The truck is San Bernardino County’s mobile vaccine unit, which brings covid-19 vaccines directly to people. But on July 15, only 22 people got a covid shot during the four hours it sat there.

Roughly 12 feet away, more people were often seen waiting by a red canopy for free, government-subsidized smartphones, intended for low-income people, than were stepping up for the potentially lifesaving shots.

Barry Luque, a 37-year-old car wash worker who visited the red canopy that day for a free phone, was lured by the truck. He had been but never got around to making an appointment. Had he not seen the truck in the parking lot on his day off, “this wouldn’t have gotten done,” he said.

It’s Luque’s job to guide drivers into the car wash, but his boss won’t let him take his mask off unless he can show proof he’s vaccinated.

“People come in from different lives, different styles, different moods at different times,” he said after getting his first dose of the Pfizer-BioNTech vaccine. “I’ve got to guide them carefully and gently, and it’s kinda hard for them to see the smile on my face.”

Luque and the other 21 people who got vaccinated that day — in addition to the scores of others who drove by or waited in the McDonald’s drive-thru line without seeking a shot — offer a snapshot of California’s stalling vaccination effort.

Some who finally got the shot, like Luque, were motivated by mandates from employers or are tired of wearing masks. Others want to visit other countries, and vaccinations travel or quarantine requirements. Some were persuaded, at long last, by family and friends.

Those who continued to hold out primarily cited potential side effects and distrust of the medical system.

Recent polling shows that no matter which tactics are used, a are unlikely to budge on getting a shot, creating an increasingly dangerous scenario as the highly contagious delta variant . In California, about 2,800 people were hospitalized for covid or suspected covid — more than twice the number six weeks earlier — as of Wednesday.

About were fully vaccinated by then, according to the U.S. Centers for Disease Control and Prevention, ranking the state 18th among other states and the District of Columbia.

But the overall rate masks deep disparities among, and even within, regions. In geographically and ethnically diverse San Bernardino County, of eligible residents were fully vaccinated as of Wednesday, with the lowest rates among young people, men, Latinos, Blacks and those who live in the poorest and unhealthiest communities. Statewide, the profile of unvaccinated people is largely the same.

One way local and state leaders are trying to get shots into residents’ arms is by hosting pop-up clinics that make covid vaccines more convenient and accessible for those who can’t or won’t sign up for an appointment.

San Bernardino County is at supermarkets, schools, churches and community centers. The state is also funding vaccine clinics, including 155 events at more than 80 restaurants in 11 counties as of Wednesday.

The pop-ups require significant resources and are showing diminishing returns. About 2,500 doses have been administered at the McDonald’s clinics so far — an average of 16 shots per event. The California Department of Public Health declined to say how much these events cost, saying it varies.

At the McDonald’s in San Bernardino, a city of more than 200,000 that serves as the county seat, eight staffers were on hand to check people in, administer shots and watch for side effects from 9 a.m. to 1 p.m. They also scheduled the necessary second dose for another local pop-up event.

Jeisel Estabillo, 36, hadn’t been vaccinated, even though she is a registered nurse who sometimes cares for covid patients at a hospital. She was one of the first people in the county to become eligible for vaccines, in December, but avoided getting a shot because she wanted to wait and see how it would affect others. She also tested positive for covid during the winter surge.

But Estabillo changed her mind and visited the vaccine clinic with her father and teenage son because they plan to vacation in the Philippines next year and hope vaccination will reduce travel restrictions or quarantines.

Estabillo also likes that vaccinated people can forgo masks in most public places, although that perk may slip away as more California counties respond to the delta surge by to mask up again indoors.

But Jasmine Woodson continued to hold out against the vaccine even though she was hired to provide security and direct traffic for the clinic. Woodson, 24, is studying to become a pharmacy technician and has been tracking vaccine news. She said she was alarmed by the of the one-shot Johnson & Johnson vaccine over concern about blood clots, and reports of rare heart inflammation . She also knows that no covid vaccine has been fully approved by the Food and Drug Administration, which puts her on high alert.

Woodson, who is Black, is also wary because these mobile vaccine events seem to take place only in low-income Black and Latino neighborhoods — a tactic public health officials say is meant to increase uptake in these communities.

“Every day there’s always something new. You’re not meant to live that long, so if you get it, you get it, and if you don’t, you don’t,” Woodson said of covid.

Maxine Luna, 69, who came to the nearby red canopy to get a phone, also was not swayed. A longtime smoker whose doctor has been pleading with her to get a covid shot, she fears side effects, mentioning a friend who battled two weeks of headaches, diarrhea and vomiting after getting vaccinated.

To mitigate her risk, Luna sticks close to her home, which she shares with her brother, who is vaccinated, and her sister and brother-in-law, who are not.

“We’re not out and about, we don’t go to shows, and we don’t go to crowded places,” she said.

Concern about side effects is holdouts cite for not getting a covid vaccine, said Ashley Kirzinger, associate director of public opinion and survey research for Â鶹ŮÓÅ. (The KHN newsroom is an editorially independent program of Â鶹ŮÓÅ.) This is followed by fear that the vaccine is too new or hasn’t been tested enough.

Kirzinger said it’s important to acknowledge that some people simply can’t be persuaded.

“They don’t see themselves at risk for covid, they think that the vaccine is a greater risk to their health than the virus itself, and there’s really no incentive, no stick, no message, no messenger that’s going to convince these populations,” she said. “It’s going to be really hard to reach the goals set by public health officials, with the decreasing enthusiasm around the vaccine that we have seen in the past several weeks.”

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at  (Kaiser Family Foundation). Â鶹ŮÓÅ is an endowed nonprofit organization providing information on health issues to the nation.

This story was produced by , which publishes , an editorially independent service of the .

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Aunque nunca sabe exactamente lo que va a recibir, Lesli Pastrana está agradecida por el banco de alimentos Mercado El Sol. Lo visita desde que perdió su trabajo en enero. Un viernes reciente se llevó huevos, ramen, fideos y avena.

Ella y su esposo viven en Estados Unidos sin papeles. Antes de la pandemia, se las arreglaban con sus salarios y los cupones de alimentos que recibían para sus dos hijos pequeños, ambos ciudadanos estadounidenses.

Pero ahora Pastrana ha perdido su empleo en una fábrica en la que trabajó 10 años, y a su esposo le redujeron la jornada laboral en un depósito a medio tiempo, por lo que la pareja debe ahorrar hasta el último dólar para su apartamento de dos habitaciones por el que pagan $1,500 al mes, en Tustin.

Pastrana está pensando en reducirse a una sola habitación para su familia de cuatro miembros. Está preocupada por sus hijos.

“No quiero que les preocupe que no tenga trabajo en este momento”, dijo. “No conocen la gravedad de la situación, pero perciben la tensión”.

Cupones de alimentos adicionales podrían ayudar a aliviar la carga de Pastrana y reducir las visitas a la despensa de alimentos, pero como todos los inmigrantes indocumentados en los Estados Unidos, ella y su marido no son elegibles para estos beneficios, a pesar de haber trabajado y pagado impuestos aquí.

Los demócratas de la legislatura estatal propusieron este año expandir el programa de cupones de alimentos financiado por el estado de California —que atiende a unos 35,000 inmigrantes autorizados que no cumplen los requisitos para recibir cupones de alimentos federales— a todos los californianos que reúnan los requisitos de ingresos, independientemente de su estatus migratorio.

El costo de la ampliación propuesta, a partir de 2023, sería de unos $550 millones al año.

Pero después de negociaciones con la administración del gobernador Gavin Newsom, la propuesta se redujo a un proyecto de dos años y $30 millones que actualizaría el programa estatal de ayuda alimentaria para que pueda aceptar solicitudes de algunos de los , en caso de que el programa se extienda para abarcarlos en el futuro.

, que se está considerando en la legislatura, ampliaría el beneficio de los cupones de alimentos a los indocumentados una vez que se actualice el sistema y la legislatura haya asignado fondos para la expansión.

Por ahora, el estado no se ha comprometido a ampliar el programa. Pero los esfuerzos de la legislatura este año ponen a California a la vanguardia en la ampliación de la ayuda alimentaria para residentes sin papeles.

Los activistas dicen que el estado tiene la responsabilidad de ayudar a alimentarlos, especialmente porque , dando de comer al estado y al resto del país.

“Están trabajando y arriesgando sus vidas, no sólo por la pandemia, sino ahora mismo por la ola de calor”, señaló la (demócrata de Sanger), coautora del proyecto de ley, cuyo distrito está en el Valle Central. “Arriesgan sus vidas para proporcionarnos alimentos. ¿Por qué no vamos a invertir también en ellos?”

El programa sería caro y el estado tendría que pagarlo por completo. Ahora mismo, California cuenta con un superávit de $76,000 millones, pero los ingresos del estado pueden variar de forma brutal. Por ejemplo, las restricciones económicas de la pandemia hicieron que la administración de Newsom justo el año anterior.

California ya ha ampliado la elegibilidad de los inmigrantes indocumentados para su programa de cobertura sanitaria Medicaid. Desde el año pasado, permite que los menores de 26 años participen , a un costo de unos $450 millones anuales.

A partir de 2022, serán elegibles los inmigrantes indocumentados de 50 años o más, y se espera que los gastos anuales del estado aumenten a $1,300 millones para el año fiscal 2024.

Hasta un millón de inmigrantes no autorizados cumplirían con los requisitos de ingresos para los cupones de alimentos, según Jared Call, de Nourish California, que copatrocinó el proyecto de ley de Hurtado. Pero el programa probablemente comenzaría ofreciendo la prestación a subgrupos, como los niños y las personas mayores.

Para tener derecho a los cupones de alimentos en California, la mayoría de las familias tendrían que ganar el 200% o menos del nivel federal de pobreza según el tamaño de su hogar. Para una familia de cuatro personas, esto significaría ganar .

La oficina del gobernador se negó a comentar la propuesta de “Alimentos para Todos” y su financiación, citando las conversaciones en curso con la legislatura para finalizar el presupuesto.

Los conservadores han expresado cautela. Los senadores estatales republicanos votaron en bloque contra el proyecto de Hurtado. En un correo electrónico, el senador Brian Jones, (republicano de Santee), dijo que se le pide a los contribuyentes de California que “soporten la carga de una situación fronteriza caótica que es responsabilidad federal”.

En la Asamblea, donde los comités debaten el proyecto de ley, el legislador Steven Choi, (republicano de Irvine) sugirió que la generosidad del programa agravaría los problemas en la frontera entre Estados Unidos y México al animar a la gente a tratar de migrar a California.

Incluso los demócratas, que tienen supermayoría en ambas cámaras de la legislatura estatal, son cautelosos a la hora de asumir compromisos que no pueden cumplir. El programa “Alimentos para Todos” tendría que en caso de que los ingresos se retrasen o de que aumenten otros gastos, según un informe presupuestario de la Asamblea.

, que Newsom tenía previsto firmar el lunes 12, incluye otras medidas para favorecer el acceso a la comida para las personas de bajos ingresos, independientemente de su estatus migratorio, como una mayor inversión en bancos de alimentos y un a todos los estudiantes de las escuelas públicas de California, sin importar sus ingresos.

La enorme demanda de comida de emergencia durante la pandemia puso de relieve la inseguridad alimentaria. En California, afirmaron no haber tenido suficientes alimentos durante los tres primeros meses de cuarentena, un 22% más que antes de que comenzara la pandemia en marzo de 2020, según un estudio realizado por investigadores de la Escuela de Salud Pública Fielding y la Escuela de Asuntos Públicos Luskin de la UCLA.

Como consecuencia, los bancos duplicaron o triplicaron su distribución de alimentos. Las escuelas, cerradas para la enseñanza, mantuvieron las cafeterías en funcionamiento para que las familias pudieran acudir cada semana a desayunar y almorzar gratis. Las organizaciones sin fines de lucro se apresuraron a organizar entregas de alimentos de emergencia para los enfermos de covid.

Pero las personas que están detrás de estos esfuerzos aseguran que la entrega caritativa de alimentos son parches que, a menudo, provocan la distribución de alimentos poco saludables, dan lugar a un enorme despilfarro y privan a la gente de la posibilidad de elegir.

“Los bancos de alimentos reciben lo que no quiero llamar ‘comida de segunda mano’, pero a menudo son alimentos próximos a su fecha de caducidad”, apuntó Claudia Keller, del Banco de Alimentos Second Harvest, en el condado de Orange. “Alimentos que pueden tener un alto contenido de azúcar, sal y grasa. Y eso, para nosotros, es un perjuicio para los más vulnerables de nuestra comunidad”.

Los activistas dicen que hay una solución mejor contra el hambre: simplemente dar a las familias dinero en efectivo o cupones para que compren su propia comida.

Vanessa Terán, del , en la Costa Central de California, dijo que esta es la razón por la que su organización, que atiende principalmente a trabajadores agrícolas inmigrantes indocumentados, pasó de organizar colectas de alimentos a recaudar dinero para tarjetas de prepago para comestibles.

“Las personas pueden comprar lo que necesitan, y además hay una dignidad de comprador”, señaló. “Pueden tomar decisiones para sus familias que satisfagan mejor sus necesidades”.

El mismo enfoque fue adoptado por el programa federal de beneficios, conocido a nivel nacional como SNAP y en California como CalFresh y a menudo llamado cupones de alimentos o food stamps, que envía a los beneficiarios tarjetas de dinero en efectivo para comestibles, que se recargan automáticamente cada mes.

Se estima que los inmigrantes indocumentados constituyen el 8,1% de la fuerza laboral de California, según un resumen de datos de 2019 del . Un análisis de 2019 del California Budget & Policy Center, una institución no partidista, estimó que los inmigrantes indocumentados del estado .

Hurtado elogió la decisión de sus colegas de ampliar Medi-Cal a más grupos de inmigrantes indocumentados, diciendo que “el hambre y la salud van de la mano”.

“La base de la buena salud es tener acceso a una alimentación adecuada, y saludable”, expresó. “Pero creo que algo es mejor que nada, y estoy contenta con el progreso que estamos haciendo”.

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Even though she never knows exactly what she’ll get, Lesli Pastrana is grateful for the Mercado El Sol food pantry. She has frequented it ever since she lost her job in January. On a recent Friday, she walked away with produce, eggs and staples like ramen noodles, pasta and oats.

She and her husband are both in the United States without legal authorization. Before the pandemic, they got by with their wages and the food stamps they received for their two young children — both U.S. citizens.

But now that Pastrana has lost her job at a bowling supplies factory where she worked 10 years, and her husband has been downgraded to part-time work at a warehouse, the couple must save every dollar for their $1,500-a-month, two-bedroom apartment in Tustin. Pastrana is looking for a single room to rent for her family of four. She’s worried about her kids.

“I don’t want them to focus on the fact that I don’t have a job right now,” she said. “They don’t know the magnitude of the situation, but they can sense the worry.”

Additional food stamps could help lighten Pastrana’s load and cut down on trips to the food pantry, but like all undocumented immigrants in the U.S., she and her husband are not eligible for these benefits, despite having worked and paid taxes here.

Democrats in the state legislature this year proposed opening California’s state-funded food stamp program — which serves about 35,000 authorized immigrants who don’t qualify for federal food stamps — to all income-eligible Californians, regardless of immigration status. The cost of the proposed expansion, starting in 2023, was put at about $550 million a year.

But after negotiations with Gov. Gavin Newsom’s administration, the proposal was pared down to a two-year, $30 million project to update the state food aid program so it can accept applications from some of the in California, should the program be extended to them in the future.

A in the legislature would expand the food stamp benefit to the undocumented once the system is updated and the legislature has appropriated funds for the expansion.

For now, the state has not committed to expanding the program. But the legislature’s efforts this year put California at the forefront of extending food aid to unauthorized residents. Advocates say the state has a responsibility to help feed them, especially since toil in California’s fields, feeding the state and the rest of the country.

“They’re working and risking their lives, not just through the pandemic, but right now through a heat wave,” said (D-Sanger), co-author of the bill, whose district is in the Central Valley. “They’re risking their lives to provide food for us. Why wouldn’t we invest in them as well?”

The program would be expensive, and the state would have to foot the whole bill. Right now, California is flush with a $76 billion surplus, but state revenue can swing wildly. For instance, the pandemic’s economic restrictions had the Newsom administration just the year before.

California has already expanded eligibility to undocumented immigrants for its Medicaid health coverage program. Since last year it has allowed people under age 26 to participate , at a cost of roughly $450 million annually. Starting in 2022, unauthorized immigrants age 50 and over will be eligible, and the state’s annual costs are expected to grow to $1.3 billion by fiscal year 2024.

Up to 1 million unauthorized immigrants would meet the income requirements for food stamps, according to advocate Jared Call of Nourish California, which co-sponsored Hurtado’s bill. But the program would likely begin by offering the benefit to subgroups such as children and seniors.

To qualify for food stamps in California, most families would have to earn 200% or less of the federal poverty level for their household size. For a family of four, this would mean grossing no more than .

The governor’s office declined to comment on the “Food for All” proposal and its funding, citing ongoing discussions with the legislature to finalize the budget.

Conservatives have expressed caution. Republican state senators voted as a bloc against Hurtado’s bill. In an email explaining his “no” vote, Sen. Brian Jones (R-Santee) said it asks California taxpayers to “bear the burden of a chaotic border situation that is a federal responsibility.”

In the Assembly, where committees are debating the bill, member Steven Choi (R-Irvine) suggested the program’s generosity would compound problems at the U.S.-Mexico border by encouraging people to try to immigrate to California.

Even Democrats, who hold supermajorities in both houses of the state legislature, are wary of making commitments they can’t keep. Food for All would need to be in case revenues lag or other spending increases, according to an Assembly budget report.

, which Newsom was expected to sign Monday, includes other measures to make food available to poor people, regardless of immigration status, including more investment in food banks and a to all California public school students, regardless of income.

The crushing demand for emergency food assistance during the pandemic put a spotlight on food insecurity. In California, said they went without sufficient food during the first three months of the pandemic lockdown, up 22% from before it began in March 2020, according to a study by researchers at UCLA’s Fielding School of Public Health and Luskin School of Public Affairs.

Food banks in response doubled or tripled their food distribution. Schools, closed for classes, kept cafeterias running so families could drop by every week for free breakfasts and lunches. Nonprofits scrambled to organize emergency grocery deliveries for those sick with covid-19.

But people behind these efforts say charity food giveaways are stopgap solutions that often distribute unhealthy food, result in massive waste and rob people of choice.

“Food banks get — I don’t want to say ‘hand-me-down food’ — but they often get food near its expiration date,” said Claudia Keller, chief mission officer of Second Harvest Food Bank in Orange County. “Food that might be high in sugar, salt and fat. And that, to us, is a disservice to the most vulnerable in our community.”

Advocates say there is a better solution to hunger: Simply give families cash or stamps to buy their own food.

Vanessa Terán of , on California’s Central Coast, said this is why her organization, which primarily serves undocumented immigrant farmworkers, switched from organizing food drives to raising money for prepaid grocery cards.

“People are able to buy what they need, and also there’s a shopper’s dignity,” she said. “They can make choices for their own families that best meet their needs.”

The same approach was taken by the federal benefits program — known nationally as SNAP and in California as CalFresh and often called food stamps — which mails beneficiaries grocery-usable cash cards that automatically reload each month.

Undocumented immigrants make up an estimated 8.1% of California’s workforce, according to a 2019 summary of data from the think tank. A 2019 analysis by the nonpartisan California Budget & Policy Center estimated the state’s undocumented immigrants .

Hurtado praised her colleagues’ decision to expand Medi-Cal to more groups of undocumented immigrants, saying “hunger and health go hand in hand.”

“The foundation for good health is having access to adequate food, and healthy food,” she said. “But I think that something is better than nothing, and I’m happy with the progress that we’re making.”

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Newsom, a self-described feminist and the father of four young children, has long advocated family-friendly health and economic policies. Flush with a projected budget surplus of $75.7 billion, state politicians have come up with myriad legislative and budget proposals to make poorer families healthier and wealthier.

They include ending sales taxes on ; adding benefits such as doulas and early childhood trauma screenings to Medi-Cal, the state’s Medicaid program; allowing pregnant women to retain Medi-Cal coverage for a year after giving birth; and a pilot program to provide a universal basic income to low-income new parents.

“COVID-19 laid inequity bare for all to see,” Assembly member Wendy Carrillo (D-Los Angeles) said in a written statement. She is the co-author of Senate Bill 65, led by Sen. Nancy Skinner (D-Berkeley), which would pour hundreds of millions of dollars into family and health care programs annually, focusing on minority groups that Carrillo said were “pushed out of the social safety net by the prior White House.”

Newsom and the Democratic-controlled legislature are unified on major health care and social safety-net expansions, which would direct billions in health benefits and cash assistance to the state’s most vulnerable residents and low-income parents. Legislative Democrats for years have pushed a progressive agenda to help struggling parents and families, featuring proposals like those to permanently end taxes on menstrual products and diapers — .

“We don’t need to balance the budget on half of the population that has a uterus,” said Assembly member Cristina Garcia (D-Bell Gardens), who has to the “pink tax” on diapers and menstrual products.

Skinner, chair of the Senate budget committee, is among the powerful lawmakers who’ve put forward legislation to make childbirth safer and parenthood more affordable. Her bill, which cleared the Senate and was up for consideration this week in the state Assembly, has several features that would dramatically expand maternal health care (transgender men also get pregnant and give birth).

Before the pandemic, Medi-Cal covered mothers only up to 60 days after their pregnancies ended unless their income fell below a certain line or they had a mental health diagnosis. Skinner’s bill, part of a to improve birth outcomes, would expand full Medi-Cal coverage to 12 months after the end of a pregnancy. Other would intensify state reporting and reviews of fetal and pregnancy-related deaths and severe maternal morbidity, expand housing benefits for families that have a pregnant member, and increase training programs for midwives.

Newsom’s $268 billion budget blueprint includes about $200 million a year to fully implement the expansion of Medi-Cal coverage for new mothers, with matching dollars from the federal government until those funds expire in 2027. If the expansion were not renewed, the state would revert to previous Medi-Cal qualifications.

in California in 2017, the last year for which data could be found.

“Not all postpartum issues end at 60 days, and when patients lose insurance, we can’t address them in the usual way,” said Dr. Yen Truong, an OB-GYN who works with the American College of Obstetricians and Gynecologists on legislative issues in California.

About half of pregnancy-related deaths occur during the pregnancy or on the day of delivery, but about 12% take place after giving birth, according to the Centers for Disease Control and Prevention.

The U.S. had 17.4 early maternal deaths per 100,000 live births in 2018, according to the most recent CDC data with state figures. California’s rate, , was among the lowest in the nation, but the state collects data on maternal deaths in a way that could result in underestimates.

California’s overall numbers also obscure stark racial disparities. Statewide, Black infants averaged , compared with an average of three deaths among white babies. Data from 2013 from showed Black women had pregnancy-related deaths at rates more than four times as high as the overall rate in the state’s largest county.

“Given our state’s wealth and medical advancements, this is unacceptable,” Skinner, vice chair of the Legislative Women’s Caucus, said in a news release.

Democrats also appear unified on another aspect of Skinner’s bill: a pilot program to test a universal basic income program for struggling families. The bill would give $1,000 a month to low-income expectant and new parents with kids under 2 years old in counties that decide to participate. Newsom has also proposed for pilot programs for universal basic income.

These issues could play well, especially among women, and improve Newsom’s standing going into a recall election later this year, said Rose Kapolczynski, a longtime campaign consultant to former U.S. Sen. Barbara Boxer who has worked on reproductive health care issues in Sacramento.

Indefinitely rescinding sales taxes on diapers and menstrual products — the taxes have been — is a particular no-brainer because of its bipartisan appeal, she said.

“It’s hard for Republicans to attack something that is a tax cut, and sales taxes are regressive, so progressives would like it,” Kapolczynski said.

As for Medi-Cal expansions, Kapolczynski said that even though it wouldn’t affect most Californians, the pandemic has made health care even more important to voters. “The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills,” she said.

Investing in California’s young families could help close the racial gap in maternal and infant mortality, said Nourbese Flint, executive director of the Black Women for Wellness Action Project, which endorsed Skinner’s bill.

Flint is especially excited about the possibility of covering doulas through Medi-Cal. Doulas, trained as emotional and physical supports for women in pregnancy and postpartum, have been linked to and . If doulas saved Medi-Cal money by reducing cesarean births, that could enable the state to renegotiate payments for labor and delivery, according to an . Under Newsom’s proposed budget, Medi-Cal coverage of doulas would cost about .

California’s would become the first Medicaid program to include “full spectrum” doula coverage, meaning it would include care for women who have abortions, miscarriages and stillbirths, said Amy Chen, a senior attorney at the National Health Law Program.

“California has always led the country and been a little bit in front of where our federal government is when it comes to covering folks,” Flint said.

California Healthline correspondent Angela Hart contributed to this report.

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Almost all 15 companies surveyed — among the largest and most influential — have strong pro-vaccine messages from their corporate leadership, emphasizing that the shots can both help protect individuals and bring the pandemic to a close.

CVS Health, which administers covid vaccines as part of the federal pharmacy distribution program, says it strongly encourages the shots for its employees “” but won’t mandate them. Starbucks is also encouraging the shots “,” but also doesn’t mandate them.

Some companies are giving employees paid time off to either get shots or stay home if they have side effects, a trend that could increase now that the Biden administration has for smaller companies to offer up to 80 hours of paid sick leave until Sept. 30.

Target is giving hourly employees up to four additional hours of pay if they get the vaccine (two hours per shot). Amazon is offering $40 a shot for hourly workers, and Kroger is giving employees $100 if they receive both doses.

“Vaccination, in our view, is absolutely the only way out of the pandemic, both for us to get to normalcy and also for the country,” said Dr. Vin Gupta, a pulmonologist and chief medical officer for Amazon’s covid response.

Amazon, like other large retailers, has experienced covid outbreaks at its workplaces throughout the pandemic. In October it revealed that had tested positive or were presumed to have been infected with the covid virus.

The company, which includes Whole Foods Market, distribution warehouses and data centers, has organized vaccination events for employees such as delivery workers in at least 29 states, and is among the giant companies doing the most to bring shots to its workers. But for now, Amazon isn’t making vaccines mandatory.

Target, the only company among those surveyed that is offering financial incentives, extra paid time off and vaccinations at the worksite, has no plans to mandate the vaccinations.

However, the pandemic has brought a stream of fast-changing policies and recommendations from federal health authorities, and some companies, while declining mandates for now, indicated that could change.

“I don’t have a crystal ball, and I can’t predict the future, but that’s what our message is now,” said Carrie Altieri, vice president of communications for covid strategy at IBM.

Legal and public health experts caution against any mandates before the Food and Drug Administration fully licenses the shots, which could happen this summer. The vaccines were authorized by the FDA for “emergency use” and as such employers can’t require them, some legal experts have argued. Even post-licensure, though, companies could spark a backlash if they require employees to get them, said Joanne Rosen, senior lecturer and associate director at the Center for Law and the Public’s Health at Johns Hopkins University.

A mandate could anger certain employees while only marginally increasing the number of vaccinations, Rosen and others say. It would be more prudent to focus on “carrots instead of sticks,” she said.

“If the purpose of a mandate is to ensure that the largest number of people get vaccinated, a backlash to a mandate, in which you have more reluctance or opposition to vaccination, is the opposite of the outcome you want to get,” she said.

Post-licensure, employers would face fewer legal challenges to vaccine mandates, especially if staff members work with medically vulnerable or at-risk patients, as in nursing homes or prisons. Aside from these special sectors, employee mandates aren’t necessarily a good idea from a public health perspective, said Michelle Mello, a professor of law and medicine at Stanford University.

Hard-line vaccine opponents likely wouldn’t be swayed by an employment-based vaccine requirement, and it could risk alienating some in the “wait and see” contingent, she said.

About not yet vaccinated against covid said they would accept a shot if it was required, according to an April survey from Â鶹ŮÓÅ. An additional 15% who hadn’t gotten a shot expressed a “wait and see” attitude toward vaccination. And 13% flatly refused to be vaccinated.

Gains in the small group who say they’d get a shot if it’s required might not be worth the uproar a mandate could foment, Mello said.

Mandates risk further politicizing covid vaccines in U.S. society, said Brian Castrucci, CEO of the de Beaumont Foundation, a charity focused on public health.

Polling conducted by de Beaumont and GOP pollster Frank Luntz on that 36% of those who voted for Donald Trump in the 2020 presidential election agreed it was important for American businesses to encourage and incentivize the vaccines, versus 54% of Joe Biden voters. The survey also found that 41% of Trump voters believed that businesses should not be involved in covid vaccinations at all, compared with 18% of Biden voters.

“Mandating vaccination will hit every button there is on the political right,” Castrucci said.

Once public health tools and strategies become politicized, local governments can choose to simply take them off the table as an option. A new bans businesses and government entities from requiring proof of a covid vaccination. The law builds on Gov. Ron DeSantis’ , which he signed April 2.

“Vaccine verification can be a useful tool,” Castrucci said. “Now it’s no longer available in Florida.”

Despite the potential backlash, the financial case for covid vaccinations is clear, said Aaron Yelowitz, an economics professor at the University of Kentucky, given .

Taking into account the costs of a shortened life span, mental health conditions and lost income due to illness and shutdowns, the covid pandemic has cost the average American family of four almost $200,000, according to an analysis by .

Some of these costs may be borne by businesses in the form of lost productivity and higher health insurance prices, said Yelowitz. Financial incentives for the shots are thus an extremely tempting trade-off, he said.

Incentives for vaccination — like a $25 gift card or free Uber ride — are “surely worth it in terms of savings,” Yelowitz said. In the same vein, he also called Ohio Gov. Mike DeWine’s “innovative and imaginative.”

But for now, employers are sensitive about what they can and can’t demand of workers, said Lindsey Leininger, a clinical professor of business administration at Dartmouth College. The tight labor market and the fraught, ongoing negotiations over when and how to bring employees back to the office makes some companies wary of asking too much of their workers, said Leininger, who advises smaller businesses on covid vaccines and other issues.

“All of the businesses I work with have a general preference for carrot versus stick types of approaches,” she said. “How many things do you want to mandate of your employees right now?”

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Un tercio de los hispanos no vacunados dicen que quieren las dosis, en comparación con el 17% de los negros y el 16% de los blancos, según la encuesta publicada por Â鶹ŮÓÅ (Kaiser Family Foundation).

“Los resultados reflejan una oportunidad para que los departamentos de salud pública y los gobiernos locales lleguen a los hispanos con información y equipos de vacunación”, señaló Liz Hamel, vicepresidenta y directora de opinión pública e investigación de encuestas en Â鶹ŮÓÅ, quien lidera las encuestas mensuales de la organización sobre la vacuna contra covid-19.

“Definitivamente, hay una gran parte de la población hispana que está deseando vacunarse, pero no han podido encontrar el tiempo, o tienen algunas preocupaciones o preguntas, o no han podido acceder a la vacuna”, dijo Hamel.

Según los Centros para el Control y la Prevención de Enfermedades (CDC), en los Estados Unidos que han recibido al menos una dosis de la vacuna son hispanas, aunque constituyen alrededor del 17% de la población total. (Sólo la mitad de los datos de los CDC incluyen la raza o el origen étnico de las personas vacunadas).

Entre los hispanos no vacunados, el 64% estaba preocupado por la posibilidad de faltar al trabajo debido a los efectos secundarios de la vacuna, y el 52% estaba preocupado por tener que pagar las vacunas, aunque éstas se ofrecen sin costo alguno. Estas cifras son aún más altas entre los hispanos indocumentados.

“Es difícil que alguien que vive al día se tome medio día libre para venir a una clínica y tratar de vacunarse”, dijo el doctor José Pérez, jefe médico del South Central Family Health Center, una organización de salud sin fines de lucro con clínicas en todo el sur de Los Ángeles. “Si no trabajan ese día, no se ganan la vida y no comen”.

Aquéllos que se enfrentan a problemas de inmigración fueron más propensos a preocuparse por tener que mostrar una identificación emitida por el gobierno o un número de seguro social, según la encuesta de Â鶹ŮÓÅ.

Las políticas antiinmigrantes de la administración Trump asustaron a las personas que buscaban cualquier servicio de salud pública, por temor a que pudiera poner en peligro su estatus migratorio, dijo Pérez.

“Para los estadounidenses que están acostumbrados a tener orden en su vida, y no tienen que tener miedo de esto o aquello, esto puede parecer un poco extraño. Pero para la comunidad inmigrante del sur de Los Ángeles, estos son factores con los que lidian a diario”, agregó.

A pesar del mensaje esperanzador de la encuesta, la organización de Pérez sólo ha administrado una fracción de las dosis que tiene a mano, aunque ha ampliado los lugares de vacunación, y ahora ofrece una vacuna a cualquiera que entre en una de sus clínicas, dijo Pérez.

“Todo lo que podemos hacer es seguir empujando, educando, y poniendo nuestro nombre ahí fuera. Con suerte, nos pondremos al día”, apuntó.

La administración Biden anunció las pequeñas empresas que den a sus trabajadores tiempo libre remunerado para recibir la vacuna y recuperarse en caso de efectos secundarios.

Los proveedores no están autorizados a cobrar a la gente por la vacuna contra covid, y deben repartir las vacunas independientemente del estatus migratorio o del seguro médico.

En California, en donde los hispanos representan cerca del 40% de la población, el 48% de las muertes por covid y el 63% de los casos, alrededor del 32% se ha vacunado. Los casos y muertes están particularmente concentrados en los vecindarios de bajos ingresos, mayormente hispanos.

Las clínicas de salud comunitarias y las organizaciones de todo el estado están llevando la causa de las vacunas a las aceras, los supermercados y cualquier otro lugar donde se reúna la gente, buscando asegurar que sepan cómo obtener una cita para vacunarse.

En el código postal que rodea la sede principal de South Central Family Health Center, sólo el 16% de los residentes elegibles tenían al menos una dosis hasta el 7 de mayo, según el .

A cinco meses que comenzara la campaña de vacunación de la nación, mientras los CDC relajan las recomendaciones del uso de máscara, la clínica todavía está empujando la importancia de las máscaras debido a la baja cantidad de personas que se han vacunado, dijo Pérez.

La “indecisión en la vacunación” se ha convertido en una excusa general para explicar las bajas tasas de vacunación entre las poblaciones minoritarias, pero el problema es complejo, dijo Nancy Mejía, directora del programa de Acceso a la Salud de los Latinos en Santa Ana, California, una organización sin fines de lucro que tiene un contrato con el condado de Orange para llevar la vacuna contra covid a los latinos.

Las promotoras de su grupo se encuentran con personas que se enfrentan a una gran variedad de obstáculos para vacunarse, dijo.

“Oímos todas estas preguntas: ‘Bueno, no tengo seguro médico’, o ‘¿Tengo que pagar?’ o ‘No tengo correo electrónico, ¿cómo me registro?'”, contó Mejía. “Cuando la gente habla de indecisión, realmente tenemos que preguntar de qué estamos hablando, y no seguir echando la culpa a las personas que realmente tienen buenas preguntas”.

Ahora que la demanda de citas para la vacunación ha caído, Mejía y su grupo se están centrando más en eventos de vacunación móviles en edificios de condominios y estacionamientos a donde peatones y residentes pueden simplemente caminar. Los eventos son por las tardes, después del trabajo, o los fines de semana, para que la decisión de vacunarse sea lo más fácil posible.

“Vemos que otros lugares han estado abiertos todo el día y sólo han entrado cinco personas”, dijo. “Así que, para nosotros, estar abiertos sólo unas horas por la tarde, y conseguir más de 100 personas es un gran éxito”.

Carmelo Morales, de 35 años y residente de Los Ángeles, era uno de los escépticos. Tras hablar con amigos y ver publicaciones en Instagram, temía que las vacunas fueran un complot para enfermar a la gente. No veía la urgencia de vacunarse.

Pero Morales, que trabaja en una planta empacadora de carne, se ha visto profundamente afectado por los casos y las muertes entre sus colegas y sus familias en el último año. Un día a finales de abril, mientras volvía a casa del trabajo, vio que los trabajadores de salud de una iglesia cercana a su casa estaban limpiando después de un evento de vacunación contra covid.

Preguntó si había dosis sobrantes y, como su casa estaba cerca, las enfermeras esperaron a que corriera a su casa a buscar su identificación para que pudiera ponerse la primera dosis.

“Sólo pensé y me dije, oye, es mejor sólo para estar del lado más seguro”.

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One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites, according to the survey released Thursday by Â鶹ŮÓÅ. (KHN is an editorially independent program of Â鶹ŮÓÅ.)

The results reflect an opportunity for public health departments and local governments to reach out to Hispanics with information and vaccinating teams, said Liz Hamel, vice president and director of public opinion and survey research at Â鶹ŮÓÅ and director of the organization’s monthly covid vaccine surveys.

“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,” Hamel said.

According to the Centers for Disease Control and Prevention, in the U.S. who have received at least one vaccine dose are Hispanics, though they make up about 17% of the overall population. (Only about half of the CDC’s data includes the race or ethnicity of vaccinated individuals.)

Among unvaccinated Hispanics, 64% were worried about missing work because of vaccine side effects, and 52% were concerned about having to pay for the shots — although the shots are offered at no cost. These numbers are even higher for Hispanics who lacked lawful permanent resident status.

“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,” said Dr. José Pérez, chief medical officer of the South Central Family Health Center, a nonprofit health organization with clinic locations throughout South Los Angeles. “If they don’t work that day, they don’t earn a living and they don’t eat.”

Those facing immigration issues were more likely to be worried about being asked to show government-issued ID or a Social Security number, according to the Â鶹ŮÓÅ survey.

The Trump administration’s anti-immigrant policies scared people away from seeking any public health services, for fear it could jeopardize their immigration status, Pérez said.

“For Americans who are used to having order in their life, and don’t have to be fearful of this or that, this may seem a little bit foreign,” he said. “But for the immigrant community in South L.A., these are factors that they deal with on an everyday basis.”

Despite the survey’s hopeful message, Pérez’s organization has administered only a fraction of the doses it has on hand, although it has expanded vaccination sites and now offers a shot to anyone who walks into one of its clinics, Pérez said.

“All we can do is continue to push, educate and continue to put our name out there,” he said. “Hopefully, we’ll catch up.”

The Biden administration small businesses that give their workers paid time off to get the shot and recover in case of side effects. Providers are not allowed to charge people for the covid vaccine, and must give out shots regardless of immigration status or health insurance coverage.

In California, where Hispanics make up nearly 40% of the population, 48% of covid deaths and 63% of covid infections, about . Cases and deaths are especially concentrated in dense, low-income neighborhoods that are majority Latino.

Community health clinics and organizations throughout the state are taking the case for vaccinations to sidewalks, supermarkets and anywhere else people gather, seeking to ensure people know how to sign up for a shot.

In the ZIP code around South Central Family Health Center’s main site, only 16% of eligible residents had at least one shot as of May 7, according to the . Five months into the nation’s vaccination campaign, as the CDC relaxes mask recommendations, the clinic is still pushing the importance of masks because of how few people have been vaccinated, Pérez said.

“Vaccine hesitancy” has become a catch-all excuse to explain low rates of vaccinations among minority populations, but the problem is complex, said Nancy Mejía, chief program officer of Latino Health Access in Santa Ana, California, a nonprofit that contracts with Orange County to bring covid vaccine to Latinos.

Her group’s community health workers, or promotoras, encounter people who face a wide variety of obstacles to get the shot, she said.

“We hear all of these questions about, ‘Well, I don’t have health insurance,’ or ‘Do I have to pay?’ or ‘I don’t have email, how do I register?’” Mejía said. “When folks talk about hesitancy, we really have to ask what it is that we’re talking about, and not continue to place blame on individuals who actually have really good questions.”

Now that demand for vaccine appointments has plunged, Mejía and her group are focusing more on mobile vaccine events at condominium buildings, swap meets and parking lots where pedestrians and residents can simply walk up. The events are happening in the evenings after work or on the weekends to make the decision to get vaccinated as easy as possible.

“We’re seeing other places that have been open the entire day and gotten only five people in,” she said. “So, for us being open just a few hours in the evening, and getting over 100 people — that’s a success story.”

Carmelo Morales, a 35-year-old Los Angeles resident, used to count himself among the vaccine skeptical. After talking to friends and seeing posts on Instagram, he feared the shots might be a plot to make people sick. He didn’t see the urgency of getting a shot.

But Morales, who works in a meatpacking plant, has been deeply affected by the cases and deaths he has seen among colleagues and their families over the past year. One day in late April, as he was walking home from work, he noticed health care workers at a church near his house packing up after a covid vaccine event.

He asked if there were any leftover doses, and because his house was nearby, nurses waited for him to run home to get his ID so he could get his first shot.

“I just thought about it and was like, hey, it’d be better just to be maybe on the safer side.”

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In Santa Clara County, home to Silicon Valley, 16 and older have had at least one dose as of Wednesday, compared with in San Bernardino County, east of Los Angeles. Statewide, about have received at least one dose.

The differences reflect regional trends in vaccine hesitancy and resistance that researchers have been tracking for months, said , associate survey director at the Public Policy Institute of California, a nonpartisan think tank.

In a , only 5% of respondents in the San Francisco Bay Area and 6% of those in Los Angeles said they wouldn’t be getting vaccinated. But that share is 19% in the Inland Empire and 20% in the Central Valley.

“More urban areas might be hitting a wall, but their number of shots given is higher,” said Bonner. “The rural areas might be hitting a wall maybe even before, but their shots given isn’t quite as high.”

Infectious disease experts estimate that anywhere from 50% to 85% of the population would need to get vaccinated to put a damper on the spread of the virus. But overall state numbers may mask pockets of unvaccinated Californians, concentrated inland, that will prevent these regions from achieving “herd immunity,” the point at which the unvaccinated are protected by the vaccinated. Epidemiologists worry that the virus may continue to circulate in these communities, threatening everyone.

The regional differences could be attributed, at least in part, to political opposition to the vaccine, said Bonner, as about 22% of Republicans and 17% of independents in the survey said they wouldn’t be getting the vaccine, compared with 3% of Democrats.

But officials and epidemiologists see some encouraging signs that the state has yet to hit a wall of vaccine refusal. “As a strongly blue state, one would expect that California is less likely than red states to hit a relatively low ceiling of vaccination, assuming that the access is good and the messaging is strong,” said , chair of the department of medicine at the University of California-San Francisco School of Medicine.

As of Wednesday, 77% of , and 68% of those ages 50 to 64, had received at least one dose of covid vaccine, according to a KHN analysis. These large percentages reflect the early vaccine eligibility of these age groups and are a hopeful sign considering how difficult it was to get a shot in the beginning of the year, said , an assistant professor at the University of California-San Diego specializing in infectious diseases and public health.

“I’m very hopeful that addressing access would pick up at least another 10-15% before we need to really start addressing myths and hesitancy issues,” she said.

The state could see a new jump in vaccinations as workplaces, schools and event organizers begin to require the shots, Wachter said. For example, the University of California and California State University systems that their 1 million-plus students and staff members will be required to get vaccinated against covid once the shots are formally licensed by the Food and Drug Administration, likely to occur this summer.

Still, the red-blue political distinction on vaccination is meaningful within California as well as nationally. Despite depressed vaccine demand across the board, counties that lean conservative have lower rates of vaccinations.

In true-blue Los Angeles, 4.5 million first covid vaccine doses have been administered, meaning that about 55% of eligible Angelenos have gotten at least one shot.

But first-dose appointments at county-run sites were down at least 50% last week, said public health director Barbara Ferrer on Thursday. The county has opened several sites where people can walk in and , but these walk-ins don’t make up for all of the unfilled spots.

Last week probably marked the first time the county did not administer 95% of the doses distributed to it, she said.

In San Diego and Orange counties, meanwhile, vaccination appointments are going unfilled or taking days to get booked up.

About 20% of appointments in Orange County started going unclaimed on April 25 and the slack has persisted, said Dr. Regina Chinsio-Kwong, deputy health officer.

However, based on survey data from last winter indicating that about to get vaccinated against the coronavirus, the county is still expecting more residents to seek out appointments. As of Sunday, about had received at least one dose.

In San Diego, officials expect all appointments to be filled despite the slowdown, said county spokesperson Michael Workman. had received at least one dose as of Wednesday.

In San Bernardino, the slowdown started in late March, said county spokesperson David Wert. Only had gotten at least one dose as of Monday.

Across the state, officials are unclear on the extent to which hesitancy or lack of access to a vaccine are responsible for the slowdown.

Campaigns to educate, convince and reach out to people have started to pick up throughout the country, including targeted messaging for conservatives. Ten GOP doctors in Congress urging their constituents to get vaccinated.

Santa Clara is shifting most county-run sites to enable walk-ins and expanding evening and weekend hours to make it easier for working people to get a shot. San Diego and San Bernardino are also allowing walk-ins.

Other counties are returning unused doses to the state to be redistributed, a bounty from which Los Angeles County has benefited, according to Barbara Ferrer, director of the county public health department. Representatives from Blue Shield and the California Department of Public Health would not say which counties are sending doses back.

California’s good pandemic news, which has enabled counties to reopen many businesses, is one of the challenges to getting less-than-enthusiastic people in for their shots right now, said Wachter of UCSF.

As of Thursday, California has at and a covid-test positivity rate of 1.3%.

“My hope is that a strong communication campaign, perhaps coupled with some degree of vaccine requirements, will get some people to jump off the fence,” Wachter said.

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California has trumpeted its reliance on science and policies it says are aimed at improving social equity.

Texas state officials have emphasized individual rights and protecting the economy, often ignoring public health warnings but encouraging vaccination — while calling it a personal choice.

Yet California’s commitment to equity the state ahead of Texas in vaccinating Latinos, who make up roughly 40% of the population in both states. Latinos have suffered disproportionately from covid because the poorest tend to live in crowded housing, get less quality health care and have been more likely to work outside the home.

In California, as of April 12; in Texas, 21%.

at reaching highly vulnerable groups during the first months of vaccine distribution, according to a recent analysis by the Centers for Disease Control and Prevention. Texas was seventh on the list; California was fifth from last.

Overall, however, California’s pandemic metrics have been better. As it opened vaccine eligibility to all ages on April 15, were either partially or fully vaccinated, compared with .

The two states were neck and neck until a harsh winter storm in February knocked out power for a week in much of Texas. “We never really recovered after that, and exactly why, beyond our size, is not entirely clear,” said , dean for the National School of Tropical Medicine at Baylor College of Medicine.

California is also doing much better when it comes to driving down infections. is 52.7 cases and 1.8 deaths per 100,000 as of April 15, with a seven-day average . Texas, meanwhile, is at 73.3 cases and 1.5 deaths per 100,000, with a seven-day average .

The states’ leaders have reacted differently to those metrics. California Gov. Gavin Newsom has set June 15 as the , barring major setbacks, but he plans to continue to require mask-wearing in public and in high-risk workplaces. Meanwhile, Texas Gov. Greg Abbott on March 10 allowed all businesses to fully reopen and lifted a statewide mask mandate.

The concept of individual freedom plays well in Texas politics and has been front and center throughout the pandemic and the vaccine rollout. While encouraging Texans to protect themselves against the spread of the coronavirus, state officials at the same time have fought local authorities’ efforts to enforce such measures.

While Newsom instituted one of the earliest and strictest state lockdowns in the country on March 19, Texas Attorney General Ken Paxton initially called local mask mandates and business restrictions “.” Abbott finally instituted a in July after a surge of the disease. Those measures met opposition within his own party, with Texas Republican Chair Allen West outside the governor’s mansion in October.

Against this tense political backdrop, Texas state leaders have been softer in their vaccination messaging compared with California. Both governors received their vaccinations on live TV, but each has offered different messaging about how their constituents should view the shots.

In an April 8 tweet, Abbott celebrated the state’s adding, “These vaccine shots are always voluntary.” That soft-pedaled message also comes through in Abbott’s stance on masks. Despite lifting the order in early March, the governor .

Public health experts in Texas have been frustrated by what they see as a half-hearted endorsement of public health measures. “It’s psychotic to have to listen to two very different messages,” said , CEO of the HOPE Clinic in Houston, which serves minorities and immigrants. “Vaccines were not made just for your individual protection. They were made for community benefit. It is a message that has been lost in our society.”

Newsom, on the other hand, talks about vaccines in terms of responsibility to others. “Getting vaccinated is a vital step we can take to protect ourselves, our loved ones and our community, and brings us that much closer to ending this pandemic,” Newsom said on April 1, when .

Newsom’s oft-repeated “north star” value is equity — the notion that the well-being of those hurt most by the pandemic should be essential to the battle against it. Starting March 4, his administration allocated 40% of its vaccines to neighborhoods that have seen 40% of covid cases and deaths. California has also invested $52.7 million to fund more than 300 “trusted messenger” community organizations to do outreach on vaccines. He didn’t make the general public eligible for vaccination until April 15 in order to prioritize more vulnerable and at-risk groups. Texas, meanwhile, fully opened the vaccine spigot on March 29.

California’s struggles to vaccinate racial and ethnic minorities and the most vulnerable, despite intense public health investment and attention to these communities, raises questions about the state’s vaccine eligibility decisions, said , assistant professor of sociology at the University of Minnesota.

Both Texas and California, like many states, first vaccinated health care workers and long-term care residents, populations that are majority white. But in Texas, people with underlying medical conditions — like Type 2 diabetes, sickle cell disease or obesity — also .

In California, people with underlying medical conditions weren’t added to the eligibility list until mid-March, and the was much more stringent than Texas’ guidelines.

“That gap between January and mid-March, that’s kind of the story to me,” Wrigley-Field said.

California officials decided Jan. 13 to prioritize people over 65. Many over-65 whites were at substantially lower risk than younger people of color, said Wrigley-Field, who that age-based eligibility benefited older, white populations at the expense of younger people of color who were more at risk of covid hospitalization and death.

Prioritizing those over 65 immediately put Hispanics at a 2-to-1 disadvantage to whites, concluded , based on at the Agency for Healthcare Research and Quality (their conclusions don’t necessarily represent AHRQ or HHS). Priority tiers for those with certain diseases and essential workers would have benefited the poor and Hispanics, respectively, and pushing them down the list “could be one of the factors why we’re seeing lower rates for these groups,” he said.

Hispanics ages 20-54 in California were than whites of the same age from March to July, according to a University of Southern California study.

, first responders and workers in education, food and agriculture became eligible for vaccination in California. County health departments were permitted to set their own schedules, however, and in Los Angeles these due to limited vaccine supply.

In effect, from December until March there was no eligibility tier that prioritized groups that were predominantly Latino or Black in the state’s largest county and the epicenter of the state’s covid cases and deaths.

The state’s approach harmed efforts to reach out to Latinos, some county health departments say. In Kern County, Latinos make up 53% of the population and 57% of covid cases, but got only 36% of the vaccines administered as of April 15. Confusion over the essential-worker eligibility tiers caused many to think it wasn’t their “turn,” said Brynn Carrigan, the county public health director.

Dr. Tomás Aragón, state public health officer and director of the California Department of Public Health, defended the state’s initial age-based approach and said it was a strategy to make sure Latinos were prioritized. He noted that, while Latinos accounted for 48% of the state’s covid deaths, the majority of those deaths occurred in .

“We are in a significantly better place today than many states, not just because our vaccine strategy saved lives and kept people out of hospitals, but also because we focused on proven public health interventions, such as masking, distancing, hand washing and tracing,” Aragón said in an emailed statement.

Vaccine hesitancy among racial and ethnic minorities has faded as educational outreach has ramped up, access has improved, and more people see friends and neighbors safely get the shot. Vaccine hesitancy instead , particularly white evangelicals, according to several polls.

But confidence in vaccines is growing even among Republicans, according to a poll recently conducted by Frank Luntz and released by the . It showed that 38% of Trump voters and 48% of Biden voters were more likely to get vaccinated than they were in March.

While some experts said consistent messaging from politicians would be helpful, time and experience watching friends and family safely receive vaccinations as well as communication with trusted individuals — particularly personal doctors — is the most effective way to overcome lingering concerns about the shots.

“What’s going to change that is getting vaccine more readily available to primary care providers … who they trust and get their questions answered, because I think they are vaccine-hesitant versus anti-vaccination,” said , chief medical officer at the University of Texas System.

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La mujer dijo en español: “¡Buenos días! ¡Hoy estamos aquí para hablar sobre covid-19! ¿Tienes un minuto?.

Después de una breve conversación, García supo que el hombre no tenía conexión a Internet ni teléfono propio, pero tenía 66 años y quería recibir la vacuna. Había ido a una farmacia en persona, pero ya no había dosis por ese día.

García anotó su nombre y el número de teléfono de un amigo, para poder comunicarse con el conductor más tarde sobre una clínica móvil de vacunas que El Sol Neighborhood Educational Center, estaba organizando para la remota y desértica ciudad, en algún momento de abril.

Luego pasó al siguiente coche. Y al siguiente. Cuando la fila comenzó a moverse, ella y su compañera, la trabajadora de salud Erika Marroquín, corrieron arriba y abajo por la acera, anotando nombres, números de teléfono y condiciones preexistentes. Era el primer día templado y soleado que la región del High Desert había visto en semanas, y el ejercicio las hacía sudar.

Después de 90 minutos, se terminó el banco de alimentos del día, y García y Marroquín habían hablado con personas en 54 autos. Encontraron a seis ansiosas por la vacuna covid y elegibles de inmediato. Otras 10 querían estar en lista de espera de dosis sobrantes.

Como en muchos estados, la implementación de la vacunación en California ha sido lenta y caótica. Más de en el estado más poblado del país han sido vacunados al menos parcialmente, mientras que otros 5,6 millones están completamente vacunados.

El 15 de abril, todos los adultos de California serán elegibles para inscribirse para recibir una vacuna y, a principios del verano, el objetivo es tener suficientes dosis para cualquier adulto que la quiera.

Pero el país necesita llevar la para evitar que el virus se propague fácilmente, un nivel llamado inmunidad colectiva por los expertos en enfermedades infecciosas. Una figura que asume que la población es homogénea en términos de vacunación.

Es por eso que la capacidad del estado para evitar otro aumento de covid puede depender de personas como García y Marroquín, trabajadores de salud comunitarios que corren contra el tiempo realizando una tarea intensa, para evitar que grupos de poblaciones con bajas tasas de vacunación en comunidades remotas o aisladas se conviertan en un polvorín para una nueva oleada de covid.

“Cuando hay zonas geográficas o grupos sociales no vacunados, realmente se arruina la inmunidad colectiva”, dijo Daniel Salmon, director del Instituto para la Seguridad de las Vacunas de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins.

Los en los Estados Unidos en los últimos años proporcionan un ejemplo aleccionador. La cobertura de vacunas a nivel estatal y nacional es bastante alta, “pero luego tienes estas comunidades donde mucha gente rechaza las vacunas, aparece sarampión importado y se genera un brote”, dijo Salmon.

Los brotes han afectado a ciertas comunidades judías ortodoxas en Nueva York, inmigrantes somalíes en Minnesota, y zonas acomodadas del sur de California donde viven padres que están en contra de las vacunas.

El coronavirus que causa covid sigue circulando ampliamente en California, aunque a niveles mucho más bajos que hace dos meses. El virus, especialmente una variante cada vez más común y más contagiosa, podría atravesar fácilmente comunidades vulnerables con bajos niveles de inmunidad.

En Adelanto, donde el 29% de los residentes vive en la pobreza, se había vacunado por completo al 20 de marzo.

Al 26 de marzo, la mayoría de las más de 15.9 millones de dosis de vacunas distribuidas desde diciembre se habían destinado a los lugares .

Las organizaciones comunitarias sin fines de lucro y las iglesias están clamando por más fondos, y confianza, para llevar la vacuna hasta la última milla, a las personas a las que han estado sirviendo durante años.

El éxito de El Sol en vacunar a las poblaciones negras, latinas y otras poblaciones subrepresentadas desacredita la idea de que estos grupos no recibirán la vacuna, dijo Juan Carlos Belliard, vicepresidente asistente de asociaciones comunitarias de Loma Linda University Health, en el condado de San Bernardino.

Loma Linda está colaborando con El Sol para dotar de personal y proporcionar dosis para las clínicas. Las personas que se presentan están listas para recibir la vacuna, aunque algunas dudan un poco, comentó.

“No son como nuestra gente de clase media que literalmente está llorando por la vacuna”, dijo Belliard. “Estas personas todavía están nerviosas pero se han logrado remover muchas otras barreras”.

Los trabajadores comunitarios de El Sol fueron financiados por un esfuerzo combinado de $52,7 millones de fondos estatales y filantrópicos que proporcionaron subvenciones a 337 organizaciones consideradas “mensajeras de confianza” en sus comunidades.

El dinero fue enviado a grupos como El Sol que tenían antecedentes probados de caminar los vecindarios, de casa en casa, para el registro de votantes o encuestas del Censo.

El Sol recibió $120,000 de la iniciativa público-privada para apoyar sus esfuerzos educativos y de divulgación general para la vacunación contra covid. Pero el grupo no sabía si obtendría algún reembolso por los eventos móviles de vacunación que organizó en el condado de San Bernardino, dijo Alex Fajardo, su director ejecutivo.

El Sol llevó a cabo un evento de vacunación el 17 de febrero en el Centro Cristiano Luz y Esperanza, una iglesia ubicada junto a una autopista de dos carriles en Adelanto, bordeada por desierto.

El personal médico, los estudiantes y las vacunas llegaron desde Loma Linda University Health, a una hora de distancia, para vacunar a 250 personas, y regresaron un mes después para darles su segunda dosis.

Rosa Hernández, de 69 años, y Patricia Pérez, de 47, madre e hija, estuvieron entre las que recibieron sus vacunas en el Centro Cristiano.

El padre de Pérez, que trabaja en el departamento de lácteos de un supermercado, se enfermó de covid en junio y no pudo regresar al trabajo durante seis meses. Nadie más en la familia de siete miembros resultó positivo, pero Rosa Hernández es una sobreviviente de cáncer y su hija estaba preocupada por ella.

A pesar de las múltiples llamadas a una línea telefónica del condado, Pérez no había podido hacer una cita para su madre. La conexión a Internet de la familia, en la cercana ciudad de Hesperia, es irregular y Pérez no podía navegar por los sitios web ni encontrar información en español, el idioma con el que se siente más cómoda.

Aprovechó la oportunidad cuando se enteró del evento de El Sol a través de alguien de su iglesia. Pérez también logró obtener una dosis adicional para ella después de que una cita fuera cancelada. Ahora ambas están completamente vacunadas, dijo Pérez, y no hubiera sucedido sin El Sol.

El grupo planea hacer tres ventanas emergentes de vacunación más en el área de High Desert. Pero el apoyo futuro para sus clínicas, el alcance de las vacunas y la educación son inciertos, dijo Fajardo.

“¿Qué va a pasar después?”, expresó. “Cuando te necesitamos, te pagamos. Cuando no te necesitemos, adiós”.

“Esa es una evaluación muy justa”, dijo Susan Watson, directora de programas de la iniciativa Together Toward Health del Public Health Institute, el financiador filantrópico detrás de parte del trabajo de El Sol. “Aquí hay una oportunidad para que la gente piense en el futuro y en cómo hacemos las cosas, que no necesariamente deja a los grupos comunitarios fuera, a los que solo se usa cuando hay una emergencia”.

Community Coalition, una organización sin fines de lucro del sur de Los Ángeles fundada en 1990, también recibió subvenciones de la asociación público-privada para crear conciencia sobre las vacunas de covid, pero no fondos adicionales para entregar vacunas a la gente.

Aún así, movilizó al personal para tocar puertas, enviar mensajes de texto y correo electrónico a las personas elegibles para que asistieran a un evento de vacunación emergente de dos semanas en un parque del vecindario a principios de marzo: 4,487 personas recibieron su primera dosis, dijo Corey Matthews, jefe de operaciones del grupo.

El doctor Mark Ghaly, secretario de Salud y Servicios Humanos del estado, prometió proporcionar más dinero para los grupos que están vacunando a sus comunidades. “Este no es un trabajo voluntario”, le dijo a KHN en una rueda de prensa. “Este es un trabajo real, y quiero ser parte del equipo que lo hace realidad para todos”.

Barbara Ferrer, directora del Departamento de Salud Pública del condado de Los Ángeles, se hizo eco de ese sentimiento. “Estaban allí antes de que comenzara la pandemia, han estado allí todo el tiempo durante la pandemia y estarán aquí mucho después de la pandemia”, dijo.

Ya sea que esas promesas se mantengan o no, los grupos comunitarios dicen que quieren ser parte del esfuerzo de vacunación.

“Incluso si no nos dan dinero, seguiremos haciendo el trabajo”, afirmó Fajardo.

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