Rosa Reyes was eager to get a coronavirus vaccine when it was finally made available to farmworkers earlier this spring.

She has worked in hop fields around the Yakima region for 15 years, but this last year has been challenging, she said, trying to stay safe at work, keeping the virus away from her and her family.

In April, she finally found a way to get the vaccine on her day off when the United Farmworkers Foundation announced that there were spots at a clinic. Reyes saw the foundation’s post with a phone number, and she was able to get her questions answered.

The April vaccination clinic was flexible, and Reyes didn’t have to have an appointment. She was able to walk up and get her first dose easily.

This ease of access has not been viable for many farmworkers in Washington state, however. And while many clinics and organizations are bringing vaccines to farms and work sites, there is still a lot of work to be done to get farmworkers vaccinated, especially in their communities.

A December survey from the United Farmworkers Foundation found that the ideal location many farmworkers want to receive the vaccine is at a clinic or a trusted health care site, not necessarily at work, said Zaira Sanchez, emergency relief coordinator with the UFW Foundation.

“They are most interested in receiving vaccines at traditional sites, and that’s where accessibility is the most difficult issue (for) scheduling time off and making an appointment,” Sanchez said.

Taking vaccines to farmsBringing vaccines directly to workplaces can be important for those workers who don’t have transportation to get to a vaccine clinic or live in employer-provided housing.

The Yakima Valley Farmworkers Clinics, which are federally qualified health centers, had distributed 60,000 doses of COVID-19 vaccine as of mid-April.

The clinics’ staff are bilingual, and in some parts of the state, the clinics function as many farmworkers’ primary health care provider. The clinics work with local health districts, sometimes sending mobile teams out to farms, as well as offering vaccines in the communities they serve.

Victoria Larios, infection prevention specialist at the clinics, said the staff makes sure to provide comprehensive, translated materials to patients before they get their vaccine. She added that the staff takes time to answer questions, ensuring that there is a clear understanding of the risks and benefits, as well as explanation of the potential side effects.

“We want to make sure they understand what’s happening,” Larios said.

The Washington Department of Health has contracted with Medical Teams International to work with local health jurisdictions and farms, bringing COVID-19 vaccines directly to work sites in Yakima, Grant, Chelan, Douglas, Benton and Franklin counties. The organization has done and will continue to do some clinics outside of these counties as well.

The Department of Health is open to contracting with more organizations as well to bring vaccines to work sites, building off of the models developed in the last year for testing.

This vaccine work was about to begin in mid-April when the Johnson & Johnson vaccine was paused for use nationwide. Medical Teams International had primarily been requesting the single-dose vaccine due to its ease of access and some farmworkers moving locations throughout the season.

“In a lot of ways, the one dose (vaccine) is really important,” said Leslie Aaron, program manager at Medical Teams International.

Teams pivoted, and for some clinics in April, they used Moderna vaccines instead, which will necessitate second clinic visits to farms a month later. The Johnson & Johnson shots, while not specifically allocated to agricultural counties or settings, are commonly offered among providers vaccinating farmworkers, particularly H-2A visa workers who might move throughout various counties during the season.

Aaron said that vaccinations at farms will continue well into the summer with the expected arrival of more than 10,000 workers in May and June. Medical Teams International was also contracted by the Department of Health to do testing at farms.

“It’s quite a bit of work to do for the harvest season,” Aaron said.

As of May 12, Medical Teams International had hosted 15 vaccine clinics at farms in five counties, vaccinating 757 farmworkers.

Clinics at farms can range in size. Medical Teams International did a clinic with a couple dozen workers early in May, and the next week vaccinated more than 100 at one site. Farms are arranging these clinics in advance with the organization, getting the exact number of workers who want the vaccine and passing along that count to Medical Teams International.

Now that the Johnson & Johnson vaccine is approved again, the organization is back to prioritizing those vaccines, particularly for H-2A visa workers who might not be able to get their second dose at the same location.

Engaging the communityWhile critical work is being done on-location at farms in Washington state, advocates want to see more community-based clinics to serve not only farmworkers, but their families and communities.

A December 2020 survey from the United Farmworkers Foundation found that 75% of the more than 2,500 farmworkers they surveyed in Washington lived in households with four or more people. The risk of bringing the virus home to your household is something Reyes was acutely aware of.

Her son is scheduled to get his vaccine, and she convinced her mother, who was hesitant at first, to get vaccinated as well.

“Everyone in my household has been vaccinated or is in the process,” she said in April.

Reyes was able to get a vaccine because she got an alert from the UFW Foundation. The second-dose clinic on April 24 also offered first doses to community members.

Sanchez said the foundation was invited to be a part of the clinic on short notice, and she said she believes more can be done to facilitate community-based clinics for farmworkers.

“We keep missing the target, and we’re frustrated as community-based organizations that we get invited to help with the planning last-minute,” Sanchez said. “So we’re not effectively able to promote and plan.”

A February survey of farmworkers in California and Washington found little hesitancy among farmworkers. Nearly 75% of them were willing to receive a COVID-19 vaccine, according to a survey from the UFW Foundation.

Access is the key.

Washington state and federal health officials are not collecting or releasing industry-specific data on who is getting vaccinated, forcing them to rely on surveys and statistics from employers. This could make tracking how many farmworkers are getting vaccinated incredibly challenging.

Even in states that are tracking professions of each person who is vaccinated, like California, farmworkers are in the same category as restaurant workers, which will likely skew data or not as effectively show gaps, said Leydy Rangle, national communications manager with the UFW Foundation.

Getting the vaccine at work is fine, unless you have a whole workweek ahead of you and little room or allowance to take a day off. Reyes got vaccinated on a Saturday, her day off, and she said this is a common desire in her community, especially after the second dose in case people need to take a sick day.

Larios, with Yakima Valley Farmworkers Clinics, said some farms are scheduling clinics toward the end of the week, or arranging for multiple clinics, so that not all workers get vaccinated at once. Larios said not very many people need to call out sick due to vaccine side effects, however.

“It’s usually a few people that had higher fevers,” Larios said. “They’ve been mild symptoms that are tolerable and usually don’t last.”

Ultimately, more community clinics available on days off or at times that do not conflict with work are crucial to getting more farmworkers vaccinated, Reyes said. The cultural relevance is also vital.

“The information is there and provided and it exists, but it’s provided in a way that’s meant for English-speaking people,” she said.

Reyes trusted the UFW Foundation, which is why she decided to attend the clinic in April, and that community partner trust is important to getting more people to be vaccinated, she said.

“Being able to go to an event and make it a family experience is important as well, and it helps encourage other folks to do it as well – a positive social peer pressure that helps normalize it,” Sanchez said.

Ultimately, Sanchez said she thinks Washington needs to focus on community-driven events and organizations to help get the vaccines out to agricultural workers.

“Farmworkers are going to be left hanging if we don’t get them there and create the spaces for them to know where they can show up,” Sanchez said.