Horns blared and drums pounded a constant beat as fans of the Mexican national soccer team gathered recently at Empower Field at Mile High in Denver for a high-profile international tournament.
But the sounds were muted inside a mobile medical RV parked near the stadium, and the tone was professional. During halftime of Mexico’s game against the U.S., soccer fan Oscar Felipe Sanchez rolled up his sleeve to receive the one-dose covid-19 vaccine.
Sanchez is a house painter in Colorado Springs. After getting sick with covid a few months ago, he thought he should get the vaccine. But because of the illness, he was advised to wait a few weeks before getting the shot. Asked if he’s glad he got it, Sanchez answered through a translator: “Yes! He’s more trusting to go out.”
Bringing the mobile vaccine program to an international soccer match was the latest effort by the state of Colorado and its local partners to meet unvaccinated residents wherever they are, rather than ask them to find the vaccine themselves.
Long gone are the days in early spring when vaccine appointments were snatched up the instant they became available, and health care workers worried about making sure patients were eligible under state and federal criteria for age and health status.
Colorado, and most of the nation, has now moved into a new phase involving targeted efforts and individual interactions and using trusted community influencers to persuade the hesitant to get jabbed.
With about half of Colorado’s 5.78 million people now fully immunized, the challenge cuts across all demographic groups. According to the state’s vaccination dashboard, men are slightly more hesitant than women and rural residents are more hesitant than urban dwellers. Younger Coloradans have been less likely than their elders to prioritize the shots.
But perhaps no group has been harder to get vaccinated than Coloradans who identify as Hispanic. Despite Hispanics making up more than 20% of the state population, only about 10% of the state’s doses have gone to Hispanic residents, according to the state’s vaccination dashboard.
The gap is not as wide nationally: Hispanics, or Latinos, make up 17.2% of the U.S. population, and 15.8% of people who have gotten at least one dose — and whose race/ethnicity is known — are Hispanic.
At first, the gap in Colorado seemed to be an issue of inadequate access to health care. Nearly 16% of Hispanic Coloradans are uninsured, according to a KFF report. That’s more than double the rate for white Coloradans. That disparity may play a role, even though the vaccine itself is free, with no insurance requirement.
Denver has hit the 70% threshold for resident vaccination, but some Latino neighborhoods are getting vaccinated at much lower rates, according to Dr. Lilia Cervantes, an associate professor in the department of medicine at Denver Health.
“There are some very high-risk neighborhoods where most of the community are first-generation or foreign-born individuals,” said Cervantes. “And that is where we’re seeing the highest disparities.”
According to data from Denver’s health agencies, about 40% of Latinos older than 12 are vaccinated in Denver County — that’s far below the roughly 75% rate for whites.
Latinos make up 29% of the Denver population but represent nearly half of cases and hospitalizations.
If the state hopes to reach broad levels of protection from the virus, Cervantes said, “I think that it is critical that we improve vaccine uptake in our most marginalized groups, including those who are undocumented and those who are Spanish-language dominant.” Cervantes added she’s concerned the state will keep seeing a higher covid positivity rate in those marginalized groups, who make up much of the essential workforce. “This past year, I think we have seen stark health inequities in the Latino community.”
All this portends a more uneven pandemic, said Dr. Fernando Holguin, a pulmonologist and critical care doctor at the Latino Research & Policy Center at the Colorado School of Public Health.
He worries cases, hospitalizations and deaths will keep flaring up in less vaccinated communities, especially predominantly Hispanic populations in parts of Colorado or other states where overall vaccination rates are poor. “They’re at risk, especially moving into the fall of seeing increasing waves of infections. I think it is really critical that people really become vaccinated,” Holguin said. Even as parts of Colorado and parts of the U.S. — like the Northeast — are getting vaccinated at high rates, for the mostly unvaccinated “covid infections in certain communities still will be devastating for them,” he said.
He’s especially concerned about migrant farmworkers, who often have poor access to the internet and may struggle to find good information about the vaccine and avoiding the virus. “So overcoming those access, cultural, language barriers is important,” he said.
When asked what the state has done to reach out to Latino Coloradans, a health department spokesperson pointed to over 1,500 “vaccine equity clinics” in 56 counties; the Workplace Vaccination Program, which partners with businesses and organizations to provide vaccine clinics at worksites; and a Spanish-language Facebook page and covid website. She said the state’s “Power the Comeback” campaign is available in English and Spanish and aims to reach disproportionately affected populations with awareness ads, testimonial videos and animated videos.
About a third of all adults in the U.S. are unvaccinated, a “shrinking pool” that skews younger and includes people more likely to identify as Republican or Republican-leaning, according to a KFF COVID-19 Vaccine Monitor report.
They also tend to be poorer, less educated and more likely to be uninsured. The KFF report found 19% of unvaccinated adults are Hispanic; of that group, 20% said they will “wait and see” about getting vaccinated, and 11% said they’d “definitely not” get it.
Both Cervantes and Holguin credit local, state and community groups with aggressively looking to boost vaccination rates among Latino Coloradans, while also encouraging them to keep recruiting trusted community voices from within, to help deliver the message.
“You know, it’s not going to be Dr. [Anthony] Fauci saying something, that someone translates in Spanish, that you need to get vaccinated,” Holguin said. “There’s going to be people in the community convincing others to get vaccinated.”
At Empower Field, soccer fan Diego Montemayor of Denver echoed that sentiment, saying some fans who got shots themselves urged friends who came to the stadium to visit the RV and get one, too. “When they hear people that they trust sharing their experiences, that goes a long way,” Montemayor said.
Community health advocate Karimme Quintana agreed. She had come to the game as well to spread the word about the safety and efficacy of the vaccine. She works as a promotora de salud pública, a public health outreach worker, focusing her efforts on Denver’s majority-Latino Westwood neighborhood. Quintana said that population may trust someone close to them more than even a doctor.
“They need to be more educated about the covid because they have a lot of questions,” said Quintana, whose button read “¿Tiene preguntas sobre covid? Pregúnteme.” (“Do you have questions about covid? Ask me.”)
“Latino people, they listen [to] the neighbor, they listen [to] my friend,” Quintana said.
University of Colorado Health nurse Danica Farrington said the vaccine effort at the soccer tournament was heavily promoted beforehand on billboards and big screens inside the stadium during the game.
“They just plastered it everywhere and said, go get your shot,” she said. “That’s pretty influential.”
The carnival atmosphere at the stadium helped him make the pitch, said Jesus Romero Serrano, a community ambassador with Denver’s mayor’s office: “It’s a Mexico game versus Honduras! So lots of Latinos are here. This is the perfect place to be, to reach the Latin community. Absolutely!”
To capitalize on the playful spirit of the day, Romero Serrano wore a Mexico soccer jersey and a red-and-green luchador wrestling mask. In his work with the city government, he’s what you could call a community influencer. He filtered through the tailgate crowd in the parking lot, handing out cards about where to get a vaccine.
As he circulated, he admitted it’s sometimes hard for some Latino Coloradans to overcome what they see as years of historical mistreatment or neglect from medical providers. “They don’t trust the health care system,” he said.
Still, Romero Serrano kept wading into the crowd, shaking hands and shouting over the constant din of the drum bands, asking people whether they had gotten a vaccine.
The most common answer he heard was “everybody has it” — but he was skeptical about that, thinking people were just being nice.
A few miles from the stadium is the Tepeyac Community Health Center, in the predominantly Hispanic Globeville neighborhood. That’s home base for Dr. Pamela Valenza, a family physician and the chief health officer at the clinic. She tries to address her patients’ fears and concerns about the new vaccines, but many have told her they still want to wait and see that people don’t have serious side effects.
Valenza’s clinic recently held more vaccine events, at more convenient times that didn’t interfere with work, like Friday evenings, and offered free grocery cards for the vaccinated. She said she likes the idea of pairing vaccines with fun.
“The Latino culture — food, culture and community — is such a central part of the Latino community,” Valenza said. “Making the events maybe a little bit more than just a vaccine might encourage some community members to come out.”