Washington’s immigrant and refugee elders face challenges in COVID-19 vaccine access

By early December, Trang Tu had quarantined with her mother in their Seattle home for nearly a year, providing round-the-clock supervision for the 90-year-old with advanced dementia that would have been too costly at a nursing facility.

Since caring for elders is a strong cultural value for Tu, a Vietnamese refugee who immigrated to the U.S. in the 1970s, she saw the COVID-19 vaccine as the pair’s only hope for returning to the outside world.

Tu was then alarmed to learn older adults in home care were not prioritized by the state’s December draft vaccine plan. She felt invisible.

“I was reminded really clearly that taking care of our elders in home care is something that for a lot of families of color, refugees and immigrant communities, in particular, is more common,” Tu said.

So she assembled an informal collective of people and organizations that could advocate on behalf of immigrants and refugees to state and local government. It worked: A letter the group sent to officials persuaded the Washington State Department of Health (DOH) to prioritize those over 50 in multigenerational homes who can’t live independently, or are living with and caring for a grandchild.

Still, more than two weeks into the current phase, immigrant and refugee elders continue to face challenges in accessing the vaccine, from language barriers to a lack of transportation and technology, say group members Helping Link and Neighborhood House, two nonprofits that serve immigrant and refugee populations. Their experiences reflect concerns about inequities around the rollout voiced by marginalized communities throughout the state.

How it began

Prior to the pandemic, Tu’s out-of-state siblings would sometimes help care for their mother as her dementia advanced over the past five years. But the visits ended last March to limit COVID-19 exposure. Without the extra help, Tu stopped working as a consultant to care for her mother full time. They’re now surviving off of her savings.

As the pandemic surged outside, Tu watched her mother’s cognitive and physical abilities decline inside of their home. She had to keep a watchful eye on her mother to prevent falls that would require medical care. Tu said it took a toll on her mental and emotional health.

The letter underscoring the racial inequity of the state’s vaccination plan — eventually signed by more than 87 organizations and about 130 individuals — was sent to the governor and DOH on Dec. 29. It requested state funding for community-based health clinics to serve as vaccine clinics for elders.

Paj Nandi, the DOH’s director of community relations and equity, said the letter was ideally timed as they were then engaged in prioritization conversations with the governor’s office.

“The letter confirmed what we heard about prioritizing elders in home-based care settings from community members and leaders during our vaccine engagement process, particularly from BIPOC and other communities disproportionately impacted by COVID-19,” Nandi said.

Still, the vaccine remains inaccessible to many immigrants and refugees with limited English proficiency or limited technology skills, Tu and others said. For instance, PhaseFinder — the DOH’s tool to determine vaccination eligibility — is too difficult for many to navigate.

In mid-January, Tu and her mother received their first doses of the Moderna vaccine after learning at the last minute about a mass vaccination site in Monroe. Now, Tu is uncertain if the short supply will allow them to get their second dose.

A community-wide issue

Minh Đức Pham Nguyễn — executive director of nonprofit Helping Link, which serves immigrant and refugee communities — said her clients are desperate to be vaccinated. A group of Vietnamese elders she serves carpooled to the vaccination clinic in Monroe last month, only to wait for several hours and be turned away when the supply was exhausted.  

“It feels like being treated like a second-class citizen again. People who can’t access the appointment have to be really savvy with technology and they have to know the language,” Nguyễn said. Some of her clients spend several hours weekly searching for vaccine appointments to no avail.

“The state, King County and the city keep saying, ‘We want to reach out to people of color,’ but their action is not reflecting what they’re saying,” she said.

Nguyễn urges public health officials and government leaders to work with community-based organizations to inform the public about the vaccine rollout. Now is a critical time for Asian elders to access the vaccine, she said, as many of her clients want to spend the Lunar New Year with their families after not seeing them throughout the pandemic.

Emy Haruo, a resource manager for the elderly and people with disabilities at nonprofit Neighborhood House, echoed Nguyễn’s concerns about vaccine rollout. The nonprofit offers free housing and rental services, as well as unemployment and job resources to immigrants, refugees and low-income people in Seattle.

Her clients with limited English proficiency have difficulty using PhaseFinder since the tool will not appear in multiple languages until mid-February. Haruo’s team helps clients schedule vaccine appointments, works with them to find transportation and informs them of the vaccine’s possible side effects. They remind clients to visit their primary care doctor for additional medical advice after their appointments.

Janice Deguchi, executive director of Neighborhood House, said she wants public health officials to provide real-time information on vaccination sites and supplies. Organizations that are helping at-risk populations navigate the vaccine process should receive greater support from the state and King County, she said.

Officials need to take equity into consideration so that the most vulnerable people are not left behind, Deguchi said, noting, “The people that are going to be first in line to get the vaccine are going to have the computer literacy, high-speed internet, and English.”

Solutions

In response to calls for equity, DOH plans to use telephone hotlines, mailers, as well as TV and radio ads for outreach and communication, Nandi said. The department is also providing funding to more than 60 community-based media outlets and organizations to expand statewide outreach.  

On Feb. 3, DOH started a collaborative consisting of members from disproportionately impacted communities who will help inform the state’s outreach and vaccine access plans.

The Vaccine Implementation Collaborative will meet bi-monthly with DOH to learn about updates in the state’s COVID-19 vaccine distribution efforts and to get answers to questions from their communities. Members will offer feedback on outreach and rollout efforts through virtual meetings or email and have the option to form workgroups that further address specific concerns around vaccine access. Most of the participants will be unpaid volunteers, although members who take on prominent leadership roles may be compensated.

DOH is working to make PhaseFinder available in the state’s top 36 languages, he added. “This scale of vaccine distribution is one of the most complex logistical hurdles our state and country have ever had to face, especially with limited supply,” Nandi said.

In the meantime, Tu and the collective are brainstorming ways to continue advocating on behalf of vulnerable elders. They’ve discussed calling vaccine sites every day and listing the amount of vaccines available on a publicly accessible document.

As the state moves to quickly distribute the vaccine, Tu said, “It’s really important to do that in a way where people have equal access.”