Months into the COVID-19 vaccination rollout in California, groups of people who seem to have little in common continue to lag in getting their shots.

Only about 35% of Latinx and 36% of Black residents are at least partially vaccinated, according to a Los Angeles Times analysis of data from the California Department of Public Health. Vaccination rates are far higher among White, Native American, and Asian American / Pacific Islander residents. Fifty-two percent of White Californians are at least partially vaccinated, as are 49% of Native American and 63% of Asian American / Pacific Islander residents.

Yet Black and Latinx people aren’t the only groups of Californians who are lagging in vaccination rates. The predominantly Republican and White population of rural Lassen County, for instance, has the lowest vaccination rate in the state, with only 21% of residents 16 and older fully vaccinated.

Compare this to Alpine County, which also has a rural and predominantly White populace. Alpine’s vaccination rate is more than three times higher (69%) — and skews Democratic, reports Ana Ibarra at CalMatters.

Data from a KFF survey, which was conducted in April and released in May, suggest a possible unifying theory of why these groups are hesitant. “Many unvaccinated Republicans and minorities have something in common,” David Leonhardt noted in the New York Times. “They are working class. And there is a huge class gap in vaccination behavior.”

“We Overstated the Hesitancy Issue”

Republican voters and Black and Latinx Americans have lagged behind other groups when it comes to vaccinations, and this trend is continuing, according to KFF. Within every racial and ethnic group surveyed, working-class people are less likely to be vaccinated and more likely to be skeptical of vaccinations, Leonhardt reported. He considered “those same groups subdivided by class, using a four-year college degree as the dividing line between working class and professional.” Among White people, 51% without a college degree have been vaccinated compared to 76% of those with a college degree. Forty-three percent of Black people without a degree have been vaccinated, compared to 78% of Black people with a college education. Among Latinx people, 61% of those with a college degree have been vaccinated compared to 45% of those without a degree.

The KFF analysis compared White, Black, and Latinx people. While Asian Americans weren’t included in the survey, earlier KFF research has shown that Asian Americans have higher average incomes than White, Black, and Latinx people and higher vaccination rates as well.

“No matter which of these groups we looked at, we see an education divide,” Mollyann Brodie, executive director of KFF’s Public Opinion and Survey Research Program, told Leonhardt.

The vaccination process remains time-consuming and includes finding a place to get the shot, at a time compatible with work schedules, and the possible need for time off from work to cope with side effects. For the Moderna and Pfizer vaccines, this process must be repeated for a second shot.

The KFF survey findings were similar to those of a recent Morning Consult poll, which found that working-class people were less likely to get shots. Such data are causing experts to reconsider the motivations of the unvaccinated. “We overstated the hesitancy issue,” Georges C. Benjamin, MD, executive director of the American Public Health Association, told Morning Consult. “It’s still important, but we overstated it and understated the structural access issues.”

Economic Factors Keep Latinx from Shots

The KFF survey also revealed a key insight into lower rates of vaccination among Latinx people. Among those who aren’t vaccinated, 33% said “they’d like to get vaccinated as soon as possible.”

“There definitely is a large chunk of the Hispanic population that’s eager to get it, but they just have either not been able to fit it into their schedule, or they have some concerns or questions, or they haven’t been able to access it,” Liz Hamel, vice president and director of Public Opinion and Survey Research at KFF, told Anna Almendrala at California Healthline.

The reasons for Latinx lagging other groups are largely, though not exclusively, economic, Almendrala noted. Among those who haven’t been vaccinated, 64% were worried about missing work because of side effects, and 52% mistakenly thought they’d have to pay for the shots. COVID-19 vaccinations are free.

“It’s hard for somebody who lives day-to-day to take off half a day to come to a clinic and try to get a vaccination,” José Pérez, MD, chief medical officer of the South Central Family Health Center, a Federally Qualified Health Center in South Los Angeles, told Almendrala. “If they don’t work that day, they don’t earn a living, and they don’t eat.”

Lack of health insurance and connection to the health care system also keep Latinx people — and men in particular — from getting shots. “Latinx men are often heads of households, working multiple jobs to support their families. They don’t have time to get vaccinated or to vet the information they come across,” reporter Alejandra Reyes-Velarde wrote in the Los Angeles Times.

Vaccine Misinformation Is Also an Economic Issue

These economic factors explain why working-class people may have little time to investigate rumors that circulate on social media. “The main culprits are Facebook, WhatsApp, and YouTube pages in both Spanish and English filled with conspiracy theories, alarmist news coverage or chismes — gossip — about vaccines causing problems,” noted Reyes-Velarde.

For people working several jobs, “a lot of the double-checking just doesn’t happen. It’s a really bad combination,” Ilan Shapiro, MD, medical director of health, education, and wellness for Southern California’s AltaMed, one of the largest community health networks in the US, told Reyes-Velarde.

Misinformation feeds vaccine hesitancy, the KFF survey found. Fifty-four percent of Americans believe “common misinformation” about coronavirus vaccines, including fears about a “rushed” approval process, potential effects on fertility, and yet-to-be-discovered side effects. Major medical societies have debunked these fears, “but so far, that evidence is not translating to overwhelming public confidence,” Paul Sisson reported for the San Diego Union-Tribune.

The illness and death that occurs in coming months is likely to aggravate the country’s already extreme inequality.

—David Leonhardt, New York Times

Ron Nehring, a prominent California Republican, told the Sacramento Bee that the antivaccine movement is using skepticism of big government, a key component of conservative ideology, to spread vaccine misinformation among GOP voters. “What we find very often is that in disinformation campaigns and active measures campaigns, the effort is to hack into the existing biases and beliefs of the target audience,” Nehring told the Bee.

Mistrust of the vaccines and their manufacturers, including what some perceive as a “rushed” approval process, also influence unwillingness to be vaccinated.

The Morning Consult survey found that Black respondents were twice as likely as White ones to be suspicious of the vaccine makers. Outreach to Black communities started in April in California, including public service ads featuring California surgeon general Nadine Burke Harris. Yet vaccinations rates continue to lag, and in Los Angeles, Black people now have the highest rates of infection of any racial or ethnic group in the city.

Republican strategist Frank Luntz conducted focus groups with conservative Republican voters in March. Some participants said the vaccines were “rushed” and “experimental” and viewed public health messages about COVID-19 as “government manipulation,” Annie Karni and Zolan Kanno-Youngs reported in the New York Times in March.

Thirty-five percent of Republicans surveyed by Morning Consult who identified as hesitant to get the shot still cited concern about the speed of the approval process as their reason.

Knocking on Doors

A sophisticated understanding of barriers to vaccination is crucial to ending COVID-19, and then, Mollyann Brodie told Leonhardt, “we’ve just got to remove all the barriers.”

One strategy to reach California’s yet-to-be-vaccinated residents is to bring the shots directly to the community. In Sonoma County, that means volunteers like Mayra Arreguin spend their time knocking on doors and staffing food banks to reach the people who need shots but haven’t gotten them. She recently spent five days trying to fill 100 slots for vaccinations. After countless conversations, she signed up 60 people willing to make an appointment.

Public health campaigns targeted at specific communities also remain crucial. In Los Angeles, for instance, Shapiro is part of a #VacunateYa, a social media campaign encouraging Latinx community members to get their shots. The Conversation / La Conversación, supported by CHCF, is a video campaign in which trusted figures, including doctors and others who promote public health, address common concerns about the vaccines and encourage more people to get their COVID-19 shots.

California Republicans, including Nehring, Assemblyman Jordan Cunningham and state GOP chairwoman Jessica Millan Patterson have all encouraged other Republicans to get their shots, Gil Duran noted in the Sacramento Bee.

While the pandemic is waning in California, it’s not over yet, and it will continue to disproportionately affect those who lack easy access to the vaccine or who fall prey to vaccine propaganda and rumors. “The illness and death that occurs in coming months,” Leonhardt writes, “is likely to aggravate the country’s already extreme inequality.”

To send questions or comments, tweet at me with #EssentialCoverage or email me.

Heather Tirado Gilligan

Heather Tirado Gilligan is a journalist who has written for publications including Slate, The Nation, CNN, and the Washington Post. Previously, she was executive editor of the California Health Report, a news nonprofit covering disparities in health and access to health care. Heather received a master’s degree in journalism from UC Berkeley and a PhD in English from Rutgers University, where she studied race in American culture.

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