By Robin Shear
Article originally published in Spring 2021 edition of Heartbeat. Heartbeat magazine is the official alumni publication of the University of Miami School of Nursing and Health Studies.
The ray of hope COVID-19 vaccines represent has been tempered by data on who is and isn’t receiving the protective shot.
While racial and ethnic minorities have been disproportionately harmed by COVID-19 in the U.S.—experiencing significantly higher infection, hospitalization, and death rates—vaccination rates continue to lag in these more vulnerable communities.
From fear and mistrust of medical professionals to technology and transportation barriers, any number of issues may be keeping people most at risk of COVID-19 from taking this potentially lifesaving measure.
Now the School of Nursing and Health Studies is part of a National Institutes of Health initiative announced this past September to combat mistrust and fear of public health recommendations. “What this pandemic has shown us, among many other things, is how persistent inequities are,” says SONHS Professor Guillermo “Willy” Prado, vice provost for faculty affairs and dean of the Graduate School. “It’s another example of continued disparities among underrepresented groups.”
But persisting disparities cannot be pinpointed to any one cause. “It’s a confluence of many factors,” says Professor Victoria Behar-Zusman, associate dean for research and Principal Investigator (PI) of the Center for Latino Health Research Opportunities (CLaRO), a joint University of Miami-Florida International University initiative that addresses a range of health issues affecting Latino populations.
One factor, she notes, is that African American and Latino populations are more likely to work in jobs that expose them to the virus, “where they are not able to work remotely from home—essential jobs such as those in the food and health care industries, construction, and elder caregiving, many of which continued during the shutdowns,” she says. “And they may rely on public transportation which exposes them to COVID-19.”
Unnaturalized immigrants also face greater risk from COVID-19, forgoing testing because they fear being deported. And with no access to unemployment benefits or health insurance, many continue to work in jobs that expose them to the virus, she adds. Compounding matters, vulnerable communities sometimes lack information or are misinformed about COVID-19.
To assess the needs minority communities are experiencing in relation to the pandemic, CLaRO has joined the NIH’s Community Engagement Alliance (CEAL) Against COVID-19 Disparities. CEAL is a $12 million yearlong study across 11 states, including Florida, to address misinformation and mistrust about Fighting the coronavirus and related scientific responses to it within minority communities.
Florida’s CEAL team, led by physician Olveen Carrasquillo at the Miller School of Medicine, includes efforts by UM, FIU, Florida A&M University, the Moffitt Cancer Center, and Health Choice Network. Of the seven CEAL projects being implemented in Florida, each focuses on a different issue and population.
CLaRO’s project for CEAL is focused on meeting the needs of low-income urban residents, agricultural workers, and sexual/gender minorities from South Florida’s Latinx communities.
Initial results from community members reveal high levels of vaccine hesitancy among some Hispanic groups in South Florida. Although few have outright refused the vaccine, there seems to be a “wait and see” mentality that may delay vaccine uptake. Many are also suspicious of information they receive from government sources, but expressed trust in experts and our local academic institutions, says Behar-Zusman, who contributed to a national survey deployed by CEAL earlier this year.
The study leaders hope to come up with best practices and resources to provide members of these communities with sound information about COVID-19 and its treatments. “What we’re focused on in these grants is to get out there and do outreach in our communities using our existing infrastructure for community engagement and work on how to engender trust in the vaccine process in these communities,” explains Behar-Zusman, principal investigator for the CEAL grant at SONHS.
She and her co-investigator, Assistant Professor Nicholas Metheny, are addressing the Latinx sexual/gender minority community (SGM) for their portion of the grant. Working with CLaRO community partners like Pridelines and Latinos Salud, the SONHS team has conducted focus groups and surveys throughout South Florida to better understand attitudes toward COVID prevention, clinical trials, and vaccines.
“We are focusing on vaccine hesitancy and the spread of misinformation, which seems to be a major problem across our communities,” says Metheny.
The findings will help tailor communications materials to effectively promote accurate information about vaccination. Metheny says the data will also help them advise on adaptations and Spanish-language translations of existing COVID-19 educational materials, as well as offer guidance on developing new outreach resources and strategies that could help community organizations harness social and local media to improve public health outcomes.
SONHS Ph.D. student Maria Jose Baeza Robba is currently collecting and analyzing focus group data, says Metheny, and she will ultimately help get the appropriate educational materials out into South Florida’s sexual and gender minority Latinx community. Undergraduate public health student Caitlin Rempson is working with the team to make sure resource materials are “relevant and engaging” to the population, says Metheny. “Working with Maria Jose, Caitlin will also create twice-weekly newsletters with information that is tailored to the hesitations we’re seeing about vaccination in the sexual/gender minority community.”
While there is overlap among the Latinx communities that CLaRO is working with on this project—farmworkers in Homestead, low-income urban residents in Little Havana and North Miami, and SGM communities throughout South Florida—Metheny notes that the sexual and gender minority subgroup SONHS is focusing on has been uniquely affected.
“LGBT people are more likely than the general population to be financially impacted by the pandemic,” he notes, “and these problems are exacerbated when people are multiply marginalized, such as when they identify as both ethnic and sexual minorities.”
—Maria Jose Baeza Robba, Ph.D. in nursing science student.
—Barbara Gutierrez and Robert C. Jones Jr. contributed to this report.