The Orona Franco family receives a COVID-19 home testing visit from Santa Clara County health workers in San Jose on Feb. 3, 2021. The county has partnered with a group of promotoras from META, a community nonprofit based in East San Jose, to offer home testing and information about the coronavirus vaccine in one of the county's worst-affected areas. (Beth LaBerge/KQED)
uz María Abonce arrived in San Jose more than 15 years ago. Over time, she’s been to graduations, quinceañeras, workshops and made dozens of friends throughout the eastern part of the city. Now she gets to see many of those neighbors and friends again when she knocks at their door.
“We go out into the streets, eager to knock on some doors. Sometimes they open the door for us, sometimes they don’t. But there we are, offering what we have, COVID-19 tests and information,” she said in Spanish.
Abonce is a promotora, a community outreach health worker with META, Mujeres Emprendedoras Tomando Acción (Entrepreneurial Women Taking Action) and SOMOS Mayfair, two nonprofit organizations that have partnered with Santa Clara County's public health department.
“Promotoras are trusted leaders in the community,” said Analilia García, racial and health equity senior manager for Santa Clara County. “They have the trust and the relationships we as a county do not.”
As of Feb. 19, according to county data, 249,442 residents of Santa Clara County have now received at least one dose of the coronavirus vaccine. Just over 20% of those people are Latinos, a number that falls below the proportion of Latinos who have either been infected or died to COVID-19-related complications.
Health officials have expanded testing centers and pop-up vaccination sites in highly impacted areas, close to well-known neighborhood spots like La Placita Tropicana shopping center and in the Mexican Heritage Plaza in East San Jose, and the Gilroy Senior Center.
But the county acknowledges that opening up a pop-up in a hard-hit area does not necessarily result in more of its residents getting tested or vaccinated.
“For some people, it can be a digital divide. For others, it can be a matter of time because of work schedules or not feeling comfortable going to a location,” García explained.
The promotora program closes the gap that more traditional public health can’t reach.
García points out that promotoras form personal relationships with the families they meet, something that doesn’t really happen on the county’s online testing portal. Quite frequently, promotoras end up testing entire families at once. One of those families was that of Janet Franco Orona, resident of East San Jose. She lives with her husband, mother-in-law and 1-year-old baby.
While she’s gotten tested before, she’s felt a bit hesitant to take her mother-in-law, a senior, to public testing spots. “Will there be a lot of people who are already infected? Will they charge? All these things worry us when we plan on leaving the house.” she said.
But the promotora who knocked at Franco Orona’s door turned out to be an old friend and former neighbor of her mother-in-law.
“When community comes together, they will open their doors to one of their own,” she said.
Along with Abonce, eight bilingual promotoras go knocking door-to-door across East San Jose, offering residents in some of the worst-affected areas in the city the chance to get tested for COVID-19 at their doorstep through a self-swab test.
While Abonce waits as residents get tested, she answers any questions they may have. Many want to know about the new strains of the virus or what help the county can provide if they test positive. But now she's getting more questions about the COVID-19 vaccine.
“We hear so many things that we really wonder where these ideas come from,” she explained. “Folks tell us things like, ‘I’m not going to get vaccinated because it was released so quickly,’ ‘they told me that the vaccine is just water,’ or ‘the vaccine has a chip in it.' "
Abonce worries that these beliefs may seriously reduce the number of people who get vaccinated in the communities that need immunity the most, places where her friends and loved ones live.
Relying on the relationships and trust she’s built over the years, Abonce has managed to convince many neighbors to let go of these anxieties. But there are still those who refuse the vaccine, regardless of what they hear.
“We say that these are simply myths, that when pandemics or sicknesses spread, myths also tend to spread. Sometimes people make up these myths to create fear,” she said. “So we try to resolve those fears but sometimes we just can’t.”
In these cases, “The best we can do is give them the information we have," she said.
'I Would Take It but I Do Not Trust It': History and Vaccine Anxiety
Days before a COVID-19 vaccine received emergency authorization from the FDA, advocates advised state authorities that a vaccine distribution plan should take into account both the immediate impact the pandemic has had on Black and Latino communities in California and the lessons learned from coronavirus testing outreach in those populations.
While state authorities acknowledged the need to include equity in distribution plans, the latest vaccination data suggests that vaccines are reaching Black and Latino residents at rates lower than the impact the pandemic has had on those communities.
Out of the 6.7 million vaccine doses the state has administered so far, 2.9% of those who've received at least one shot identify as Black, while this group accounts for 6.2% of the state's total COVID-19-related deaths. Latinos represent 46.2% of COVID-19 related deaths in California, but have received just 16% of vaccinations so far.
Sudden changes in California's vaccination plan have resulted in confusion among residents statewide, and low dosage supply has limited the impact of massive vaccination centers, and may make it even harder for the vaccines to reach hard-hit populations.
Maurice Foster and Paula Petty, a married couple living in Oakland, fear getting sick and have done all they can to avoid exposing themselves to COVID-19. They said California's vaccine rollout process has eroded the little trust they have in state and federal authorities to provide a safe vaccine.
“I would take it but I do not trust it," Foster said. "I do not trust the government. I’ve seen the president and the first lady take it but still. I will take it because I don’t want to die, not because I trust it."
He believes the vaccine research process was not transparent, and is concerned it may have been rushed by the Trump administration for political motives.
“I don’t think Black people are more vulnerable to COVID-19," he added. "I think the government is more prejudiced towards Black people."
In San Francisco, high school senior Dara Montejo Chel has learned about incidents of medical malpractice in communities of color, especially cases of unethical sterilizations among Black and Latina women.
When Dawn Wooten, a nurse at a migrant detention center in Georgia, filed a whistleblower complaint last September claiming that hysterectomies were being performed on detained migrant women without their fully informed consent, Montejo Chel felt her anxiety shoot up.
She knows the COVID-19 vaccine is not a sterilization tool and strongly believes in the science of immunity – but she said the history she's learning weighs heavy on her mind.
“When it comes to medical research, we people of color are usually the ones put at greater risk,” she said. “For a long time, medicine has not shown it cares about us.”
Dr. Alicia Fernández, professor of medicine at UCSF, has heard similar hesitations from her patients. Her research looks at expanding access to primary health care in immigrant and Latino communities, and she’s part of the Unidos en Salud initiative that’s brought COVID-19 testing into San Francisco's Mission District and the Fruitvale District in Oakland.
Vaccine hesitancy, she points out, while present across different demographics, differs based on access to adequate medical information and lived experiences. She’s identified a couple broad categories so she can address these anxieties more effectively.
“The first bucket is misinformation,” she said. Misinformation includes believing that the vaccine has dangerous side effects (like infertility or mutations), or that it was developed too quickly.
The second bucket consists of what Fernández refers to as alternate health beliefs: deeply held ideas about professional medicine or different types of care that make it difficult for an individual to go out and seek immunization. Alternative understandings of wellness can sometimes come from family traditions or a desire to provide care when hospitals are inaccessible due to lack of coverage or language.
“These beliefs may include never getting a vaccination, never putting anything into their body,” she said.
Then there’s everything else, but Fernández explained that an overarching feeling of worry relating to health and receiving care explains many of these experiences.
“What I try to do is sort out what people are feeling. I acknowledge that there are many reasons patients have to not trust doctors with these sorts of issues,” she said. “The history of health care abuses both in Puerto Rico, in the Dominican Republic and other places comes up.”
Throughout the mid-20th century, the Eugenics Board of Puerto Rico encouraged and oversaw hundreds of thousands of sterilizations of women on the island as a population-control mechanism. Many of these women were not properly informed by physicians about the procedure and believed that the operation was easily reversible.
One-to-one conversations between doctor and patient are critical, Fernández explains, because that is when physicians can meet their patients where they are.
“If the doctor is comfortable with it, it’s important to share a little bit of our own stories of why we came to take the vaccine,” she said.
Talking about his own vaccine experience has been effective for Dr. Adrian James, chief medical officer at the West Oakland Health Council, who has cleared up vaccine worries not just with his patients but also with his staff.
WOHC sees almost 8,000 patients every year, many of them Black East Bay residents. Last December, WOHC announced a partnership with Covered California to tackle vaccine hesitancy among Black communities in the state.
“I let folks know that this is a community problem," James said. "This is everyone. This is not the Tuskegee experiment, only dealing with African American men. This is a community issue, we’re asking everyone to get the vaccine."
James makes reference to a 1932 study conducted by the U.S. Public Health Service and the Tuskegee Institute on Black men working as sharecroppers in Alabama. These men were informed that they were signing up to receive free medical care – they weren't told they would be part of a study looking at the effects of untreated syphilis.
When details of the experiment were leaked to the press 40 years later, hundreds of participants had died never knowing they had the disease or ever received treatment. Now, Black community leaders and health workers in Alabama are organizing to regain the trust of residents who immediately think of the Tuskegee experiment when they hear about the COVID-19 vaccine.
“We as a people do have a reason to be hesitant," James said. "But this is not the time. There are too many people dying."
‘I Want to Be One of Those People Taking the Vaccine’
For the past nine months, the Latino Task Force, a coalition made up of dozens of community-based organizations, has partnered with the San Francisco Department of Public Health and UCSF’s Unidos en Salud to provide weekly pop-up COVID-19 testing sites.
During that time, Jon Jacobo, health chair of the task force, has been able to talk to the hundreds of Latino and immigrant residents while they wait in line to get tested for coronavirus or get their flu shot. He’s noticed that feelings about getting vaccinated, whether that is for the flu or COVID-19, can differ based on generation and immigration experience.
“When we had the pop-up for flu shots back in September, the folks that would be coming in to get vaccinated were predominantly monolingual Spanish speakers,” he said.
According to Jacobo, recently arrived immigrants in line were very enthusiastic.
“In our home countries, maybe you don’t have access to free quality health care. And so now that you’re in the U.S., and this is available, it could be very advantageous,” Jacobo explained.
On the other hand, it’s been among second-generation immigrants and younger residents where he’s noticed a cooler reception towards the COVID-19 vaccine.
“For folks who were born here and grew up here, a lot of misinformation is present on social media," said Jacobo.
However, he points out that overall, these feelings are a lot less common than expected. While the results have not been released yet, the Latino Task Force managed to poll over 6,000 people at its testing site on the corner of Mission and 24th streets last month. Jacobo estimates that over 80% of those surveyed had a very favorable opinion of the vaccine.
He hopes his team can publish all the data from the survey in the coming months, but according to Jacobo, the initial findings signal that those surveyed trust local and state governments a lot less than physicians and community initiatives like the Latino Task Force.
“I think the city needs to learn that it’s OK to not have all the answers at the moment,” he said. “Sometimes we just don’t have an answer at the moment. And we need to be comfortable with saying, ‘We are working on it and we will get it.’ ”
Confusion about where vaccinations are offered and lack of accessibility to these places can end up sowing distrust for the vaccine when there wasn’t distrust before, he added.
The first neighborhood vaccination site in San Francisco opened up in the Mission District on Feb. 2, thanks in part to the advocacy of the Latino Task Force, who sought to bring a vaccination center into the heart of the Mission and a block away from the 24th Street BART station, where COVID-19 tests are offered every week.
Community organizers need care providers and public health authorities as much as the latter needs the former to provide trust and credibility to vaccination efforts, Jacobo said. This coalition is effective when community members lead and shape the outreach while the other two partners actively follow and fund this work.
“As an academic physician, it’s really helped me to work more closely with community-based organizations,” said Dr. Fernández of UCSF. She thinks that the model built to combat the pandemic and provide access to the vaccine can be replicated to confront other health crises that disproportionately affect communities of color, like diabetes or obesity.
“We’re going to need a lot of structural change, a lot of changing the social determinants of health, and that’s going to require all of us to work together,” she said.
As for the coalition, that shouldn’t fall apart after the pandemic ends, Jacobo said. “I know that from here on out, we are going to be working in this city towards a new normal.”
He added, “I don’t think that any of us want to go back to ignoring the inequities and the painful, glaring realities lived by the have-nots in the city.”
Back in January, Jacobo, along with a few other members of the Latino Task Force involved in testing efforts, were vaccinated. Some volunteers got to see the moment firsthand. Among those present was Esteban Torres, a freshman at City College of San Francisco.
Torres had felt unsure about taking the vaccine for a few weeks. But when he saw some of his friends and older relatives take the chance, he felt a flood of relief. But also a sense of responsibility.
“When I saw that, I told myself I want to be part of that. I want to be one of those people taking the vaccine, doing it for everyone in my family and doing the most I can for anyone in my community,” he said.
KQED has brought together information on how and where to get vaccinated for COVID-19 in the Bay Area and is answering questions you may have about the process. Check out our guide, available in English and Spanish here.