HIALEAH, Fla. (AP) — Rigoberto Montesinos, a veteran of the Bay of Pigs invasion in Cuba, was so worried about side effects from the COVID-19 vaccine that he initially wasn’t going to get it, relenting only when two friends died from the disease.

But when he finally decided to get the shot, the 82-year-old couldn’t find doses where he lives in Hialeah, a Miami suburb that’s about 95% Latino. He got an appointment in nearby Miami Beach, but it was canceled. After struggling for weeks, Montesinos got his first dose last week.

“At my age, and with the virus spiking, I can’t be putting myself at risk,” said Montesinos, a Cuban exile who helped try to overthrow Fidel Castro in 1961.

From elderly Cuban Americans in Florida to farmworkers in California, Latinos face daunting barriers to getting COVID-19 vaccines, creating risks for public health as the coronavirus mutates and spreads.

America’s more than 60 million Latinos — like other people of color — have been disproportionately affected by the virus, and many are struggling with issues like a lack of knowledge about the shots, state vaccine websites that don’t have Spanish instructions, ways to find appointments in their communities and fears they could be targeted for immigration enforcement.

It comes as states, cities and counties are grappling with how to ensure people of color and other underserved communities are getting the vaccine, with some targeting vulnerable ZIP codes and working with community groups to sign people up. In Arizona, where language is a barrier for some Latinos and until recently English was the only option on the state website for vaccine appointments, a university researcher is working on an online Spanish language campaign to address vaccine misconceptions.

Latinos, like other groups, also are frustrated by insufficient vaccine supplies.

Montesinos’ 70-year-old nephew, Luis Morejon, was still trying to get inoculated in the Miami area last week. He’s a cancer patient, and he and his wife also have diabetes.

“We’ve spent a year hiding in this home,” Morejon said.

An AP-NORC poll of U.S. adults in late January showed about half of both Hispanic and Black Americans are extremely or very worried about themselves or family members being infected with COVID-19. That’s compared with about 4 in 10 white Americans.

The poll says Latinos’ willingness to get the vaccine is similar to the American public overall. About 65% of Latinos said they definitely or probably will get the vaccine when it’s available to them or that they already have received at least one dose.

With a tendency for health problems like diabetes, obesity and hypertension, Latinos are one of the groups at highest risk from COVID-19 in the U.S. It’s not just a problem for them, but for public health.

“The virus doesn’t differentiate, we need to vaccinate everyone,” said Arizona State University researcher Gilberto Lopez, who’s trying to debunk vaccine misconceptions in Spanish. “Otherwise, it will just keep on mutating and we’re never going to get rid of it.”

In New York, married physicians Dr. Victor Peralta and Dr. Ingrid Felix-Peralta administered shots last week at a public housing complex through the SOMOS network that provides health care to low-income minorities.

“Latinos make up a large proportion of our front-line workers. They work at supermarkets, restaurants, food industry and they are working during the day so it’s hard to find time to get vaccinated,” said Peralta, a pediatrician.

Nellie Hernández, a 73-year-old Puerto Rican, said that after surviving throat cancer and seeing friends die from COVID-19, she was relieved to get her second dose.

“I go out and run my errands, and I feel a bit more secure,” she said.

Fear of deportation can be an issue for Latinos in the U.S. without permission, though the Department of Homeland Security says vaccination sites will be considered off limits for routine enforcement.

“We know that we don’t always get the correct address and phone number when we see patients,” Peralta said about those at his pediatric practice.

Some politicians say people without legal status should not be prioritized for vaccines, even equating all Hispanics, a majority of whom are American citizens or legal residents, with the fraction of people in the country illegally. U.S. Rep. Debbie Lesko, an Arizona Republican, drew criticism last week after proposing an “Americans first” vaccine policy.

Along with fears of deportation, education also can be a problem.

Advocates for Guatemalan farmworkers in Lake Worth, Florida, north of Miami, said some migrants can’t read or write in any language and most lack a car or driver’s license.

The Guatemalan-Maya Center there has started a list of workers who want to be vaccinated and offered its offices as a possible site, assistant executive director Mariana Blanco said.

It’s important to consider demographics when setting up vaccination sites, said Tomás León, senior vice president of the Arizona-based Equality Health Foundation. He said states need to collect information about the race and ethnicity of those getting shots to ensure equal access.

“Hispanics are overrepresented in coronavirus cases and more likely to suffer worse outcomes,” he said.

Many vaccination sites are far away from underserved, high-exposed communities, León said. They’re often drive-thru, requiring a car.

He said community organizations can help reach Latinos in hard-hit areas like Arizona’s Yuma County, where they account for two-thirds of those infected by the virus.

“As efforts to distribute the COVID-19 vaccine continue, trust and acceptance of Hispanics will be crucial,” León said.

In diverse South Florida, the sprawling Jackson Health System says nearly half of the 65,000 seniors it’s vaccinated as of early February identified as Hispanic.

The hospital system has partnered with 55 churches, temples and community organizations targeting seniors in low-income, minority communities who have struggled using technology to sign up for a vaccine.

Madeline Barrios spent two recent Sundays with her clipboard outside St. Dominic Catholic Church near Miami’s Little Havana, registering older people for the shots.

“I think people feel more comfortable, especially seniors, in person, asking someone they can talk to,” Barrios said.

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THE HEALTH DIVIDE

Fear of losing jobs, distrust of the medical community and close-knit housing conditions have led to higher rates of COVID-19 cases and deaths among California’s Latinos. Experts point to the economic realities faced by many Latino families as well as longstanding inequities to explain why the pandemic has hit this community so hard.

A lack of personal protective equipment against the virus on farms, factories and ranches as well as poor access to testing and other issues even in urban areas have hurt essential workers across the Golden State and nationwide, and many of those workers are Latinos.

The high transmission rates and deaths show that employers, the medical community and other sectors all need to build a stronger network to address fears and unite people so they will seek better care, according to activists and health experts.

“If a worker gets infected, there’s no salary coming into the family,” said Maria Lemus, founding executive director of Visión y Compromiso, a California-based volunteer network of promotoras or health promoters, during a recent National Fellowship event. Lemus said that’s one reason why many Latinos, especially migrant farmworkers, may be hesitant to be tested for COVID-19 or seek early care. “I also have to put some of it on the employers. It’s their responsibility to see if the workers are sick (or) healthy. That’s not happening.”

Of the nearly 360,000 people who tested positive for COVID-19 in California since the pandemic began, 60% have been Latinos. Of the more than 16,000 Californians who have died, almost 50% were Latinos.

“Among Latinos, the impact in terms of infections is happening in younger ages,” said Dr. Sergio Aguilar-Gaxiola, a widely recognized expert on immigrant mental health at UC Davis. “I think that part of the story is that these are primarily essential workers. This population doesn’t have the luxury like you or I to stay at home. They have to go and work. So essential workers have been particularly impacted by COVID-19, and Latinos comprise a big portion of those essential workers across the nation, not just California.”

Luis Magaña, a longtime worker advocate and founder of Lucha Migrante in Stockton, sees this firsthand when he promotes self-care to farmworkers and ranch hands in California’s Central Valley. Farm owners often won’t allow testing to be done on site, so Magaña said tests have to be held at clinics. At one event, 600 workers signed up to be tested, but only 300 arrived. Of those, more than 200 tested positive for the virus. Some workers won’t get tested for fear their employers will find out they are sick and fire them. Many workers also worry about high medical bills.

Workers often feel like they have no choice, Magaña said. They have to work to survive.

A recent study that focused on low-income Californians found that one-third of respondents delayed receiving care for urgent or emergency health issues during the COVID-19 pandemic. The study also reported high levels of stress among the more than 2,200 Californians surveyed by the California Health Care Foundation and National Opinion Research Center at the University of Chicago.

Researchers found that 96% of Californians with low incomes report “struggling with the stresses of COVID-19 — including access to food, rent, and childcare.”

“Substantial numbers of people of color say their mental and physical health is worse as a result of the racial discrimination they have experienced throughout their lives,” according to the researchers.

The study found 94% of Latinos surveyed had been impacted by at least one of these stressors during COVID-19.

“It is becoming increasingly clear how many vulnerable populations are delaying the health care they need — with consequences that should concern us all,” Carlina Hansen, senior program officer on CHCF’s Improving Access team, said in a statement. “This is impacting everything from mental health to other health issues. Even in the midst of the pandemic, this survey highlights the next health crisis brewing among some of the state’s most vulnerable groups.”

Lemus, the director of Visión y Compromiso, said her organization is strengthening several programs to help address these stressors, including home visits in which promotores talk about issues such as nutrition and exercise.

“These are not new issues,” Lemus said of the lack of health care among migrant workers in the fields. Lemus worked in the farms as a child, just outside of Fresno.

“I’m an older adult and I still see the same things that I experienced when I was 10 years old,” she said, citing poor housing conditions and a lack of basic services.

“We still have farms and ranches (that) do not provide the services they should to their workers,” she added. “I think if we can ask anything of (employers) is to partner with the community. We want (workers) to continue working, to be healthy. They want their produce to be picked and we want (workers) to have income.”

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