Partnership with trusted community organizations, a diverse bilingual workforce, and a grassroots communication and outreach strategy were key to a successful community based vaccination clinic aimed at expanding uptake and access among Latinos with limited English proficiency.

The COVID-19 pandemic has disproportionately affected minority groups including Latinos and especially among Latinos with limited English proficiency. Once vaccines became available, Latinos lagged behind in COVID-19 vaccination coverage, especially during the early phase of vaccination roll out. Latino migrants with irregular migrant status faced unique challenges to access vaccination, including language barriers, concerns about immigration status, and lack of familiarity navigating the US health care system. A nationally representative study in the US showed that in May, two thirds of undocumented Latinos reported uncertainty about their eligibility and concerns about social security or government ID requirements, and 43% did not know where to go. They also reported difficulty obtaining vaccine information in Spanish and registering through digital portals, and most were unaware that in the US the vaccine was available for free, regardless of immigration status.

The investigators of this study had a personal interest in expanding access to vaccination to this vulnerable group. Dr. Page is an infectious disease specialist from Uruguay and during the pandemic, she and co-author Ben Bigelow helped establish a coalition between the Johns Hopkins Health System, religious leaders, and community organizations to open a bilingual COVID-19 hotline and implement free SARS-CoV2 community-based testing to target disadvantaged Latinos in Baltimore City and surrounding areas. Leveraging this infrastructure, the trust gained through this initiative, and the expertise of bilingual and bicultural community health workers, the team implemented vaccination clinics at one of the local churches to facilitate access for Latinos with limited English proficiency.

What we did

Eighteen free community vaccination events with bilingual staff were conducted between February 26, 2021, and May 7, 2021. Between 150 and 200 first doses per week were allocated for this initiative.

A variety of outreach methods were used to increase vaccine uptake. The number for the bilingual COVID-19 hotline was distributed to vaccinated individuals to share with their networks and advertised through Spanish language local media outlets and community partners (passive outreach). In addition, the community health workers canvased Latino neighborhoods and laborer sites to offer appointments for vaccination (street outreach). Walk-up appointments became allowed as the pandemic progressed (walk-up).

What we found

• Vaccinated patients were predominantly Latino and were Spanish speakers with limited English proficiency. Despite concerns about hesitancy, uptake and vaccine series completion was high. A total of 2250 individuals were vaccinated, 92.4% self-identified as Hispanic, and 88.7% were LEP Spanish speakers.

• Different outreach methods reached different subgroups. Active phone outreach using linked medical history data reached older people and those with comorbidities. Street outreach focused on essential workers, and walk-up appointees were more likely to be Black and English proficient.

• Second-dose completion rate was very high and did not vary by outreach method. The second dose completion rate was 98.7%. Second dose reminders were sent by call and text message from trusted community health workers and likely contributed to this high completion rate.

Was this outreach successful? How should future groups aim to target disadvantaged communities?

Our free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the United States. However, this was a small scale intervention and more work needs to be done nationwide to minimize disparities in COVID-19 and other health outcomes. What should future groups do to insure high-uptake of community programs?

1. Partners with trusted community organizations and structures.

As pent-up demand for vaccination nationwide has subsided, community-based initiatives that can leverage social networks and build community trust. This can both increase access to and normalize vaccination for marginalized or vaccine-hesitant individuals.

2. Have a bilingual and bicultural workforce with flexible appointment scheduling.

The coalition participated in more than 40 Spanish language community informational forums, and the clinical director was designated a bilingual Maryland GoVAX COVID-19 vaccine ambassador. These combined efforts helped mitigate language barriers, concerns about immigration status, and lack of understanding about the healthcare system.

3. Increase the use of high-touch and low-tech approaches.

Our outreach methods overcame technical barriers by focusing on low-tech approaches. These methods included in-person outreach, hotline access, Spanish language media, and word of mouth that were easy to navigate and did not rely on advanced digital or health literacy.

To learn more, read our article in the November 2022 issue of the Journal of Public Health Management and Practice.

•  “High Uptake and Series Completion of COVID-19 Vaccine at Community-Based Vaccination for Latinos With Limited English Proficiency“ 

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Dr. Kathleen Page is an infectious disease specialist at Johns Hopkins School of Medicine. She is originally from Uruguay and her work focuses on promoting health equity for Latinos immigrants with limited English proficiency through community-engaged program development, implementation and evaluation.