As Oregon moves closer to administering a first dose of the COVID-19 vaccine to 70% of adults statewide, disparities remain. Native Hawaiian and Pacific Islander Oregonians have the highest vaccination rate by race and ethnicity, according to data from the Oregon Health Authority. Latinx and Hispanic Oregonians have the lowest. Alyshia Macaysa is the incoming executive director of the Oregon Pacific Islander Coalition. Oralia Mendez is a manager of workforce development and community programs at Oregon State University’s Center for Health Innovation. They join us with details behind some of the state’s vaccination rates.

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The following transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is “Think Out Loud.” I’m Dave Miller. Oregon is on the cusp of hitting 70% 1 dose vaccination rate statewide for people 16 and over. At that point, the Governor is going to lift most restrictions on public life that have been in place for more than a year. But that overall number gives an incomplete picture, because when you look at the data broken out by race and ethnicity, you can see huge disparities in vaccination rates. Native Hawaiian and Pacific Islander Oregonians have the highest overall vaccination rate in the state. It’s almost twice that of Hispanic and Latinx Oregonians who have the lowest rate. So we’re gonna take some time right now to learn about what has worked and what work still remains. We start with Alyshia Macaysa incoming Executive Director of the Oregon Pacific Islander Coalition. Alyshia Macaysa, welcome to “Think Out Loud.”

Alyshia Macaysa: Thanks Dave, Thanks for having me.

Miller: So we’re going to talk about this strikingly successful vaccination effort among Oregon’s Pacific Islander Native Hawaiian Community. But I want to start by acknowledging what came before. Can you give us a sense for how devastating Covid has been for these communities?

Macaysa: Yeah, absolutely. Well, you know, we are the Oregon Pacific Islander Coalition. I mean, we’re a grassroots effort of over 10 different community organizations. An abundance of individual Pacific Islander community leaders, you know, we have some connections to corporate employee resource groups that focus on Pacific Islanders as well. And the one thing that is very much true is that many of our leaders who organized Covid19 response work right now in Oregon have just been so personally impacted by the pandemic. I mean, many of our leaders have, are carrying 5 to 6 deaths of loved ones and family members on their shoulders, themselves. And that’s true for a lot of our community members nationally. There’s a challenge here of historical disinvestment in Pacific Islander communities when it comes to access to basic health resources and information. There is also pieces around our values of gathering as a community and what that means and without the resources to properly guide us into protecting ourselves with Covid. It was just a combination of a lot of structural issues that created this devastating impact on the Pacific Islander community. And that’s the important thing to emphasize, right, is that we always function as a community and not as individuals alone. And so we as coalition leaders just really felt the massive impact that Covid19 was having. And, you know, most of the time when our coalition leaders don’t show up to the coalition meetings, it’s because they’re either at a food drive or they’re at a funeral themselves for someone who has passed away. So, you know, Covid19 is just incredibly personal to all of us.

Miller: We are in a very different time now than in, say, January and February of this year. Because now we have more vaccine supply than demand. And in fact, you know, we’re hearing about vaccine doses expiring. But for months obviously it was the opposite. We heard so many stories about people having trouble getting vaccine appointments online. What were those early days like for members of the Native Hawaiian and Pacific Islander communities?

Macaysa: Yeah, early on, right, there was, we got approached, for example by OHSU, to be a part of their clinical trials on vaccines before they were widely available. And there was quite a bit of hesitancy. I mean our community, like a lot of other communities of color, have a really, I think have a really damaging and traumatizing relationship when it comes to clinical research and consent. And what does that actually entail? So even as a coalition whose folks are informed very much by public health and by data and science, we’re unsure of how to even approach that conversation. So there was quite a bit of hesitancy. But then as the vaccine became widely available, the next question or issue that we really focused on was is it even going to be accessible to us as Pacific Islanders, more broadly? And then let’s focus that question in even more, let’s think about the Pacific Islanders who are most impacted, who have mobility challenges, technology and internet access issues, who don’t read or write or speak in English, like what is accessing a vaccine going to look like for those folks?

It was really challenging, because part of it was just like the lack of the heads up from the Federal government at the time about when vaccines would even be available. We would hear from the different local Health Authorities only like three or four days in advance of ‘here’s the registration link, get your people signed up. But by the time we were able to connect with some of our hardest to reach community members, all of those vaccine slots would already be filled. So we really had to push local Health Authorities to hand over registration power to us. You know, it doesn’t seem like the most innovative solution, but it was actually really impactful to say we can’t have these links widely distributed for the Pacific Islander community. We, as community organizations, need the time to do the intentional engagement and outreach so that our folks who don’t have internet, so that our folks who have a lot of questions about the vaccine, have time to get the information and then we can manually schedule them ourselves.

Miller: So just...

Macaysa: Can’t measure the impact of that. No.

Miller: ...just so we understand it, a county or the state would say you have 200 vaccine doses we’ll make available to you, and it’s up to you to actually figure out who’s going to get them and then you would do that work.

Macaysa: Absolutely.

Miller: And how would you make those decisions? And what kinds of messages were you giving out?

Macaysa: Yeah, I mean, one of the things that we did was that we use our community knowledge right? I think the important thing about the coalition to emphasize is that we don’t just serve the Pacific Islander Community, but we’re part of the Pacific Islander Community. So we really have a pulse on who’s in need of the vaccine, who’s ready and willing, what influential church or religious leaders, feel comfortable and have the information to kind of model for their community of why it’s important to get the vaccine. And so we had a lot of our leaders speaking to their church congregations or their Hula Halau or their youth groups or their parent clubs. So that’s what we really wanted to do, was first connect to the Pacific Islanders who were willing to get the vaccine and had done research on their own and get them access to that to show other community members of like, hey, Pacific Islanders, get vaccinated too.

Miller: So that was, that was sort of the low hanging fruit. and then that could sort of boost, you know, get the ball rolling a little bit.

Macaysa: Yeah, absolutely.

Miller: How did you deal with language issues? Especially, I’m thinking, for elders who might not speak English?

Macaysa: Yeah, I think that honestly continues to be a really big challenge. But one of the benefits of controlling the timeline of registration was that we got to do a really intentional scan before these vaccine clinics to see who needs what languages there. We could also spend our limited resources really wisely. Also many of our coalition leaders who organized the clinics speak those languages such as Samoan, Tongan, Chuukese, and Marshallese. So we always came prepared with those folks, to greet people to explain what the process was going to be in the drive through clinic, to also let them know what other resources are available. But it’s still very much an issue. I don’t think that any of the local health authorities or even the state has really invested the proper resources and infrastructure in folks who not only have the language ability, but the public health education to really accurately convey, what does getting vaccinated entail?

Miller: I’m struck by what you’re saying here, because it really seems like what has made the difference for the Pacific Islander Community, Native Hawaiian Community. It’s not Public Health Authorities, not counties or the state, but it is members of these communities, themselves, coming together, looking out for one another, organizing for one another. Is that a fair way to put it?

Macaysa: Yeah, absolutely. And I will say, at the same time, that our partnership with Multnomah County, in particular, has been really impactful. I know they’ve been doing a ton of work in terms of racial equity, health equity and community partnerships. And so we as a coalition, were able to really organize and push them and say, hey, we’re not seeking permission to do this, but we are inviting you to be a part of this important, culturally specific work. Do you want to partner with us as a local Health Authority? And of course they said absolutely, yes. And then we’ve been able to really take that relationship and use it as a model for other parts of the state, where they may not have the same racial equity framework as a, as a public health authority. But we say Pacific Islanders know how to serve Pacific Islanders best, and our Multnomah County Clinics are an example of that. We know how to get the job done. So let us partner with you in, you know, Marion County, in Union County, etcetera. So that’s what we’re really pushing now.

Miller: As I mentioned in my intro, the state has tracked vaccination rates by race or ethnicity. It’s actually for six groups of Oregonians. That’s the way the state has divided up the data. Native Hawaiian or Pacific Islander, Asian, White, Native American, Black and Hispanic / Latinx. Two things stand out for Native Hawaiians and Pacific Islanders. One, that we’ve been talking about, is at the highest rate by far, vaccinations in the state. But the other is, it’s the smallest population, about 37,000 people, according to state numbers. To put that in perspective, so that 37,000 compared to about half a million Latinos. Has that been an advantage, in terms of being able to reach individual people, given that there’s a smaller pool of people you have to reach?

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Macaysa: Definitely. And I think the other piece that really supported our work was that culturally, we’re just a really tight knit community, right? And there aren’t those massive power differentials or barriers between the folks who are Pacific Islander and work in these service nonprofits and the like, the everyday Pacific Islanders, who also need the vaccine. So it’s just that tight knit culture. The other thing is just the devastating historical disinvestment in Pacific Islanders in this state means that there weren’t a lot of other entities that we got, we had to work through, right? Because there aren’t a lot of long standing and effective relationships between service providers and Pacific Islanders. So we as a coalition who understand culture, who speak the language and who know how to do this work in a really different way. We really have the space to lead. And because of how devastating the impacts of Covid19 have been in our community, we gladly took up that space and said, cool, we’re going to lead this work.

Miller: In just a second, we’re gonna be talking about Oregon’s Hispanic and Latino communities, which as I mentioned, have the lowest vaccination rate statewide. I’m curious, given everything you’ve been talking about, how much of what you are talking about in terms of successful efforts, how much of that you think is transferable to other communities?

Macaysa: I think it’s absolutely transferrable. And I think the other thing to note is that because we have not had the same level of investment in partnership as Pacific Islanders, as other communities of color have had, we also look to the success of their work right? Like we’ve partnered very intimately with the American Indian, Alaska Native community on our vaccine clinics and seeing the way they really transformed their relationship and power dynamics with the Health Authority. We’ve also gotten a bunch of resources and mentorship from the Black and Latinx communities as well. And so, I think there is this moment in time, this critical crossroads that all communities of color are at, we say we’re no longer seeking permission to do culturally specific work and that, if anything, the pandemic shows that communities need to be at the forefront of leading this response, and the recovery from Covid as well.

Miller: Alyshia Macaysa, thanks very much for joining us.

Macaysa: Absolutely. Thanks for having me.

Miller: Alyshia Macaysa is the incoming Executive Director of the Oregon Pacific Islander Coalition. If you’re just tuning in, we’re talking right now about a tale of two vaccination rates. Native Hawaiians and Pacific Islanders in Oregon have the highest rates of any racial or ethnic group, as documented in state data. Hispanic and Latino Oregonians, as I mentioned earlier, have the lowest rate. And my next guest is trying to change that. Oralia Mendez is a Manager of Workforce Development and Community Programs at Oregon State University’s Center for Health Innovation. Oralia Mendez, welcome to “Think Out Loud.”

Oralia Mendez: Thank you, Thank you for having me.

Miller: I’m curious what was going through your mind when you heard just now that the work being done for Oregon’s Pacific Islander and Native Hawaiian communities and the success that they have seen.

Mendez: Yeah, so yeah, definitely, you know, thought provoking, right, what can we do to not reinvent the wheel? What is working for other communities? As a public health professional, I’ve always strived to not reinvent the wheel, where can we partner, where can we use some successful strategies to reach our communities, and then just going off of that. I also was thinking our communities have some similarities, but they are also different, and our fears are different. So there are other challenges for the Latino / Hispanic population that have caused us to not necessarily reach those high rates of vaccination.

Miller: What are the fears or specific challenges that you have in mind? You know, when you said that they’re different, what are the ones that you see as specific to Oregon’s Hispanic and Latino population?

Mendez: Yeah, so you know, there’s some that relate to a lot of our population is seasonal, migrant farm workers, so Ag workers, and the schedules for the seasons are different, some are really long hours. You know, people get up at four in the morning to be ready to go for work at six AM. And then they go through and work until seven PM, eight PM. And so those 9 to 5 clinics are really not attainable. And so also, there’s loss of wages, because some of these are temporary seasonal jobs. There’s a lot of fear of losing wages to take time off. You know, sometimes they have to take a whole day, sometimes they have to take half a half a day, to go to a vaccine site, get the vaccine, and then if there are any side effects, you know, they may fear that they may need to lose wages there. Additionally, location, language, as it was mentioned, I think language is also a challenge. Fear of cost. There’s a fear of cost, even though there is information that we know that there’s no cost for the vaccine. There’s still that fear of needing to show an identification. Are they going to ask me for ID? Are they going to ask me about my citizenship status? And just a lot of, also myths, sometimes can be barriers.

Miller: So if you meet somebody these days who hasn’t gotten vaccinated, what’s your approach?

Mendez: Asking why are you not getting vaccinated? Of course, not being pushy about it, just asking why, and then providing information on if it is, you know, a myth, providing actual scientific information, reliable information that they can actually look up or provided either in a video form because we we have learned in the work that we have done in Lincoln County, that not everyone speaks, not every Latino or Hispanic speak Spanish. There are other languages that are spoken as well, so providing the information that is culturally appropriate for them.

Miller: At this point what do you think is a bigger issue that’s leading to this low vaccination rate, access to vaccines or hesitancy about vaccines?

Mendez: Definitely access. I see that a lot. I mean just you know, if we look at vaccination rates and then we compare that to the demographics across the state, seeing the population, the Latino / Hispanic population rates across Oregon, the counties that have the lowest vaccination rates are also the ones that have the highest Latino populations. So some examples include Umatilla, Morrow County and my hometown of Malheur Camp or my home county, Malheur. And so you know, what can we do? Maybe there’s capacity, maybe there’s access. Some of these are really rural areas. So I definitely see access being the major challenge.

Miller: This is such an important point because I can imagine people saying wait, there have been mass vaccination sites offering vaccines, some of them from seven AM to seven PM for months, now. There are walk up clinics where you don’t need an appointment. You can get a shot at pharmacies. County Health Departments have had a lot of pop up vaccination events. you’re saying, nevertheless, access is still a major issue. So what do you see as possible solutions? I mean, it seems like the solution can’t be mass vaccination sites, you know, at the airport. If we’re talking about people who are maybe seasonal migrant farm workers who are moving around. So what are the options?

Mendez: Right? It’s that collaboration piece, that partnership with farmers, that partnership with, you know, maybe it’s a seafood packing company, maybe it’s a restaurant, really partnering with employers and offering the opportunity to bring a clinic to their sites where maybe workers can come in during a break and get their vaccine and then still be monitored. So there’s not necessarily a loss of wages or if the employer, you know, there’s an example that we’ve given in Lincoln County, where a restaurant employer noticed a pop up vaccination clinic right next to their restaurant and said, hey, let’s shut down for an hour and let’s have everybody go get vaccinated and no loss of wages or anything like that. So, that really motivated a lot of employees to go ahead and go get vaccinated. So definitely, going to local areas where people feel comfortable going to and then offering the vaccine.

Miller: As you heard, one of the really striking things about Alyshia Macaysa’s conversation was that it was really, although she did say that she had good partners with, for example, the Multnomah County Health Department and didn’t have bad things to say specifically, you know about about the state or or other public health entities, that it was really up to Native Hawaiian and Pacific Islander Community members themselves, to do this work. What role can or should County Health Departments or State Health workers play in everything we’ve been talking about?

Mendez: Yeah, I definitely feel like there’s that support that’s needed, right? So, some of what we’re doing essentially in the work that we’re prioritizing now, we still partner with the local County Health Department, but they are mostly doing like, who can be the vaccinators, who can be the people that help register, but really having community members be there, as the first face that you see is someone familiar, someone that looks like you. That’s really important. And then having our local Health Department as support to provide the vaccine so that the other kind of logistical things that we need. But other than that, I think we’re also taking a similar approach where we’re recruiting community members to really lead, this work

Miller: Is the Johnson and Johnson vaccine a key part of the strategy you’re talking about. I mean, to go back to the farm worker Pop Up example or the vaccine clinic outside of a restaurant, it seems like being able to vaccinate people in one dose would be key.

Mendez: Yes, definitely. So, before the announcement of pausing the Johnson and Johnson vaccine, there were a lot of people, Hispanic and Latino community members who were like, yes, I want to get the vaccine and I want to get that single dose one. Then of course, when all that communication came about, Johnson and Johnson not being able to be provided at the events that we thought we would be able to. Then that created a little bit of hesitancy around that. But people are starting to be confident in the J and J vaccine again. And so that is definitely a key part in the efforts that we’re doing. So we’re still going to be offering the two dose vaccines. But in addition to that, we do have some J and J., as well that we like to offer just in case there are those that would like to get just a single dose.

Miller: Oralia Mendez, thanks very much for joining us today.

Mendez: Thank you.

Miller: Oralia Mendez is Manager of Workforce Development and Community Programs at Oregon State University’s Center for Health Innovation.

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