The pace of COVID-19 vaccinations has increased rapidly in North Carolina this month with the growth in vaccine supplies, the addition of new vaccination sites, and expanded eligibility. But the push to vaccinate millions of people continues to face challenges — especially in historically underserved communities where strained relationships with the government and health care providers make some people resistant to accepting the shot.
And while many of these issues have been explored in Black and Latinx communities, advocates for Asian-American communities in North Carolina say their unique struggles in the pandemic aren’t widely understood.
Part of that problem: a general misunderstanding of who Asian Americans are and how separate communities have their specific challenges.
“Our community is a monolithic group often referred to as Asians American and Pacific Islanders,” said Hyun Namkoong, policy advocate with the North Carolina Justice Center’s Health Advocacy Project. NC Policy Watch is also a project of the North Carolina Justice Center.
“But we have more than 17 million members and 50 different races and ethnicities,” Namkoong said. “And we’re just put into this huge category. Among us we speak so many languages and have so much diversity and a lot of times it’s this single category of Asian Americans/Pacific Islanders that really hides a lot of the disparities and challenges that our communities are facing.”
In an online event hosted last week by North Carolina Asian Americans Together, Namkoong shared statistics that go beneath the surface of the broad ethnic and racial designations. As a large group, Asian Americans appear to have a lot of attributes that would lead to better access to health care and better health outcomes: high education levels, high median incomes, low rates of obesity and a general life expectancy rate about the same or higher than non-Hispanic white people.
But when this picture is broken down into the many and diverse groups that actually make up the larger designation, important differences become apparent.
Asian Indian and Filipino communities are among the highest earning, according to U.S. Census Bureau statistics, with incomes well above the U.S. median of just over $50,000 a year. But many Asian communities — Thai, Laotian, Samoan, for instance — fall beneath the U.S. median. Others — like Burmese, Bhutanese and Micronesian communities are near the bottom of the Asian Americans’ income scale, earning between $25,000 and $30,000 a year.
In North Carolina, one of only 12 states not to expand Medicaid, this can mean a lot of Asian Americans lack health insurance and access to good medical care. Research shows that Korean, Vietnamese and other Asian Americans are significantly less likely to have health insurance coverage as compared to Indian-Asian and Chinese-American communities.
The pandemic has also hit Asian Americans hard, economically speaking. Half of all minority owned businesses in America are owned by Asian Americans, Namkoong said. That can put them at increased risk of losing their business and with it their health coverage.
Beyond health coverage, there are barriers of language and culture that are different across the many different Asian communities in North Carolina.
Research shows that 74% of Asian Americans speak a language other than English at home with their families. Many “heritage speakers” can serve as translators for their relatives who speak limited English, Namkoong said. But that can be difficult in a medical setting.
“Translating in a medical setting is extremely difficult,” Namkoong said. “It’s just a type of vocabulary you don’t use on an everyday basis. I speak Korean. I can talk with my parents. But I can’t talk about my liver. I don’t know how to say tuberculosis. I don’t know how to say chemotherapy. That’s just language that is out of my skill set.”
Only 1 in 4 U.S. teaching hospitals provides training for doctors to work with interpreters, Namkoong said. Health resources like literature and websites are often offered only in English and Spanish — including the Find My Group NC website from the North Carolina Department of Health and Human Services that is supposed to help people find their designated vaccination group. When Asian language translations are available, they tend to offer perhaps two or three native languages, even though Asian Americans in North Carolina speak dozens of different languages.
Culturally, Asian-American families have the highest percentage of multi-generational households. That can make issues like school reopening or navigating in-person jobs difficult, Namkoong said. While most children may be less at-risk for the worst outcomes of COVID-19, they can transmit it to older relatives who are at greater risk. It can also be harder to socially distance or quarantine in a household that includes several generations of people with varying risk factors and lifestyles.
Historical racism and a current spike in hate crimes toward Asian Americans because of right-wing rhetoric during the pandemic can also make community members wary of going through the bureaucratic processes involved in getting vaccinated.
At another NCAAT event last month Hattie Gawande, deputy director of governmental affairs for the North Carolina Department of Health and Human Services, said it’s important for people to understand that no ID or other paperwork is necessary to get vaccinated.
“From the very beginning of our vaccine distribution efforts, we have been telling people that you not only don’t have to have an ID but you only have to self-attest to eligibility to get a vaccine,” Gawande said.
That means that no one will have to prove they are a frontline worker or otherwise eligible because they are part of a specific group. Those administering the vaccine are to take people at their word. No proof of employment, insurance, driver’s license or Social Security number is necessary.
But helping people understand that can be a heavy lift, Gawande said. Even if they do, they may still be resistant.
“In general our communities do — already before COVID — have a bit of a stigma around health care, around going to the doctor, around certain treatments and modern medicine,” said Phian Tran, NCAAT’s community engagement director.
“I know some folks I’ve been hearing now have been saying, ‘I’m just going to rely on my traditional medicine, my TCM (Traditional Chinese Medicine),’ that kind of stuff,” Tran said. “And sometimes, especially the way the pandemic has been politicized, it’s a little difficult to have these conversations with people who are just not on board.”
Gawande said she has seen this within her own family, including What’s App and Facebook posts in which family members have discussed “natural immunity to the virus.”
“The only thing that has worked for me is to make it personal — to say this is why I’m getting the vaccine and this is why I know it’s safe,” she said.
There are people who might not feel safe at this stage, she said. But once they know friends and family who have been vaccinated without ill effects, that could change.
Jenny Lee, a case investigator with the Mecklenburg County Department of Public Health, said emphasizing those who have been vaccinated and their experiences can help.
“I always mention our health care workers or those running the country have already gotten their vaccines,” Lee said. “We’re not trying to get rid of those people. We’re trying to stop the spread so that we can eventually go back to a restaurant or just be outside and hang out with our friends again.”
But making the conversations personal to the family can often be even better in overcoming resistance, she said.
“In our family it’s our grandma who has been fully vaccinated,” Lee said. “It’s not like we’re trying to take out grandma.”