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Mistrust in doctors, not vaccine hesitancy is the main cause of vaccination gaps in the Hispanic community 

This week, AM analysts are tracking how mistrust in doctors is affecting vaccination rates within the Hispanic community. As vaccine rollout continues, CNN reports an alarming surge in COVID-19 cases, which experts believe is due to the highly contagious Delta variant. The variant is spreading about 50% faster than the version that first began infecting people in late 2019. Although Black and Hispanic populations are among the hardest hit by COVID-19, Hispanic communities remain at higher risk of COVID-19 infections because of lagging vaccination rates. Experts believe that vaccine skepticism stems from mistrust of doctors and unethical medical practices that target people of color. 

Just last month, a report by Axios uncovered some of the reasons why people of color don’t trust science. Danté Morehead, a community health educator at Fred Hutchinson Cancer Research Center, believes that unfairness in our medical system has contributed to a distrust of doctors and science for Hispanics and Blacks. “I’m not saying that our medical system or our science is itself completely racist, but it is rooted in inequities that have historically exploited people of color for research, mischaracterized our symptoms or pain, and hasn’t provided us with equal quality access… And, these things affect our outcomes,” Morehead says. He is not alone, according to new research released by the American Board of Internal Medicine (ABIM) Foundation, there is inherent systemic racism within the healthcare system. The survey found that close to 60% of adult consumers say the U.S. healthcare system at least “somewhat” discriminates against people of color and close to 50% of physicians agreed. A little over 10% of Hispanic adults reported discrimination by a doctor.

In addition to mistrust of doctors, unethical medical practices are to blame for vaccine hesitancy. Thousands of Latinos were sterilized in the 20th century and the memories have resurfaced during the wake of the COVID-19 pandemic. The landmark case, Madrigal v. Quilligan was a civil rights class-action lawsuit filed in 1978 by 10 Mexican American women against Los Angeles County-USC Medical Center for involuntary or forced sterilization. The plaintiffs were residents of East Los Angeles, a predominately Latinx community with inadequate medical and educational resources. According to USA Today, during the 20th century, about 20,000 women and men were sterilized in California under the state eugenics policies. Liany Arroyo, director of Hartford’s local health department, says in addition to Latino residents worrying about how quickly the vaccines were developed and what long-term effects they may have, they have historical reasons to be skeptical. “There are also things that happened in the Latino community that we don’t necessarily always talk about,” Arroyo said, one of which is the experiments in the 1940s where the U.S. Public Health service used sex workers to expose prisoners in Guatemalan jails with sexually transmitted diseases. Or in the 1950s, Puerto Rican women from low-income communities were given experimental birth control pills without being told they were part of a clinical trial.

To help build trust and promote awareness, Dr. Jorge Moreno, an internist and an assistant professor at Yale School of Medicine, created a YouTube video describing his experience getting the COVID-19 vaccine. In the video, he stated that “There was very little information available in Spanish and there was little information from Hispanic providers who could speak the language or could give their experience about the vaccine.” Dr. Moreno is one of a limited number of Hispanic doctors in the U.S. The high number of COVID-19 infections and deaths among Latinos in California alone underscores the state’s shortage of culturally competent, Spanish-speaking doctors. A study by the Latino Politics and Policy Initiative at UCLA reported that “Physicians who speak Spanish are the most “under-represented in California’s physician workforce.” The study also found that there are about 62 Spanish-speaking physicians for every 100,000 Spanish speakers in the state of California. The study also uncovered that culturally competent doctors who speak the language of their patients can lead to better health outcomes, instill trust, and enable patients to be more honest about their symptoms and be open to receiving preventative care.  

To compensate for the shortage of Latinx and Hispanic physicians, the Hispanic communities have uplifted Hispanic community leadersFindings from a September 2020 study of the attitudes and impacts of COVID-19 vaccine hesitancy and resistance in Latinx communities reveal a positive correlation between Hispanic identity and vaccine intention. The study points out that Hispanic-elected officials are more likely to be trusted than white-elected officials, therefore; efforts to promote uptake should leverage voices from within the community and should reinforce the notion that vaccination is a responsibility that helps the Hispanic community at large.  

Parinda Khatri, the chief clinical officer of Cherokee Health Services in Tennessee who works to vaccinate diverse populations in her region, has seen great success working with promotoras, community leaders in the Hispanic community. “These individuals are people who work with healthcare providers to get the medical information they need to deliver, and then go out into the world where people are. It’s a mode of communication that builds on the strength of community ties.”  

These findings support the fact that public health experts need to take a deeper dive into the systemic issues that are contributing to the lack of vaccination rates among certain populations and provide strategic and comprehensive initiatives to build trust among groups of people who have felt devalued and dismissed by medical professionals and the U.S. healthcare system. 

AM analysts will continue to report on factors that are impeding vaccination rates among the American population. If you missed part one or part two of this series, please visit the “News” section of our website to learn more.

AM LLC is currently working nationwide with multiple states and public health agencies on testing, contact tracing, and vaccination programs. Counties, states, or K-12 partners that are interested in partnering with AM for COVID-19 mitigation support should contact Dr. Christopher K Orlea at c.orlea@amllc.c

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