43% of Native Hawaiians and Pacific Islanders (NHPIs) ages 18 to 44 are hesitant to get the COVID-19 vaccine, according to a new survey by researchers affiliated with the Pacific Islander Center of Primary Care Excellence and the American Association of Psychologists.
The number is concerning—especially because 48% of respondents said they are essential workers—and serves as a reminder of NHPIs’ mistrust in the U.S. government after centuries of colonialism and exploitation. As the U.S. and Pacific Islands begin to reopen, NHPIs’ hesitation could threaten efforts to achieve herd immunity, said Melisa Laelan, executive director of the Arkansas Community of Marshallese and co-lead of the Pacific Islander COVID-19 Response Team (PICRT) Policy Council. Vaccinating high-risk populations will be key.
PICRT is a coalition of NHPI researchers, health professionals, community-based organizations and advocates working to fight COVID-19 in NHPI communities, which have some of the highest COVID rates in the U.S.
When infection rates are calculated per 100,000 populations, cases among Native Hawaiian and Pacific Islanders are the highest compared to any other racial or ethnic groups in Washington D.C. and 14 of the 21 states that report disaggregated NHPI data, Vox’s Rachel Ramirez reports. They contract COVID at rates up to five times that of white people in Los Angeles County alone.
NHPI COVID death rates are also the highest in D.C. and 11 of the 16 states reporting the demographic’s mortality data.
In Hawaii, the only state that disaggregates data between Native Hawaiians and Pacific Islanders, Chuukese, Marshallese, and Samoan residents are more than twice as likely to suffer severe COVID outcomes compared to other racial and ethnic groups.
Experts like Manumalo Ala’ilima, executive director of UTOPIA Portland and lead of PICRT Data and Research Council, point to “longstanding inequities in income and education attainment” that drive NHPI communities’ decision to engage or not engage with recommendations like vaccines.
According to the survey, which sampled 1,262 NHPIs, two-thirds of respondents said they have a high school diploma and/or attended some college. 17% reported having a bachelor’s degree, compared to 36% of all Americans. Meanwhile, 68% of Marshallese and 62% of Samoans reported a loss of income during the pandemic; respondents identified financial stressors as their top concern.
68% of NHPIs also expressed difficulty seeing a medical provider during the pandemic. Over 40% of Marshallese, Native Hawaiians, and Samoans reported experiencing anxiety or depression.
“Delays in receiving healthcare in our community that already has high rates of COVID-19 predisposes us to poor outcomes,” said Joseph Seia, executive director of the Pacific Islander Community Association and co-lead of the PICRT Policy Council.
Because Pacific Islanders already suffer disproportionately on multiple fronts, including chronic illnesses and socioeconomic barriers that block access to health care, they are more vulnerable to COVID’s severe impacts, Ramirez writes.
Many in the Pacific Islander community, especially Micronesians who are migrants under the Compact of Free Association (COFA), are more likely to be uninsured. They’re also more likely to be frontline essential workers, increasing their risk of exposure.
Under the COFA agreement with the U.S., migrants from the Federated States of Micronesia, Marshall Islands, and Palau are allowed to travel, live, and work in the U.S. for free without a visa or time constraints. In exchange, the islands give the U.S. access to their Indigenous Pacific lands for military use. Last December, Congress agreed to restore Medicaid for COFA migrants after 25 years. Still, access to health care is never guaranteed.
“U.S. Pacific Island territories have some of the highest rates of recruitment into the U.S. Armed Forces, reflecting the commitment of our men and women who are willing to die in defense of the freedoms we Americans so richly enjoy,” Raynald Samoa, lead expert of the Pacific Islander COVID-19 Response Team, testified before Congress last year.
Yet Pacific Islanders, already at higher risk of infection, continue to “report experiencing discrimination in health care settings and a mistrust in seeking health care services,” Samoa said.
NHPIs have urged the government to partner with NHPI community-based organizations to collect data and inform hesitant NHPIs on the vaccine through “community and culturally aligned practices.” They’re also calling on the government to fund poverty reduction programs aimed at boosting NHPIs’ financial autonomy and closing the educational achievement gap.
Most notably, the coalition implores the government to expand all federally funded benefits to include “habitual residents” so citizens of the Federated States of Micronesia, Palau, and the Marshall Islands are covered.
Though not explicitly stated, the report reinforces the need for widespread data disaggregation—and why it matters. “It’s vital that public health data researchers in the U.S. change how we collect race and ethnicity information in population health surveys. To understand vast differences between the Asian and NHPI experiences, we cannot keep lumping them together,” Ninez Ponce, director of the UCLA Center for Health Policy Research, told UCLA Newsroom. “If we don’t make this change, we’ll never achieve health equity.”
