Fútbol, Flags And Fun: Getting Creative To Reach Unvaccinated Latinos In Colorado

Horns blared, and drums pounded a constant beat as fans of the Mexican national soccer team gathered recently at Empower Field at Mile High in Denver for a high-profile, international tournament.

But the sounds were muted inside a mobile medical RV parked near the stadium, and the tone was professional. During halftime of Mexico's game against the U.S., soccer fan Oscar Filipe Sanchez rolled up his sleeve to receive the one-dose COVID-19 vaccine.

Sanchez is a house painter who lives in Colorado Springs. After he got sick with COVID-19 a few months ago, he thought he should go get the vaccine. But because of the illness, he was advised to wait a few more weeks before getting the shot. Asked if he's glad he got it? Sanchez answered through a translator: "Yes! He's more trusting to go out."

Bringing the mobile vaccine program to an international soccer match was the latest effort by the state of Colorado and its local partners to meet unvaccinated residents, wherever they are, rather than asking them to find the vaccine themselves.

Long gone are the days in early spring when vaccine appointments were snatched up the instant they became available, and health care workers worried about making sure patients were actually eligible under state and federal criteria for age and health status.

Colorado, and most of the nation, has now moved into a new phase involving targeted efforts and individual interactions and using trusted community influencers to convince the hesitant to get jabbed.

With about half of Colorado's 5.78 million population now fully immunized, the challenge cuts across all demographic groups. According to the state's vaccination dashboard, men are slightly more hesitant than women and rural residents have been more reluctant than urban dwellers. Younger Coloradans have been less likely to prioritize the shot compared to their elders.

But perhaps no group has been harder to get vaccinated than Coloradans who identify as Hispanic. Despite Hispanics making up more than 20 percent of the state population, only about 10 percent of the state's doses have gone to Hispanic residents, according to the state's vaccination dashboard.

The gap is not as wide nationally: Hispanics or Latinos make up 17.2 percent of the U.S. population, and 15.8% of people who have gotten at least one dose — and whose race/ethnicity is known — are Hispanic or Latino.

At first, the gap in Colorado seemed to be an issue involving adequate access to health care. Nearly 16 percent of Hispanic residents in the state are uninsured, according to a report from the Kaiser Family Foundation. That's more than double the rate for white Coloradans. That might still play a role, though the vaccine itself is free with no insurance requirement. With vaccine availability now widespread, health leaders are searching for ways to communicate its availability, and support greater acceptance of the message that the vaccine will allow the vaccinated to return to their pre-pandemic lives.

Denver has hit the 70 percent threshold for resident vaccination but some of its Latino neighborhoods are getting vaccinated at much lower rates, according to Dr. Lilia Cervantes, an associate professor in the department of medicine at Denver Health.

"There are some very high-risk neighborhoods where most of the community are first-generation or foreign-born individuals," said Cervantes. "And that is where we're seeing the highest disparities."

According to data from Denver's health agencies, about 40 percent of Latinos older than 12 are vaccinated in Denver county — that's far below the roughly 75 percent rate for white Denverites.

Latino residents make up 29 percent of the Denver population but represent nearly half of cases and hospitalizations. Some of the highest case rates in the greater Denver area are in some of the mostly Latino neighborhoods, like those in west Denver, like Barnum West, Westwood, and Ruby Hill, Cervantes noted.

"I think that it is critical that we improve vaccine uptake in our most marginalized groups, including those who are undocumented and those who are Spanish-language dominant," she said if the state hopes to reach broad levels of protection from the virus. Cervantes adds she's concerned the state will keep seeing a higher COVID-19 positivity rate in those marginalized groups, who make up much of the essential workforce. "This past year, I think we have seen stark health inequities in the Latino community."

Black Coloradans also lag behind, according to the state dashboard, but not as much as Hispanic residents; they make up about 4 percent of the state's population but are a little less than 3 percent of those who have been vaccinated.

All this portends a more uneven pandemic, says Dr. Fernando Holguin, a pulmonologist and critical care doctor at the Latino Research and Policy Center at the Colorado School of Public Health.

He worries cases, hospitalizations and deaths will keep flaring up in less-vaccinated communities, especially predominantly Hispanic communities in parts of Colorado or other states where overall vaccination rates are poor. "They're at risk, especially moving into the fall of seeing increasing waves of infections. I think it is really critical that people really become vaccinated," Holguin said. Even as parts of Colorado and parts of the U.S. — like the Northeast — are getting vaccinated at high rates, for the mostly unvaccinated "COVID infections in certain communities still will be devastating for them," Holguin said.

He's especially concerned about rural migrant farmworkers. They often have poor access to the internet and may struggle to find good information about the vaccine and avoiding the virus. "So overcoming those access, cultural, language barriers is important," he said.

When asked what the state has done to reach out to Latino Coloradans, a health department spokesperson pointed to over 1,500 "vaccine equity clinics" in 56 counties; the Workplace Vaccination Program, which partners with businesses and organizations to provide vaccine clinics at worksites; and a Spanish-language Facebook page and COVID-19 website. She said the state's "Power the Comeback" campaign is in English and Spanish and aims to reach disproportionately impacted populations with awareness ads, testimonial videos, and animated videos.

The Champions for Vaccine Equity program provides information to those communities about the safety and efficacy of vaccines, as well as utilizing promotoras, medical providers, and crisis counselors to support vaccine literacy.

The health department has also reminded vaccine providers that no identification, proof of residency, or insurance coverage is required to obtain the vaccine. Also, Colorado has set up a 24/7 vaccine hotline (1-877-268-2926) to answer questions and help schedule appointments in multiple languages.

About a third of all adults in the US are unvaccinated, a "shrinking pool" that skews younger and includes people more likely to identify as Republican or Republican-leaning, according to a KFF COVID-19 Vaccine Monitor report.

They also tend to have lower levels of education and income and are more likely to be uninsured. The KFF report found 19 percent of unvaccinated adults are Hispanic; of that group, 20 percent said they will "wait and see" about getting vaccinated, 11 percent said they'd "definitely not" get it.

Both Cervantes and Holguin credit local, state, and community groups with aggressively looking to boost vaccination rates among Latino Coloradans, while also encouraging them to keep recruiting trusted community voices from within, to help deliver the message.

"You know, it's not going to be Dr. (Anthony) Fauci saying something, that someone translates in Spanish, that you need to get vaccinated, Holguin said. "There's going to be people in the community convincing others to get vaccinated."

At Empower Field, soccer fan Diego Montemayor, another Denver resident, echoed that sentiment, saying some fans who got shots themselves urged friends who came to the stadium to visit the RV and get one too. "When they hear people that they trust sharing their experiences, that goes a long way," Montemayor says.

Community health advocate Karimme Quintana agreed. She had come to the game as well to spread the word about the safety and efficacy of the vaccine. She works as a Promotora de Salud Pública, a public health outreach worker, focusing her efforts on Denver's majority-Latino Westwood neighborhood. Quintana says that population may trust someone close to them more than even a doctor.

"They need to be more educated about the COVID because they have a lot of questions," says Quintana, whose button read "Tiene preguntas sobre COVID? Pregunteme." ("You have questions about COVID? Ask me.")

"Latino people, they listen (to) the neighbor, they listen (to) my friend," Quintana says.

University of Colorado Health nurse Danica Farrington says the vaccine effort at the soccer tournament was heavily promoted beforehand on billboards and big screens inside the stadium during the game.

"They just plastered it everywhere and said, go get your shot," she said. "That's pretty influential."

The carnival atmosphere at the stadium helped him make the pitch, says Jesus Romero Serrano, a community ambassador with Denver's mayor's office.

"Absolutely! It's a Mexico game versus Honduras! So lots of Latinos are here. This is the perfect place to be, to reach the Latin community. Absolutely."

To capitalize on the playful spirit of the day, Romero Serrano wore a Mexico soccer jersey and a red and green Luchador wrestling mask. In his work with the city government, he's what you could call a community influencer. He filtered through the tailgate crowd in the parking lot, handing out cards about where to get the vaccine.

As he circulated, he admitted it's sometimes hard for some Latino Coloradans to overcome what they see as years of historic mistreatment or neglect from medical providers. "They don't trust the healthcare system," he says.

Still, Romero Serrano kept wading into the crowd, shaking hands and shouting over the constant din of the drum bands, asking "Hey guys, you get the vaccine?"

The most common answer he heard was "everybody has it" — but he was skeptical about that, thinking people were just being nice.

A few miles from the stadium is the Tepeyac Community Health Center, in the predominantly Hispanic Globeville neighborhood. That's home base for Dr. Pamela Valenza, a family physician and chief health officer at the clinic. She tries to address her patients' fears and concerns about the new vaccines, but many have told her they still want to wait.

They want to see that "people who are vaccinated are not going to get complications. That people who are vaccinated are not going to get serious side effects," she says.

Valenza hoped the state's $1 million drawings, launched in May, might help. Her own clinic recently held more vaccine events, at more convenient times that didn't interfere with work, like Friday evenings. It offered free grocery cards for the vaccinated.

Valenza said she likes the idea of pairing vaccines with fun.

"The Latino culture, food, culture, and community is such a central part of the Latino community," Valenza said. "Making the events maybe a little bit more than just a vaccine might, might encourage some community members to come out."

This story comes from NPR's health reporting partnership with Colorado Public Radio and Kaiser Health News (KHN).

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