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Conspiracy Theories Aren’t the Only Thing Holding Back US Vaccination Efforts

Structural barriers are at play. If we want more people vaccinated, we must give guaranteed sick leave to all workers.

A sign points to a COVID-19 vaccination clinic offering the Pfizer vaccine to anyone over the age of 12 who wants it, at Crenshaw High School in the predominantly Latinx and Black neighborhood of South Los Angeles, on July 8, 2021. The clinic was empty except for the staff working there.

Part of the Series

When it comes to resistance to receiving the COVID vaccine, you’ve probably heard about the conspiracy theories — the wild assertions that vaccines contain microchip tracking devices, that they can alter your DNA, that they can “shed” or spread from person to person, or even the claim by some that the vaccine makes you magnetic. Much of the discourse around vaccine hesitancy is centered around these bogus conspiracy theories, and as a result, they’ve often been discussed in connection with the U.S. failure to meet the Biden administration’s goal of vaccinating 70 percent of American adults by July 4. But there’s a much less discussed factor when it comes to vaccine hesitancy — and it has nothing to do with conspiracies.

Many socioeconomic barriers and structural injustices are still impeding vaccination in a variety of communities across the country, particularly in marginalized communities.

“When we look at the barriers that could be considered structural or access barriers, the most common one that we hear from people does relate to work — and that is the concern about having to take time off of work, specifically due to side effects,” Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation, told Truthout. “We also find concerns around needing to provide documentation. So, about a third of people who haven’t been vaccinated say that they’re concerned they might have to provide a Social Security number or a government-issued I.D. in order to get the vaccine.”

Although many vaccination sites are required to request Social Security information for the purpose of charging administrative fees to insurance companies or the federal government, providing this information is not an official requirement for vaccine eligibility. However, there is still quite a bit of confusion around the ID requirement, which is exacerbated by the fact that these requirements can vary from county to county — with many requiring some form of photo ID (not necessarily government issued). So, although the Centers for Disease Control and Prevention has stated that vaccines are available to anyone — including undocumented immigrants — there needs to be more information available to these communities (and those serving them) detailing specific requirements when it comes to providing identification.

Another compounding factor in vaccine hesitancy among certain marginalized communities — particularly Black and Latinx communities — is a concern about being able to get the vaccine from a place they trust.

“There’s already a lot of fear and mistrust out there, but on top of that, you add these structural barriers and it adds another layer,” Olveen Carrasquillo, chief of general internal medicine at the University of Miami, told Truthout. “People fear that they may be arrested by immigration officers, that they’re going to be charged a lot of money, that they are going to somehow owe this debt from being vaccinated, that it’s going to somehow be charged against them if they try to apply for immigration status.”

Carrasquillo and his team have been working hard to break down many of these informational and structural barriers. They’ve found that working with local and trusted community leaders is helpful in reaching marginalized groups who have yet to be vaccinated. One of these initiatives is the Community Engaged Alliance Against COVID Disparities, which is sponsored by the National Institutes of Health. Carrasquillo is part of the Florida component of this program, which is a statewide coalition of academics and community members, which, according to Carrasquillo, is trying to increase the vaccine uptake in marginalized communities.

“One of the biggest challenges is making sure the vaccine is available when people are not working, because not all employers will provide people with paid time off to do this — they have to lose a day of work, lose a day of pay,” he said. “Strategies like offering vaccination to people who work in what we call the ‘after hours,’ either evenings and weekends, is critically important.”

The Alliance that Carrasquillo is a part of, in Florida, has been able to bring in state workers to administer vaccines in immigrant communities and communities of color during events at which speakers like him provide information to community members to assuage their fears and mistrust.

“Combining the fact that we made it very convenient right there at their workplace so they can get the vaccine and at the same time there’s somebody addressing their concerns or fears — that was a win. Those are the kind of community-based strategies that really help,” Carrasquillo said.

However, even the best vaccine access doesn’t address another concern many workers face: the prospect of missing work (and even losing a job) thanks to potential vaccine side effects. Around 24 percent of Americans don’t have access to paid sick leave, and because employers are not required by law to provide this leave, despite being in the middle of a devastating pandemic, concerns about side effects impacting work ability have become a significant factor which can help to explain why the vaccine rollout has begun to slow down. It should be noted that many people don’t experience side effects from the vaccine, and among those who do, often these side effects only last up to a day. However, for folks with little job security, even a day of missed work can be a significant concern.

As with many aspects of COVID’s impacts, from infection and death rates to the availability of testing, barriers to vaccination fall squarely along race and class lines. The same Kaiser Family Foundation poll found that information and access barriers disproportionately impact Black and Latinx adults.

“What we’re seeing is that these populations don’t have the flexibility in terms of their current employment or having child care to take care of their kids so they can get vaccinated — and so there are barriers that these populations face with their vaccine access,” Ashley Kirzinger, associate director for the public opinion and survey research team of the Kaiser Family Foundation, told Truthout. “These are not the people that are adamant that they’re not going to get vaccinated. They just need some assistance — whether it’s in terms of time off from their employer or making it part of a routine medical visit, or whatever it may be.”

There are a number of initiatives being proposed by policy makers which recognize the reality of structural and work-related barriers when it comes to vaccine access. On the federal level, the Biden administration has announced a business tax credit that would offset the cost for employers with fewer than 500 employees to provide full pay whenever employees need to get a COVID-19 vaccination or recover from that vaccination.

States have also begun to focus on sick leave–related barriers to vaccination. For example, the state of New Jersey has proposed a bill which would provide retroactive sick leave for workers who had to miss work after taking days off because of vaccine side effects or quarantining due to COVID. The bill would require employers to cover two weeks of sick leave if an employee can’t come to work because they are quarantining, experiencing COVID symptoms, awaiting a test result, or caring for a sick family member or child.

Other states already have similar policies in place. California’s COVID-19 supplemental paid sick leave law went into effect in March and mandates that all California employers with more than 25 employees provide more paid sick leave and add more qualifying reasons for leave, such as attending an appointment to receive a COVID-19 vaccine or experiencing symptoms related to the vaccine itself. Although temporary, policies such as these are an important first step in addressing the vaccine barriers faced by many workers.

All this is not to say that there aren’t individuals out there who aren’t adamantly opposed to the vaccine regardless of any structural barriers. According to Kirzinger, these individuals comprise roughly 15 percent of those polled and tend to be largely Republican and white Evangelicals, often citing ideological or conspiratorial reasons. However, focusing our attention on the structural barriers faced by those who are open to being vaccinated could bring up the number of vaccinations in the U.S.

Further, focusing on the informational and structural barriers — particularly the concerns around sick leave from work and out-of-pocket costs — forces us to begin asking larger questions. COVID has, in so many ways, revealed the inadequacies and shortcomings of the way we organize a wide variety of institutions in the U.S., from health care to social services and much more. Vaccine access is just another issue on top of a long list of issues that have starkly exposed the structural racism and classism that permeate every aspect of our society.

“COVID is just a symptom, right? The fact that COVID disproportionately affected our communities and the fact that the COVID vaccine uptake was low in our communities — those are symptoms that were based on these underlying structural determinants of health that put us at risk,” Carrasquillo said. “Every time we have a major disaster or a major disease outbreak, it disproportionately hits the same communities. At some point, we have to ask why it is that COVID disproportionately impacts the most vulnerable.”

There are a number of ways to begin answering that question, but it’s hard to imagine an answer that doesn’t include a fundamental critique of our current economic system. The fact that health care is a for-profit industry and that paid sick leave is not guaranteed in this country are major systemic barriers to vaccine access and overall health outcomes in general. Free vaccines and policies attempting to address issues around sick leave are important, but are limited and temporary solutions. Advocates emphasize that more is needed to address the chronic, structural barriers to health in this country.

“The structural racism and the structural inequalities that result from these policies are key things,” Carrasquillo said. “These are things that doctors themselves won’t be able to address — they require more upstream interventions.”

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