This story was originally published by The Colorado Sun.
Una versión en español de este artículo está disponible para leerse aquí.
Julissa Soto arrived at the church early on Ash Wednesday, as good a day as any for her to urge people to think about mortality.
She’d been in church a lot lately, part of a job that she, a devout Catholic, had come to see as its own kind of spiritual calling. So, when the priest stepped forward during Mass to begin the distribution of ashes and nodded in her direction, she did not hesitate.
Soto rose from her seat in the front pew, walked to the pulpit and began, speaking in her native Spanish, to preach the gospel of COVID vaccination.
Protect yourself and your loved ones, she told the congregation. Protect your community.
She closed her remarks with a simple: “Thank you and God bless you.” And, then, after the priest used his thumb to place ashes in the shape of a cross on her forehead, she returned to her seat.
One Mass down. Four more to go that day at Church of the Ascension Catholic Parish in Denver’s Montbello neighborhood.
Soto is an independent health care consultant and Latino community advocate who for months has been organizing vaccination clinics in the kinds of places public health officials traditionally don’t go or struggle to access. Churches. Nightclubs. Markets.
Sometimes these venues are reluctant to open their doors to vaccination clinics out of concern for the controversy they may create — Soto says she spends weeks or months winning over a parish’s priest before she can host a clinic at his church. Other times, they are places where health leaders haven’t thought to put a clinic. Either way, the work requires a deep understanding of the community and deep trust from its members.
By her count, her clinics have vaccinated more than 13,000 people since September, the vast majority of them Latino.
The need is great. Colorado’s Latino population has the lowest vaccination rate of any racial or ethnic group in the state — something Soto attributes not to vaccine resistance but to a lack of adequate opportunities to learn about the vaccines and to get the shot.
“We need to get out there and hustle vaccines,” she said. “I really feel like we have not done a good job of being where we need to be.”
Now, though, state and local health officials have begun to transition away from their emergency management-style approach to COVID, closing community vaccination and testing sites and moving those services into the traditional health care system — the very place where Soto has seen it can be so difficult for many Latino families to access treatment. She fears her community, already hard hit during COVID, is again about to be left behind.
“Everybody’s done,” she said of the attitude she sees from the state’s leaders toward COVID. “They don’t want to talk about it.”
And, to that, she has a message: “I say, ‘Yeah, your people are done, but not mine.’”
By official numbers, Colorado has done a dismal job of getting its Latino residents vaccinated.
According to figures from the Colorado Department of Public Health and Environment, only about 39% of the state’s Hispanic population has received at least one dose of a coronavirus vaccine. For the state’s white population, the rate is roughly the same as for the state as a whole — 77%.
A recent Kaiser Family Foundation analysis placed Colorado’s Hispanic vaccination rate slightly higher, at 42%. But, even then, Colorado’s rate ranks second-lowest in the nation, tied with Idaho and ahead of only South Dakota.
Colorado also has the second-greatest disparity between white and Hispanic vaccination rates in the analysis: 37 percentage points.
All of this is occurring in a state where health officials have talked about prioritizing equity since the very beginning of the vaccination campaign, with Spanish-language ad campaigns and mobile vaccination buses traveling to community sites such as schools, libraries and community centers. Even to those who study racial disparities in health care, it is unclear why Colorado has done so poorly.
“We’re trying to understand why our state is performing so much worse, especially given everything we’ve done,” said Alexandra Kellogg, the manager of the Tri-County Health Department’s partnerships and strategies program, which works with Soto on many of her clinics.
Part of the disparity may be a data illusion, the state has argued. It’s possible that Latino residents may be less likely to report their race and ethnicity than other populations. CDPHE has done statistical modeling to try to estimate the true vaccination rates. But even then, the rate among Latinos is slightly less than 48%, while the rate among whites rises to 82% — a gap that remains the nation’s second-largest by some distance.
“The signal is we have a disparity,” said Dr. Lisa DeCamp, an associate professor of pediatrics at the University of Colorado School of Medicine who is also a faculty member at the Colorado School of Public Health’s Latino Research and Policy Center. “Maybe it’s a little narrower than we’re seeing. But the disparity still exists.”
To Soto, though, the reason for the disparity seems obvious: Colorado has not made enough of a commitment to understanding the Latino community and going to places that would make vaccination most convenient. So that is how she started visiting churches across the Denver metro area and Colorado Springs, first convincing the priests to host vaccine clinics, then persuading the parishioners to attend.
She is not bashful in her pitch. Her clinics offer incentives — often masks and COVID test kits; sometimes gift cards. She has tried to woo young women to the clinics by describing how handsome the doctor on hand to answer questions is. There’s food. Maybe music.
Soto is a naturalized U.S. citizen with a master’s degree in public health. She freely shares her personal story with people at her clinics — how she was born in Mexico and first crossed the border into the country in the trunk of a car, speaking no English. She can relate to anyone in the community, she says. She calls everyone she sees, affectionately, mija or mijo.
“Everyone is my family here,” she said. “That’s how you have to treat people.”
“This is a vaccine party.”
And, sometimes, it literally is. She has held clinics at the Stampede, a nightclub in Aurora. One last week took place at La Plaza Colorado, a large marketplace and event space.
She tosses out an idea for a clinic at a Hooters. “Hot wings and vaccines, let’s do it,” she says. Or what about a vaccine car wash? Or at a wheel and tire shop?
“Public health shouldn’t be shameful,” she said. “We should go to where we need to go.”
On a recent Sunday, Soto was at a clinic at St. Pius X Catholic Church in Aurora, just blocks from the Anschutz Medical Campus.
The clinic was supposed to open at 10 a.m., to coincide with the first Mass of the day letting out. But by 9:20 a.m. there was already a line so they opened early. Don’t tell her there isn’t a demand for vaccines in the Latino community, Soto said.
The clinic, in partnership with Tri-County Health, vaccinated about 200 people that day, many receiving their first or second doses. There were cheers every time a child received their first shot. Soto made sure pregnant women and seniors could cut the line. She told clinic workers not to give anyone a hard time about missing vaccine cards from earlier doses. No IDs required. Remember to be friendly and smile.
“I tell everyone they are bilingual, even if they don’t speak Spanish,” Soto said. “You speak English and you speak heart.”
A week earlier, one of her clinics had vaccinated about 150 people during a snowstorm in Colorado Springs. Her clinic on Ash Wednesday ran for more than seven hours, during which time she spoke at eight different masses.
But the work for them begins far before that. Soto said that in the week before her church clinics, she will spend days walking through the surrounding neighborhoods, knocking on people’s doors to let them know about it or leaving fliers at apartment buildings. She visits Latino grocery stores, and bangs on the back doors of restaurant kitchens.
When Sunday comes, she arrives with an SUV packed full with boxes of COVID test kits to hand out. She makes sure to sit at the very front of the church, to show the priest her respect and reverence.
The priest at St. Pius X had been particularly difficult to win over because he was worried too much talk about vaccines in his church would alienate some parishioners, she said. It took six months before he agreed to host a clinic.
On that Sunday, Soto listened intently to his words during the sermon, about loving your friends and enemies, and planned how she could incorporate them into her own speech. When it was her turn, she closed her pitch to attend the clinic set up in the parking lot outside by telling the congregation: “So, invite your friends — and also your enemies.” The church erupted in laughter.
One reason why it is so vital to have people who understand the Latino community doing vaccine outreach is because there are so many barriers for the community, said DeCamp, the CU-Anschutz professor. The disparity in vaccination rate is really just a reflection of all sorts of socioeconomic barriers to access.
People in the Latino community disproportionately hold jobs that may make it difficult to get time off to get vaccinated, DeCamp said. Or they may not be able to take sick time to miss work if the vaccine causes a severe side effect. The state has rules to allow for both — but knowing about those rules and actually being able to take advantage of them is another matter, especially if you don’t speak English.
Nationally, people who are Latino or Hispanic are less likely to be able to work from home and less likely to have flexible work schedules, according to the federal Bureau of Labor Statistics. The same is true in Colorado, where a 2020 report from economists at Colorado State University found that more than half of Hispanic men and women in the state held jobs with low work-from-home potential, while more than half of white men and women held jobs with at least moderate work-from-home potential.
In Colorado, polling has shown that the pandemic has battered Latino families. One poll found that 60% of Latino families saw their work hours or pay cut during the pandemic, while 50% had trouble paying rent or mortgage. Another poll found that Latinos are more likely than any other racial or ethnic group to say that the cost of living is a very serious problem in Colorado.
“The economic precarity that families may be in may be a real disincentive to vaccination,” DeCamp said.
The barriers go beyond economics. Immigrants living in the country without authorization may fear that getting vaccinated will bring them to the attention of immigration agents — though the state has ordered providers not to require identification to receive a vaccine. Hispanic Coloradans are more likely than whites to report being treated poorly by the health care system. And language barriers can also present a problem.
“We need to have a change in our system so they feel welcome to receive care,” said Rich McLean, a board member with the Aurora Health Alliance who has worked with Soto for years to improve health equity in the city.
This need for highly specialized engagement to reach underserved populations is getting public health leaders’ attention. Kellogg, with Tri-County Health, said her department, seeing Soto’s success, has begun to send its own community advocates out into neighborhoods in advance of vaccine clinics. Previously, they would have only been at the clinic, to answer questions. The department has also hired a communications specialist who is a native Spanish speaker.
“We’re really looking internally at how can we get more staff in the community, having face-to-face conversations,” Kellogg said.
Hovering over these discussions is a concern about how long special equity clinics — like the ones Soto organizes — will be able to continue as the state and nation scale back their COVID responses.
CDPHE has vowed to continue providing funding for the equity clinics.
“We’re certainly not moving on,” said Scott Bookman, the incident commander for the state’s COVID-19 health response.
The clinics are primarily funded through federal money, which is expected to last at least through June. But it’s unclear how much more funding might be coming to the state after that. Without the money to fund the clinics and other efforts, experts fear COVID may have an especially disparate toll in the future.
“That’s the concern, that (the Latino community) could continue to have the long, slow suffering that goes under the radar because we don’t have the necessary funding to lose these gaps,” DeCamp said.
Soto says her work on the vaccine clinics is exhausting.
She puts in 50 to 70 hours a week even before the clinic starts, she said. She puts hundreds of miles a week on her car and misses time with her children and grandchildren. She’s received criticism and insults.
“I always get the heat,” she said. “I get the anti-vaccination. I get the anti-immigrant. I get anti- everything.”
But she says she’s not burnt out, not even after more than a year of nonstop work promoting the vaccine. She can’t be.
As she buzzed energetically prior to the start of her Ash Wednesday clinic at Church of the Ascension, doing last-minute checks and joking with clinic staff, she thought about the toll of the job.
“Sometimes, I get sad and I wonder how the hell I got into this,” she said, catching herself.
“Here I am, at church, and I’m cursing.”
Her mind returned to her point.
“But I have gone too far to go back.”
Moments later, just before the clinic opened, she gathered with the clinic workers and held out her hands for a prayer.
“All of us are brothers and sisters today,” she said. “We are going to work together to save lives.”
And with that, the prayer ended, as it needed to. A family had already lined up to get vaccines for their children.
The Spanish-language version of this article was translated by Alejandra X. Castañeda, who also edited both the English and Spanish-language versions.
