At 72, Dolores Fontalvo is part friendly neighbor, part psychologist. She's also a linchpin in the state of Maryland's successful effort to narrow the vaccination gap between its white and Latino residents.
Fontalvo is one of dozens of volunteer promotoras — literally, health promoters — with CASA, a Latino and immigrant advocacy group. The job involves visiting high-traffic areas like shopping malls and farmer's markets in heavily Latino neighborhoods in the Maryland suburbs of D.C. With her long braid swinging and her eyes smiling behind a mask, she spends her days approaching other Latino immigrants who, like her, primarily speak Spanish, to make sure they know where and when to get vaccinated against COVID-19.
These days, Fontalvo says, many people are eager for the information or have already gotten their shots. But occasionally she encounters misinformation. "People hear negative rumors like, oh, the vaccine contains a microchip or vaccines kill people," Fontalvo tells me in Spanish.
Her answer to that? "All of us are vaccinated and we're all healthy. Nothing has happened to us."
In Maryland, as in the rest of the U.S., vaccination rates for Latinos have lagged behind rates for whites. But in recent weeks, many states have seen a growing share of vaccines go to Hispanics.
As of last week, 50% of Maryland's Latino population had received at least one dose of the COVID-19 vaccine, making it one of a handful of states to hit that milestone, according to the Kaiser Family Foundation. And public health experts say the promotora model of community outreach has been key to Maryland's success.
"When you can get a vaccine from someone in your community, someone that you know and you have a prior relationship with, you're more likely to," says Neil Sehgal, an assistant professor of health policy at the University of Maryland School of Public Health who has been studying the state's response to the pandemic.
CASA's promotoras have been seeding that relationship with the Latino community for decades, with outreach on long-term issues like diabetes and HIV.
Fontalvo has been doing the job for nearly 18 years. She says she often encounters people who suffer because they lack support. I witnessed this first-hand one day in June, when a woman named Antonia Aquino approached Fontalvo outside a Latino grocery store in Langley Park, Md., asking where she could send her grandson for a shot. Suddenly, Aquino broke down crying as she recalled her own bout with COVID-19 last year, which landed her in the hospital.
"I said goodbye to my children. I lost my job," Aquino told Fontalvo. She said she now faces a pile of unpaid bills, with nowhere to turn for help — and she wants to see her grandson get protected. Fontalvo comforted Aquino, encouraging her to look to better days ahead, then gave her phone numbers to call for financial and mental health assistance.
Throughout the pandemic, CASA's promotoras have provided this kind of vital support to a community left reeling, says Dr. Michelle LaRue, the director of health and human services at CASA.
"Our community has suffered not only from COVID but also all the social consequences that have come with COVID, so housing insecurities, food insecurities, financial insecurities due to job losses or hours cut," LaRue says.
She says promotoras helped spread the word about how to prevent COVID-19 and where to get tested. They also connected people to desperately needed resources like food and rent assistance. And early on, CASA recruited promotoras to participate in COVID vaccine trials.
"We use that to promote vaccines," LaRue says. "So we know for a fact that this vaccine works on us, and to try to bridge some of those trust issues that our community may have."
But it's not just trust issues that explain the vaccination gap among Latinos nationwide, says Samantha Artiga, vice president and director of racial equity and health policy at the Kaiser Family Foundation. She says Latinos have faced an array of barriers to vaccination. Many lack paid time off work, transportation or Internet savvy.
"Some people have concerns about getting the vaccine in terms of negative consequences on immigration status," Artiga notes. She says surveys have also found larger information gaps among Hispanic adults on where to get the vaccine and whether they're eligible, as well as language barriers.
Cindy Escobar, 24, has been working as a promotora for just a few months. She says she decided to take the job after she got vaccinated and found herself fielding questions from friends and family about where they too could go to get a shot. "That's what pushed me into this, wanting to help them," she says.
When Maryland formed its vaccine equity task force in February to help overcome some of these issues, it turned to CASA and its promotoras early on, says Brigadier General Janeen Birckhead, who heads the task force. She says the task force homed in on Maryland's D.C. suburbs because the Latino population there had been hit so badly by COVID, and it wanted to capitalize on the trust that CASA had already built.
Birckhead says promotoras have played a critical role in expanding vaccine access. Not only do they get the word out, they also help staff bilingual clinics in neighborhoods with large Latino populations that are open off hours and late hours so people can go after work.
"It's that on-the-ground work that we have to continue to do to get into the community," Birckhead says. "The trusted voice, the person you may know or the person you may trust, and they're bringing the message to you about the vaccine."
Sehgal of the University of Maryland says the promotora model is also being used increasingly in other places, including in southern California. But the way that Maryland's CASA program works — with its robust partnerships with community clinics, county leaders and the state vaccine equity task force — stands out.
"Nationally I think CASA and CASA's partners are really leading the way," he says.
He'd like to see expanded government support for the promotora model continue beyond the pandemic to combat other health disparities.
Promotora Dolores Fontalvo says she'll be ready. She says helping people is what gets her out of bed each day. When I ask her how much longer she plans to stay on the job, she tells me, "Until my body gives out."
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