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How Misinformation, Fear Create 'Vaccination Deserts'

In California’s Central Valley, public health experts have used the desert concept to describe counties with limited access to life-saving inoculations due to a number of factors that create intractable barriers.

(TNS) — Junior Toscano's mom texts him every day, pleading with him to get vaccinated against COVID-19 and giving him lists of clinics where he can get the shot.

But the 29-year-old agricultural worker from Tipton isn't ready.

He knows many people, including his girlfriend, who have fallen ill to the virus. And in the past month alone, two of his friends died from complications related to the disease. Still, he hasn't made vaccination a priority, in part due to the misinformation about the shot he's read online.

"I know it's serious," he said. "But I just haven't done it."

Toscano's concerns are common in some Tulare County communities, where hesitancy and misinformation continue to pose barriers to widespread COVID-19 vaccination. Just 43% of eligible Tulare County residents are fully vaccinated, trailing far behind the statewide average of 63%, according to the most recent data from the California Department of Public Health.

Even in a county with a low overall vaccination rate, communities like Toscano's hometown of Tipton have become "vaccination deserts" — areas where vaccine uptake is especially low. Public health experts have used the concept to describe counties with limited access to life-saving inoculations. But amid the coronavirus pandemic, it's also been used to describe communities that have low vaccination rates, either due to a lack of access or other, more intractable barriers.

Just 31% of those eligible to get the vaccine in Tipton and the surrounding area have been fully vaccinated, according to recent state data analyzed by the Brown Institute for Media Innovation's Documenting COVID-19 project in collaboration with the Central Valley News Collaborative. In Tipton, an unincorporated community in Tulare County, about 38% of the town's 3,238 residents live in poverty and almost all are Latino immigrants and farmworkers.

Low vaccination rates in some Tulare County ZIP codes — including 93272, the one containing Tipton — are especially concerning now, as the dangerous Delta variant surges across the state and country. Tulare County health officials are hoping that many Latino immigrants who have taken a wait-and-see approach over the past four months might now be willing to get a shot, and are trying to make it easier for them to do so.

The Tulare County Health and Human Services Agency has been targeting Tipton, along with the neighboring Citrus Belt communities of Lindsay and Sultana, inviting people to get vaccinated at well-known venues like the Tipton Portuguese Hall, a 100-year-old Catholic banquet space that seats 700, as well as gas stations, family-run pharmacies and local libraries.

Four days a week, workers from the health tech company Color help promote vaccine drives among the hesitant and skeptical. The county is also enlisting the assistance of Vision y Compromiso, a community-based organization that has promotores, or community health workers, in Tulare, Kern and Riverside counties.

But so far, there's proven to be a limit to how effective outreach and incentives can be among those who simply won't take the vaccine — a group that Tiffany Swarthout, Tulare County's public health manager, dubs the "vaccine stubborn."

Over the course of three vaccine events held in Tipton this past May and June, just 10% of the 450 vaccine doses on hand were administered, according to county statistics obtained by Documenting COVID-19 project. A vaccine drive at Tipton's public library last week was particularly dismal. Just eight of more than 100 available doses were administered, and four doses were thrown away at the end of the day, due to lack of interest.

"There's going to be people who aren't going to get vaccinated and that's their right, that's their choice," Swarthout said. "What we're going to do is make sure the access to the vaccine is there for those that want it, and keep coming back every week."

Experts warn that vaccination deserts in one region can affect the community at large. Areas with a high concentration of unvaccinated residents who do not practice social distancing or mask-wearing can create the perfect conditions for the spread of the Delta variant. This could lead to an increase in breakthrough infections and widespread outbreaks, even among vaccinated populations, according to Dr. Paramvir Sidhu, chief clinical officer for the Family Healthcare Network, a federally qualified health center based in Visalia.

Across the country, the highly transmissible Delta variant accounts for 83% of new COVID-19 cases and could lead to a peak of 850 deaths per day by mid-October if vaccination rates don't increase, according to the COVID-19 Forecasting Hub, a research group working with the Centers for Disease Control and Prevention. Unvaccinated individuals make up 97% of hospitalizations due to complications from the virus, according to the most recent data from the CDC.

Already, local Tulare hospitals and clinics have seen a doubling of patients in the past two weeks and, while hospitals have strong supplies of equipment and ventilators, there are widespread shortages of available doctors, nurses and support staff, said Tim Lutz, director of the Tulare County Health and Human Services Agency.

While Tulare's rate of cases hasn't increased as quickly as the state of California's overall, cases have steadily increased throughout July and the seven-day average of new cases has gone up from 900 at the end of June to over 8,000. Genome sequencing shows that the Delta variant is now the primary variant in the county.

"The highest risk are the people who are unvaccinated, so they're at a bigger risk of getting the virus quickly and can have much more severe disease symptoms," Family Healthcare Network's Sidhu said.

Distrust, misinformation contribute to vaccine hesitancy

Community advocates say the county's poorest residents, many of whom lack access to transportation and critical healthcare resources, face particular challenges getting vaccinated.

Residents living in unincorporated areas in the Valley like Tipton are among the poorest in the state, lacking basic necessities such as potable drinking water, sewer systems, safe housing or paved roads and streets.

These residents often live in poor conditions due to decades of disinvestment and deteriorating infrastructure, said Mari Perez-Ruiz, executive director of the Central Valley Empowerment Alliance Services, a grassroots organization that advocates on behalf of the Valley's rural and disadvantaged populations. They also lack political representation from a city council or access to many local resources like a fire department, hospital or a police station.

These conditions can sew distrust in government, she said. During a pandemic, that could explain why many residents in unincorporated areas are more likely to believe misinformation circulating within their communities rather than advice from government officials or public health departments, she said.

"When that system is lacking, it makes it very difficult for communities for communication to flow and it doesn't help with the level of trust," she said. "They have been neglected over and over again, to the point where people learn to rely on themselves."

Vaccination deserts also exist in areas that lack adequate healthcare altogether, said Elizabeth Strater, director of strategic campaigns at United Farm Workers, which has been working to help vaccinate farmworkers in isolated communities.

"The rural healthcare system has been in dire straits for years," she said. "And not just in California. Less densely populated areas just simply do not have the infrastructure."

Federal officials' decision in April to briefly pause use of the one-shot Johnson & Johnson vaccine made low-income farmworkers even more reluctant to get vaccinated, for fear of possible side effects, experts said.

The county has increased its efforts to vaccinate some of its more rural, unincorporated areas through public health outreach campaigns, including mobile clinics and vaccine events aimed at harder-to-reach groups like farmworkers. But those vaccination drives have produced limited success.

"It's surprisingly low on that vaccine uptake," said Lutz of Tulare County's Health and Human Services Agency. "And that one really sticks out at us because we've offered a lot of vaccine opportunities there for weeks at a time."

But it's not just unincorporated communities like Tipton that have emerged as vaccine deserts, according to state data.

Some more populated cities in Tulare County have also lagged in their vaccine rollout. Of the nearly 15,000 people living in the zip code including Lindsay, a city of about 13,300 people that is 87% Latino, nearly 41% have been fully vaccinated.

Demand for vaccines in Lindsay has dwindled, too. After 10 vaccination events between May and July, only 46% of the nearly 1,500 available doses were administered, according to the Documenting COVID-19 project. Between 10% and 30% of available doses were administered at the weekly vaccine events at the Lindsay Farmers Market in July.

Education, outreach needed to fight misinformation

In mid-July, the Bee interviewed five people at the only market in town, the Tipton Food Center, and all of them said they had not been vaccinated. Their stories illustrate why eliminating vaccination deserts will require more than just the implementation of local vaccine clinics.

Alvaro Saucedo, 38, a farmworker and immigrant from Zacatecas, Mexico, fell ill with COVID-19 when the virus first swept through the region last year. Though he recovered, he said he's still hesitant to take the vaccine.

He didn't experience any severe symptoms and would rather risk getting sick again than getting inoculated, he said. He fears he could get an allergic reaction or experience adverse side effects from the vaccine. He said he doesn't intend to get the shot unless an employer or the law mandates he do so.

"The vaccine could have severe long-term side effects," he said in Spanish. "Who's to say that in a couple of years, there won't be reports of people having high blood pressure, or heart problems, or loss of eyesight, or what have you because of the vaccine. I don't trust it."

Janet Pano, 40, a mother of six who lives near Tipton, said many people in the community — herself included — have delayed getting vaccinated due to misinformation. Some, she said, rejected the vaccine after use of the Johnson & Johnson vaccine was paused this spring. Since then, she said she hasn't received or heard a lot of accurate or positive information about the vaccine.

The more people know about the vaccine, the more likely they are to get it, she said.

"There isn't a lot of information about the vaccine," she said in Spanish. "And honestly, I keep forgetting to make an appointment, but I do want to get the vaccine because COVID-19 hasn't gone away."

Zoya Hasan has heard such concerns plenty of times. Hasan is an onsite manager with the healthcare company Color, which works with public health departments to provide free COVID-19 testing and vaccine services across the state.

At a free vaccination clinic in Tipton last month, she told The Bee that misinformation spreads even more rapidly in small towns than in larger, urban areas, contributing to an increase in vaccine hesitancy among community members.

"We're bridging the gap between counties where there's maybe vaccine hesitancy or low vaccine resources," Hasan said. "What I would say it boils down to the most is just a lack of education and a lack of resources. These vaccines are actually very, very, safe, and they've been studied."

Hasan said she understands why so many residents in rural areas who don't have easy access to information or resources about the vaccine may feel hesitant. But she hopes that through additional outreach and education, residents will start to trust in the efficacy of the vaccine.

"We all have a lot of unanswered questions and it's totally okay to be worried or concerned or to not know what's going on," she said. "But if they're willing to ask the questions, then we're willing to answer them and meet them where they're at. And ultimately, the decision is up to them."

She added: "But if we can maybe see the benefit for themselves and their community, maybe we can all move forward and get that vaccination and get those rates up and get everyone back to a little bit more of a safer world."

Caitlin Antonios is a California-based reporter working with the Documenting COVID-19 project at Columbia University's Brown Institute for Media Innovation and is supported, in part, by the L.A. Press Club and the Charles M. Rappleye Investigative Journalism Award. Jake Kincaid and Bianca Fortis worked with the Documenting COVID-19 project at Columbia University.

(c)2021 The Fresno Bee (Fresno, Calif.) Distributed by Tribune Content Agency, LLC.
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