19 vaccine appointments through Masshealth.
Illinois has held “mobile sign up events” scheduled by local health departments that reached out to discreet, hard-to-reach communities and invited them to register for vaccine appointments. Providing vaccine clinics with extended and weekend hours and at workplaces where essential work takes place -- like meat processing plants, manufacturing facilities, and ranches -- will also be needed to immunize essential workers.
Louisiana state officials cited a plan to create community mobile strike teams that will travel to areas that rank high on the social vulnerability index to administer vaccines. The strike teams will be staffed by the National Guard and funded by the Federal Emergency Management Administration, which reimburses states for 100 percent of costs associated with the National Guard’s COVID-19 relief efforts.
#6. Develop systems to identify and overcome unanticipated or emerging barriers to vaccine sign ups and clinics.
Across the country, barriers to signing up for and receiving vaccines differ. In some cases, sign up sites crash or phone call lines are not answered. In our work across the state, we’ve found that there are local systems that do not have one single Spanish speaker at a call center to help community members make their appointment. In others, an individual is unable to sign up for a vaccine without an email address, or insurance information, although that information is not actually required in order to receive the vaccine. Regardless of what the barrier is, it’s important to quickly identify barriers so they can be addressed, and we continue to make progress.
There are a number of ways to quickly identify emerging problems including: creating an ombudsman office (to hear complaints and suggest fixes quickly); handing out Know Your Rights cards with a hotline number and electronic form on the website to collect mderogatory data about providers; conducting civil rights testing or “secret shopper” testing of sign up systems and vaccine access at clinic sites to identify barriers due to language spoken, insurance status, immigration status, identity, or other issues. Another important way to identify and resolve barriers is to include people who have lived experience related to health equity in vaccine implementation into the design and implementation of Colorado’s system. For example, Washington state’s COVID vaccine implementation committee includes a community leader serving or representing immigrants, African Americans, Asians, Latinos, and Native Hawaiian Pacific Islanders, along with members who are uninsured, have disabilities, or live in rural areas.
We are committed to working together to actualize Colorado’s vaccine equity efforts so that our state can lead the country in vaccine equity metrics for immigrants and people of color. It is through these efforts and partnerships that we raise the important issues we’re experiencing in real time. Our organizations have been on the leading edges of health equity efforts, working with public health, elected officials, and local families. These shared experiences have informed this letter.
We would appreciate a confirmation that this letter has been received and read, as well as an outline on which recommendations will be implemented and the respective timelines for action. Please send your correspondence to Theresa M. Trujillo, Director of Community Organizing, at Theresa.Trujillo@centerforhealthprogress.org, and Joe Sammen, Executive Director of Center for Health Progress at Joe.sammen@centerforhealthprogress.org.
Thank you,
Organizations
9to5 Colorado
Adelante Community Development
American Friends Service Committee
Asian Pacific Development Center (APDC)
American Academy of Pediatrics, Colorado Chapter
Center for Health Progress
Clinica Colorado
Coalition for Immigrant Health
Colorado Association for School-Based Health Care (CASBHC)
Colorado Children's Campaign
Colorado Consumer Health Initiative (CCHI)
Colorado Cross-Disability Coalition (CCDC)
Colorado Fiscal Institute (CFI)
Colorado Immigrant Rights Coalition (CIRC)
Colorado Jobs with Justice
Colorado Latino Leadership, Advocacy, and Research Organization (CLLARO)
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)
Colorado Statewide Parent Coalition
Cultivando
DAWN Clinic
El Movimiento Sigue
Hunger Free Colorado
Indivisible
International Rescue Committee in Denver
Mi Familia Vota
OneMorgan County
Re:Vision
Tepeyac Community Health Center
Tri-County Health Network
Voces Unidas de las Montañas