By Jun Nucum
SAN FRANCISCO – It has been three years since the pandemic began but about 24% of Filipino Americans (FilAms) in California, according to the 2021 tracking data, are still not fully vaccinated and boosted despite having a high percentage of health workers and professionals.
FilAms are said to have been disproportionately impacted by the pandemic by three key factors: overrepresentation as frontline and essential workers (e.g., healthcare, food production, and delivery sectors), social inequities (i.e. barriers to economic opportunities, healthcare services, education, and other necessary resources), and the inherent distrust in government (due to historical mistreatment and systemic discrimination). These disparities, together, make this population vulnerable to Covid misinformation that have led many to become hesitant about vaccines.
Additional probing questions
Today, it’s important to look into the three factors that have impacted the FilAm community with the question as to whether they have changed, especially the distrust in government and the continuing impact of Covid misinformation.
Also, do the reports of anti-Asian hate crimes and incidents, related to the pandemic and fueled by false information and conspiracy theories, also added another layer of Covid misinformation?
In Filipino culture, “Pakikisama” is the desire to belong and be a part of a group and words of mouth play a crucial role. But it also has a negative effect as it can also perpetuate false information and rumors on issues like Covid and vaccines. So after three years, have these social conversations among friends and relatives on Covid and vaccines changed in any way?
And finally, it has been widely recognized that virtually all demographic groups have experienced mental health issues due to the constant barrage of Covid misinformation, fueled by political polarization, and the uncertainty around the pandemic. In the FilAm community, have these stressors caused many to augment their distrust towards government’s Covid information and become hesitant about vaccination?
What data tells us about where we are
In a July 2022 article “Latest Data on COVID-19 Vaccinations by Race/Ethnicity” by Nambi Ndugga, then federal data from the Centers for Disease Control and Prevention (CDC) show that 78% of the total population in the United States have received at least one dose of a COVID-19 vaccine while vaccination coverage increased in the first half of 2022, vaccination and booster uptake has leveled off and remains uneven across the country.
Overall, Asian (62%) and White (56%) people had the highest shares of eligible people who had received a booster dose as of July 6, 2022, while across the 36 states for which a total vaccination rate could be calculated by race/ethnicity as of July 11, 2022, 87% of Asian, 67% of Hispanic, and 64%of White people had received at least one COVID-19 vaccine dose, higher than the rate for Black people (59%).
The overall vaccination rate across states for Asian people was higher compared to White people (87% vs. 64%), which was reflected across all reporting states except for North Dakota, South Dakota, and Colorado.
Lawrence Lipana, a dual board-certified physician, specializing in anesthesiology and pediatrics with a subspecialty in regional anesthesiology and acute pain medicine, found a January 2022 study which says that Filipino nurses in Southern California are actually 14% more likely to get vaccinated than their white counterparts.
A September 2022 study shows 85.6% of healthcare workers in North America were vaccinated with 83.6% physicians and 77.4% nurses leading those vaccinated. 74% of Los Angeles County healthcare workers were fully vaccinated.
“The number of those vaccinated with an updated booster in LA county is at 23% so there are a multitude of factors affecting the decision to vaccinate/not vaccinate. Decreasing death rates, less availability of vaccine pop-up clinics, looser federal mandates, more people getting COVID and realizing they only experience a mild illness, lack of education about effectiveness of the bivalent boosters,” said Lipana.
On whether the cited three factors still have have strongly impacted the FilAm community or have they changed either positively or negatively, especially on the distrust in government and the continuing impact of Covid misinformation, Lipana said that the biggest change is probably COVID fatigue and despite the CDC not making the official declaration, the world has transitioned from the pandemic to the endemic phase of the outbreak.
Lipana added that he has not personally talked to any of his Filipino friends/family about vaccine status/booster status.
“I can, however, tell you that in just about all my social circles in Southern California, life has gone back to pre-COVID. Even those who were initially very cautious with COVID have returned to flying on airplanes, enjoying amusement parks, and attending indoor sporting events and concerts,” shared Lipana. “Of course, this is not medical advice, as everyone needs to take their risk tolerance and personal health into consideration.”
Lipana also stressed that the constant barrage of Covid misinformation and uncertainty around the pandemic have caused distress and confusion to the hesitancy.
“Filipinos are generally a resilient and gregarious group of people! We love spending time with friends and family and enjoying the blessings in life. The COVID-19 pandemic caused nearly everyone to feel anxious and nervous, but it also strengthened bonds between colleagues in healthcare and forced people to evaluate their priorities in life,” Lipana said.
Little Manila’s Equity in COVID and Health Outcomes (ECHO) Team Director Kevin Sunga of Stockton California observed that access to health services and economic inequality go hand-in-hand in contributing to negative attitudes on vaccine uptake and that still remains to be true for communities today.
“During the pandemic there was a reliance on community-based organization to outreach and coordinate clinics helping increase vaccine rates among our residents, many of whom are Filipino/Filipino-American. Collectively, we helped make a positive impact increasing vaccination rates. It’s no surprise,” Sunga initially reported. “But the Federal Emergency legislation that allowed for funding to pass seamlessly to community funding COVID-19 related work is scaling back at a rapid rate pulling resources and staff capacity that helped with building healthier communities. That means less accessible opportunities for people to get vaccinated and reliance on traditional healthcare systems that many don’t trust. This is also a problem for residents that can’t access a clinic for miles.”
Sunga also admitted that misinformation does play a role, especially around the belief that the primary series is enough protection against variants.
“We want to point out that we’re seeing more misinformation opposed to disinformation. It’s not the inherent purpose of the residents we talked to spread information maliciously. It’s a misunderstanding in protocols that we need to clear up. Racist and discriminatory policies against our communities, especially for the Filipino and Little Manila community, brought disinvestment,” said Sunga.
Sunga said that disinvestment leads to less opportunities and lack of quality education in immediate community for decades and the systemic issue that has led to much of misinformation that is perpetuating in their communities.
Sunga said he considers that Filipino Americans tend to be more trusting of their healthcare providers as it has been identified in their outreach efforts.
“FilAm’s are more inclined to listen to their healthcare provider and get vaccinated to protect loved ones. The sense of “Kapamilya” is strong among our FilAm’s. I think the attitudes towards healthcare and health agencies have positively increased but there’s still more that needs to be followed-up on such as keeping up with general health checks where stigma still exists,” said Sunga.
Most definitely the pandemic caused many mental health issues, such as anxiety and stress, among Filipino Americans as Sunga stated.
“Sharing space at parties, celebrations or just as family is one of our key traits as Filipino Americans. At the height of the pandemic, all that paused and many were isolated. Some of our residents who were due to celebrate weddings or graduations couldn’t do it so that definitely takes a toll. That is indeed a loss. Loss of opportunity is just as real as physical loss. Physical loss from death due to COVID-19 or other disease was also a reality,” said Sunga.
Add to this, Sunga cited that hospitals were actually more strict during the time of COVID that resulted in having limited visitations and hours in seeing a very ill loved one and that funeral attendance were limited due to social distancing which is really unfortunate but necessary for those who are grieving.
Sadly Sunga and his group see the reduced attitude to bivalent booster uptake is fatigue from the constant updates in safety protocols and fatigue on the COVID-19 subject matter which has been the priority for the last two years.
“I think people are glad to get together. As we approach an Endemic, there are more conversations around what’s next. Some questions I’ve heard are if COVID-19 vaccine schedule will mimic the flu vaccine schedule and the worry of what COVID-19’s long-term effects for those who tested positive in the past. Residents are thinking about what recovery looks like during the unprecedented time we endured,” said Sunga.
California Nurses Association and National Nurses United Filipina American President Zenei Cortez remarked that, three years into this pandemic, the Federal and State governments made it a little easier to access vaccines and booster shots but not until after healthcare justice advocates like nurses who fought for equal and easy access to vaccines and booster shots.
“This is not how we should treat people, especially those who cannot afford to pay for health care. We should all have equal access to healthcare when we need it, regardless of who we are. Healthcare is a human right!” declared Cortez. “FilAm nurses have been in the forefront in helping educate the public and our communities about the importance of being vaccinated and boosted. Our FilAm nurse members have also participated in giving vaccine shots and boosters in public healthcare clinics in the communities throughout the state.”
In a statement, Cortez reminded that frontline nurses have been battling the pandemic nonstop although they are tired, not just physically, but emotionally and mentally as well.
The healthcare and hospital industries have branded nurses as being burned out but that is far from the truth as she underscored that they are morally distressed.
“We know we can do more for our patients and their families, but our working conditions and resources are preventing us from doing so,” vowed Cortez. “Nevertheless, we will continue to care for our patients regardless. As far as how long we can keep it up? Nurses do not know. Only time will tell. Until then, we will remain true to our patients, we will continue to advocate for them.”
Nurse Practitioner and Consultant Richard Yap admitted that, in his line of work in health care, the Filipino community have strongly impacted and changed Covid 19 positively and that Filipinos who refused to be vaccinated from the start of Covid 19 had undergone series of vaccination due requirements of Health Agencies that only vaccinated individuals can work in the system.
Yap also observed that there is no increase of hate crimes among Filipino crimes and incidents related to the pandemic of false information and conspiracy theories.
“Every year, since the pandemic started, the issues on Covid 19 become clearer and more clarified that nobody becomes a monster after the vaccination of COVID 19. At present, the acceptance of Covid 19 vaccination and to have a complete series of vaccination are getting higher acceptance. At present almost 90% of my co-workers had completed the vaccine up to the 3rd booster shot,” recounts Yap.
Yap also remembered that word of mouth played a crucial role to negative effects as it also perpetuated false information and rumors on issues like COVID 19 and vaccines like when Filipino Americans started to question the efficacy of vaccines and where it was produced.
“Words of mouth had changed to positive information and best benefits that highlighted what vaccination does to preserve life, especially to populations of people with comorbidities that generally described Filipinos health status having diabetes, hypertension and immunocompromised person,” Yap stressed. “A large number of Filipinos have accepted the practice of getting vaccinated to be healthy and to build a strong immune system.”
Mental health issues
Yap also viewed that the pandemic mental issues were evident, especially in the first year of pandemic, to Filipino Americans who suffered from such as anxiety and stress and the constant barrage of Covid misinformation and lies and uncertainty around the pandemic have not helped the situation.
“Suffering and confusion due to the hesitancy in taking the vaccine were proven in the first year of Covid 19. Add to this, the increase of death to frontliners caused many old doctors and hospital practitioners to leave the field and decided to call it quits. This resulted in chaos in health care delivery,” rued Yap.
People with Empathy organization’s co-founder Christine Von Raesfeld who has experiences as a patient to speak globally around topics related to health and healthcare think all of the cited factors are important and even more relevant now than in the past.
“Though we have many professionals who work in the healthcare space, we also find that when it comes to any type of illness there are still many stigmas associated that keep us from openly discussing topics around health,” Raesfeld discerned. “Lack of information about vaccines, misinformation about efficacy or side effects, mistrust, and the undervalue of benefits compared to an overestimated risk and cost of vaccination, are some of the reasons we still see hesitancy in our community.”
Raesfeld continued that with that hesitancy in mind, it’s important to educate people not only about the vaccine but to also highlight the personal and social benefits that vaccination can provide. With social gatherings being a big part of Filipino culture, protecting family members from possible infection needs to be addressed.
Community leadership as solutions
“We also must consider the way that social media is used, especially in the Philippines where fake media has already influenced elections. With a history of political agendas and no certified media, it’s often difficult to sort fact from fiction,” Raesfeld observed. “As our community becomes more educated around COVID and the vaccine, I see the conversation shifting. As a culture who holds family in high regard, discussions around protecting loved ones have had an impact in lowering vaccine hesitation.”
Raesfeld believes that having known community leaders assist in education/awareness campaigns has also helped build trust and reduce hesitancy, through simplified messages with a focus on the personal and social benefits the vaccine can provide as through community conversations, some of the hesitancies have been addressed, though more educational campaigns are needed.