Francesca Rattray and Corin Reyes of the San Antonio Young Women's World Christian Association (better known as YWCA) have a shared passion: serving people. Rattray serves as CEO of the institution, while Reyes is the Director of Health Equity. In 2020, both faced an unprecedented challenge: the COVID-19 pandemic and its impact on Latino communities.
The YWCA is a women's organization whose mission is to "eliminate racism and empower women," according to its official website. In San Antonio, they work at the Olga Madrid Community Center, located in in the western part of the city where 33% of the inhabitants live in poverty, which is well above the city average, and 9 out of 10 people are Latino. From there, they organize activities to care for and educate children and adolescents, support the well-being of communities, promote racial justice and gender equality, and promote economic empowerment.
The arrival of the pandemic revealed the gaps and deficiencies of the health system in the Hispanic community. For Francesca Rattray, the first days of living with the virus were difficult and complex. “In the early days of the pandemic, tests were not widely available. There were long lines when I arrived, and then, while there was information about how to do the test, the results were not fully understood. In broad strokes, there was confusion, chaos, and lack of access,” Rattray described.
By September 2021, San Antonio had surpassed 4,000 deaths since the pandemic's start. But COVID-19 hit the Latino population in San Antonio in a magnified way. Officials from the Metropolitan Health District knew that those killed by coronavirus so far had been “disproportionately Hispanic and Latino”; many of them had not been vaccinated.
A survey carried out by the Health Department in August 2021 -8 months after the vaccines were available- indicated that, of the 1.2 million Latinos in the city, 60% were not vaccinated. Health care providers claimed this was due to misinformation about COVID-19 and vaccines as well as the spread of rumors of negative side effects, which made Latinos reluctant to get the vaccines.
The situation was untenable and urgent measures had to be taken. Corin Reyes explained that in the poorer neighborhoods of San Antonio, vaccines were not readily available to people. Instead, the vaccination events were being carried out in central parts of the city, which inhabitants of the most remote areas and with the fewest resources could not access.
Mission: bring vaccines closer
“One of the main things we had to do was bring the vaccine to the neighborhoods so that people could access it”, that was the task that Reyes and the YWCA team set out to address, to eliminate the lack of access to vaccination events for Latinos in the poorest areas of San Antonio.
They saw an opportunity to achieve this, working with a well-known partner institution: the National Alliance for Hispanic Health (the Alliance), which developed “Vaccines for All/ Vacunas Para Todos” to provide information on the vaccines and fund Community Health Workers throughout the U.S..
Francesca Rattray said that the relationship between the YWCA of San Antonio and the Alliance began with a small partnership years ago to conduct a longitudinal study on the health of Hispanics. This bond grew, and trust relationships developed between the Latino communities and these institutions over time, which facilitated the implementation of “Vaccines for All”.
Vaccines for All relied on community health workers whose work in the Latino communities in which they live made them trusted sources of information. This trust built over time made it easier to reach people who were most reluctant to get vaccinated. Additionally, it facilitated the distribution of the doses to neighborhoods with the most access problems since the community health workers were the ones who immunized the people.
One of those promoters was María Quintero, who works alongside Reyes and Rattray at the YWCA. At the beginning of the vaccination process, she had to face scared members of the Latino communities who were full of doubts about vaccines and had only experiences the lack of adequate attention from the health system.
"At the beginning, it was very hard, but as we talked to them and provided all the information about the vaccines, everything began to improve," Quintero said, adding that after the visits she made, she found a positive response from the communities that translated into their willingness to be vaccinated.
“People were not sure; they did not know what effects the vaccines would have. So we tried to explain to them in Spanish and tell them not to be afraid. The communities we visited responded very well after we explained the side effects to them,” she added.
Reyes emphasized that they had to persevere to achieve their objective as the reception was not so warm. Instead, people asked, “Why are you here?” and added “We don't want to get vaccinated.” Reyes said they listened and learned and built a strategy to have many small conversations with people and make them feel comfortable with them and the information.
Misinformation and language barriers were two main obstacles to the YWCA's vaccination work. People’s reasons for not being immunized were many— religious reasons, beliefs about the alleged harmful effects of vaccines for pregnant people, and distrust regarding its components. That was where the community health workers had a major impact in dismantling false information and generating security in the people.
Not surprisingly, language barriers also had to be overcome. Nationally, 20% of Latinos living in the United States do not speak English or have difficulties with the language; a situation that was an essential element to consider in a city like San Antonio, where 6 out of 10 inhabitants are Latino. Additionally, according to data from the Nielsen in 2020, Latinos were 57% more likely than non-Hispanics to use social networks as the primary source of information about COVID-19. As we know social media exposed people to more misinformation than what exists on other platforms.
“The vaccine arrived, and we faced the disinformation campaign in English, not to mention Spanish. All this experience showed us how important trust relationships are and, in turn, showed us how much work remains to be done in many other areas.”
Lessons for the healthcare system
In Rattray's opinion, part of the pending work addresses inequality and neglect by the health system towards the most vulnerable Latino groups, a situation that significantly harmed them during the pandemic.
“COVID-19 revealed that there were already gaps in the system. This forced us, as a city and even as a country, to speed up the creation process for two vaccines and information and all services.” commented Rattray. The work carried out by the YWCA and "Vaccines for All" to communicate and bring health vaccines to the communities were essential.
Supporting community health workers is a good practice that the health system can adopt to reduce the gaps in care for the poorest Latinos. In Reyes' opinion, when implementing health programs, "it is necessary to involve people with lived experience from the initial phase." She cited as a positive example the gradual change in the attitude of the Hispanic communities that the YWCA reached out to through the community health workers.
“Over time, people began to know us. Thanks to them [community health workers], people began to recognize us as a reliable source of vaccine information. The community health workers were bilingual; they understood the culture, so the people began to understand. What we know today is that this has flourished and expanded. When people want to organize an event in the communities we serve, they know they can count on us to get it done,” she declared.