Oralia Miranda takes great care to stay healthy and limit her risk of exposure to COVID-19.
The 70-year-old who has a history of being immunocompromised rarely leaves her South Tucson apartment except for doctor’s appointments and lab visits.
Last Saturday, clad in double masks and a face shield, Miranda was among the first in line to receive a COVID-19 vaccine at a mobile clinic organized by the Pima County Health Department and South Tucson’s Housing Authority.
“It’s a privilege, it’s really good,” Miranda said in Spanish about being able to get the vaccine so close to home. “I feel very comfortable, I can see that everybody is very attentive and it makes me happy, it makes me comfortable and it gives me security.”
For her, the first vaccine dose means she’s one step closer to eventually being able to go places like the grocery store again.
Miranda was among 72 seniors vaccinated that day at the clinic, which was meant for the older residents of the housing authority’s low-income apartment complexes and Section 8 properties.
The event was the second mobile clinic coordinated by the county Health Department to reach underserved communities in an effort to provide more equitable access to the vaccine. Of those vaccinated at the clinic, 78% were Hispanic, according to a county memo. The Health Department hosted three other clinics this weekend in communities with largely Black and Latino residents.
“As we have more vaccines, we are hopefully going to see a lot more distribution to our vulnerable disadvantaged populations,” said Dr. Theresa Cullen, Pima County’s public-health director. “We use a rubric to determine where we will offer a mobile (clinic) and then we work closely with a community group in that area to get the word out to those community members.”
Data from the Arizona Department of Health Services, while incomplete, shows white residents in Pima County have received the lion’s share of vaccine doses — a trend that is apparent statewide.
Of the 173,783 people in Pima County to receive their first vaccine, only about 14% are Latinos, even though this group makes up about 38% of the county’s population. In addition, 2.4% are Native American, 1.5% are Asian, 1.1% are African American, and 0.4% are Native Hawaiian or other Pacific Islander. The race of nearly 40% of people who have received a vaccine is unknown, however.
Statewide, nearly 50% of the 1.1 million first doses have gone to white residents, 8% to Hispanics, 3% to Native Americans, 2.3% to Asians, 1.5% to African Americans and 0.2% to Native Hawaiians or Pacific Islanders. The race of close to 36% of those vaccinated is unknown.
While Pima County is faring slightly better than the state in getting the vaccine to seniors of color, there’s still more work to be done.
“In terms of the racial/ethnic distribution of the folks who are getting vaccines, even though it does not quite reflect the racial/ethnic distribution of this community we are doing pretty darn good, especially when we compare ourselves to the state PODs (point of distribution sites), especially when we compare ourselves to some of our sister counties, I think we do very well,” Dr. Francisco Garcia, the county’s chief medical officer, said in a recent news conference. “Again we can do better; this is not nearly good enough.”
In Pima County, the highest number of vaccinations have been distributed to the 85718 ZIP code in the northern part of Tucson near the Catalina Foothills. Over 10,000 vaccines have been given to residents of this ZIP code so far, where there’s been 1,754 COVID-19 cases and 37 deaths recorded as of Friday. At the same time, the ZIP code with the highest case count — 85706, on Tucson’s south side — has received only 4,300 vaccines, where there’s been 10,250 cases and 160 deaths.
When compared to 85706, the north-side ZIP code does have a higher percentage of residents over the age of 65, which could explain its higher vaccination rate. However, the south-side ZIP code has a nearly 18% infection rate in a population where 90% of people belong to a minority community. This is compared to a 6% infection rate for 85718 with an estimated minority population of 25%, according to census tract data.
“When I think about where they were concentrating the vaccinations initially I thought why wouldn’t they go to where the hot spots were initially? Isn’t that where you would want to go?” says Betty Villegas, executive director of the South Tucson Housing Authority and former interim Pima County District 5 supervisor. “You know that’s where people are still having to go to work, you know that’s where people are still the most vulnerable, so why wouldn’t you plan to address the most vulnerable people first?”
Barriers to access
Lack of access to technology and transportation are among the biggest barriers to vaccine access for the communities of color. Language barriers and vaccine hesitancy are also factors.
Seniors who don’t have a computer or internet can’t even attempt to schedule an appointment online and often have to rely on relatives or friends, if they can, to help register for a vaccine. Registration assistance hotlines are available, but wait times, which vary and can be an hour or more, are a source of frustration for many.
For those who don’t drive or have a vehicle, getting to one of the mostly drive-thru vaccination PODs poses a second challenge.
At the recent mobile clinic, seniors simply had to show up, which for many meant walking across the street or just a few blocks, filling out a paper registration form and staying for a 15-minute observation period after receiving their shot.
A couple of residents who attended the mobile clinic said they were able to schedule appointments at different vaccination sites several weeks out after waiting on the phone for a long time or having help from someone, but having the clinic in their neighborhood was more convenient to get to. And for several who have other health conditions that make them more vulnerable to the virus, it meant they could be vaccinated more quickly.
Miranda was accompanied to the clinic by her husband, Jose Miranda. Although they are separated, he drives her to her doctor’s appointments and brings her groceries.
“I still drive and everything, but people who can’t go anywhere by themselves, how are they going to get the vaccine?” he said.
The ease of getting vaccinated at the mobile clinic was a contrast to 75-year-old Jose Miranda’s own experience trying to register for a vaccine. He doesn’t have the internet so he asked his son to help him get an appointment. Jose Miranda says his son tried for hours to get help registering over the phone, but nobody answered.
“At (Oralia’s) last doctor’s appointment I told the nurse, ‘I don’t know how I’m going to do it, I don’t use the internet.’ It’s a big problem,” he says. That was a few weeks ago when vaccine registration was available only to people 75 and older. The doctor was able to help Jose Miranda make an appointment at the University of Arizona.
“The problem is that people who are her age or who are older, if they don’t have a computer or don’t know how to use it, how are they supposed to get the vaccine?” he said.
Villegas, of the housing authority, helped advocate for the mobile clinic.
“When I came to this job I saw where all the vaccination events were, and then I looked at my new community I was working in and I realized I have two buildings with seniors, many over 75 and over 65, that don’t have access. They don’t have people that can take them and they don’t know how to make appointments,” she says. “It was really good when Dr. Cullen saw that there is a need for the mobile units here in these hard-to-reach communities because you have to come to them.”
District 5 Supervisor Adelita Grijalva agreed, saying mobile clinics help take the confusion and hurdles out of the vaccination process. Rather than having to navigate the online registration process and face potential transportation issues, the mobile clinics focus on word-of-mouth communication through community partners that residents trust.
The housing authority’s staff made phone calls to its residents to gauge how many people would like to be vaccinated and also left paper flyers on everyone’s doors to remind them about the clinic.
“It’s that peer-to-peer, doctor-to-patient kind of relationship that really helps inform decisions,” Grijalva said. “Those relationships with smaller organizations and churches is how these communities are going to be vaccinated. Because it’s people that they trust.”
Leading up to the county’s first mobile clinic at St. John’s Evangelist Church, Grijalva said her best friend’s dad was going door to door telling people about the event. Over 500 people were vaccinated that day, the majority of whom were elderly, Hispanic and Spanish speakers.
The unique challenges that face minority communities are not new, however. For Tucson Mayor Regina Romero, the pandemic has only emphasized the hardships that disadvantaged communities have faced throughout history.
“We’ve always known that access to health care, access to reliable transportation, access to Wi-Fi and the internet have long existed for communities of color, but the pandemic has exacerbated and highlighted those issues,” she said. “These are also the communities that have had the highest rates of infection during the pandemic.”
Impact of COVID-19 by the numbers
In addition to age, race and ethnicity can be additional risk factors for severe illness associated with COVID-19. According to public-health officials, long-standing systemic and social inequities put many people from minority groups at an increased risk for hospitalization and death from the virus. While seniors of color tend to have increased rates of chronic diseases and underlying conditions, they also tend to live in areas with higher rates of poverty compared to white seniors.
“The COVID-19 mortality rate is highly influenced by race and ethnicity, so we know we need to target certain areas based on that,” Cullen said. “We also know that high social vulnerability may also mean low immunization rates. What we’re trying to do is get in those areas where, for multiple reasons, people have not been able to get the vaccine.”
In Pima County, there are approximately 212,000 people over the age of 65, 76.4% non-Hispanic white, 17.5% Hispanic or Latino, 2.2% Black, 2% Native American and 2.2% Asian.
While they only account for 20% of the population, older adults make up 80% of COVID-19 related deaths and 47% of hospitalizations. Over 2,200 county residents have died from the virus since the pandemic began.
The disproportionate impact of COVID-19 on minority communities is clear in local census tract and ZIP code data. In Pima County, the ZIP codes with the highest number of virus-related deaths also have some of the highest social vulnerability scores, as indicated by the Centers for Disease Control and Prevention.
The CDC’s Social Vulnerability Index helps public-health officials and emergency-response planners identify and map the communities that will most likely need support before, during and after a hazardous event. The index ranks the relative vulnerability of every U.S. census tract, as well as by county, and is based on factors such as socioeconomic status, minority status, language, housing and transportation.
Pima County’s overall social vulnerability score is 0.8717 — on a scale from 0 to 1 — indicating a high level of vulnerability. These scores are also given to each of the county’s 241 census tracts.
One of the highest social vulnerability scores in the county — 0.9927 — belongs to the census tract of South Tucson. According to the index, there are approximately 5,600 people living in this census tract, an estimated 700 of whom are over the age of 65. Nearly 90% of the residents living in the census tract belong to a minority, over 40% are living below the poverty line and an estimated 13% “speak English less than well.” In addition, an estimated 30% of households in this area do not have access to a vehicle.
In this case, high social vulnerability certainly correlates with a high number of COVID-19 cases and deaths. The county ZIP code with the highest number of virus-related deaths is 85713, which includes South Tucson. There have been over 7,000 cases and nearly 200 deaths associated with this ZIP code alone.
By using this social vulnerability data, county officials can target specific communities that may face unique challenges that make them more vulnerable to COVID-19.
Lingering concerns
While county officials continue to develop plans to serve hard-to-reach communities, vaccine availability continues to be an issue throughout the state and will likely continue to have an impact on minority and other underserved communities.
“The reduction in vaccine allocation to our county means that a lot of these pop-up mobile sites that are targeting the people that have been hit the hardest by COVID-19 are going to be delayed or reduced,” Grijalva said. “But that is the demographic that is dying.”
While the state health department continues to focus its efforts on vaccinating as many people as possible through several mass distribution sites, including the University of Arizona, some are concerned that this will continue to take vaccines away from distribution in hard-to-reach communities.
“It has to be very intentional, and that has not been the approach with these huge 24/7 vaccination centers,” Romero said. “Geography and intentional distribution is not part of that model. Even though the University of Arizona is a wonderful partner in the vaccine effort, these sites were not made for marginalized communities and underrepresented communities.”
Cullen said Friday, however, that the county planned to use 10% of its vaccine allocation to meet needs at mobile clinics.
The county also continues to search for new ways to reach vulnerable communities. In addition to mobile units, the county was recently selected as one of only three communities in the nation to partner with Uber to provide transportation services for disadvantaged communities to ensure they have equal access to public-health resources.
“The good news is I know we can make changes and head in the right direction in terms of equity,” Cullen said. “The concerning news is that I know our large PODs and the state PODs can contribute to that inequity. It behooves us, and really requires us, to figure out how to ensure that we are getting vaccine to the population that is most at risk.”
