DESPITE having arguably the highest number of health workers per capita in the community, Filipino Americans rank below other Asian populations in terms of vaccination rates.
There are three possible contributing factors that may have led to low vaccination rates among Filipino Americans, including those residing in Los Angeles County.
Among these are: the high exposure to COVID-19 misinformation through social media; historical trauma and distrust toward the government, and doubts on safety and efficacy of vaccines.
Social media dilemma
“It took us a while to get the vaccine. I always watch videos and read items in social media about the vaccine. At first, we didn’t want to get it because we read from the internet that the first vaccine that was available (one dose Johnson & Johnson) was not that effective and those who will be vaccinated first will serve as guinea pigs to test if the vaccine works or not,” said digital creator Aireen Marquez, 46, a mother of two teenage boys.
Marquez, who has lived with her family in Hawthorne for more than three years when the COVID-19 pandemic was at its peak, admitted that when the vaccine became available in late 2020, they opted to wait to get vaccinated due to their exposure to a lot of misinformation on social media.
The deadly coronavirus, caused by the SARS-CoV-2 virus or COVID-19, wrought havoc on mankind at the onset of 2020. Millions of people were affected and perished due to the lack of adequate and appropriate information about this infectious disease.
Originally identified in China in 2019, the virus is characterized by symptoms, including fever and cough, and is capable of progressing to severe respiratory symptoms and in some cases death, especially in older people and those with underlying medical conditions.
The World Health Organization (WHO), after more than 100,000 cases in 114 countries and over 4,200 deaths, declared COVID-19 a pandemic on March 11, 2020.
At the beginning of the pandemic, WHO told the public that the best way to prevent and slow down transmission was to be well informed about the disease and how the virus spreads. People were asked to protect themselves and others from infection by staying at least one meter apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently.
According to the study “Social Media Use and Misinformation Among Asian Americans During COVID-19” by Stella K. Chong, Shahmir H. Ali, Lan N. Ðoàn, Stella S. Yi, Chau Trinh-Shevrin and Simona C. Kwon, social media has been crucial for seeking and communicating COVID-19 information.
However, it has also promulgated misinformation, which is particularly concerning among Asian Americans, including Filipino Americans, who may rely on in-language information and utilize social media platforms to connect to Asia-based networks.
This study noted that Asian American social networks are distinct from other communities. These networks may include family in other Asian countries and include dissemination of non-English information on social media.
In the same study, it showed that Asian Americans, who comprise 5.5% of the U.S. population are leading users of internet and mobile technologies, evidenced through higher ownership of smartphones, laptops, and wireless networks.
Approximately 94% of Asian American households, the study stated, own a smartphone in the U.S, which increases access to the internet and social media for entertainment, information seeking, and social connectedness
In particular, Asian Americans (many of whom are first generation, foreign-born immigrants) utilize the internet and social media to seek and receive up-to-date health information.
Based on a Pew Research Center report, social media also allows for cross-national social connectedness to family and friends in home countries, and the efficacious transfer of health, political, economic-related information in native languages.
True to this report’s findings, Marquez says her constant communication with immediate family in the Philippines through social media platforms like Facebook also swayed them against getting immunized early.
“Back home in the Philippines, when my brother, a member of the Armed Forces in the Philippines, told me he already got his vaccine, and he turned out to be fine, then we thought, we should be okay, too,” she added.
She also says most of her family members back home work as frontliners so they were required to get vaccinated, even despite personal beliefs.
“My family are mostly soldiers, nurses, lawyers, police officers and doctors. They interact with the public that’s why they need to be vaccinated. Everybody seemed to be fine after getting the vaccine so all our fears about the effectiveness of the vaccines eventually faded off,” said Marquez.
But she says their vaccine hesitancy also did not last that long as they were left with no choice but to get jabbed.
“My husband’s employer required all employees to have the vaccine so when he went to get his vaccine, me and my sons also got ours,” she recalled.
The WHO defines vaccine hesitancy as the delay in the acceptance, or blunt refusal of, vaccines.
The United Nations-sanctioned agency also described vaccine hesitancy as one of the top 10 threats to global health in 2019. Conversely, vaccine confidence relates to individuals’ beliefs that vaccines are effective and safe.
Marquez, meanwhile, points out that being a frequent traveler, full vaccination is also a must.
“We have no choice but to comply with the government’s travel rules. We always visit our parents in the Philippines,” she added.
It was noted that despite the prevalent use of social media among Asian Americans including Filipino Americans, there has been limited research on Asian Americans’ pattern of social media use by age, gender, and socioeconomic status. Frequently, Asian Americans are not included in national datasets on social media use and engagement.
The lack of disaggregated data on Asian Americans reportedly took its toll on a young Filipino American adult whose naviety on COVID-19 misinformation cost her her job.
A 25-year old Fil-Am, based in Downtown LA, who requested anonymity, used to work as a medical assistant at a physical therapy clinic in Torrance. However, she lost her job for refusing to be vaccinated due to a fear of unwarranted side effects of the COVID vaccine.
Prior to heightened pandemic scare, Mary (not her real name), said she spent most of her time on various social media apps and platforms. Her apparent failure to decipher a misinformation from a fact about COVID-19, led her to a more unfortunate “side effect.”
“It’s really frustrating that I opted to get fired than to get the vaccine which efficacy, I believe at that time, had yet to be fully established. I was so scared that I might not be able to bear another child if I get that anti COVID shot,” said Mary, who has a 4-year-old daughter.
Charles Lawrence Chamorro, an administrator of the popular Southern California (SoCal) Pinoys social media group, is adamant and more discerning of the information being disseminated on these social media platforms.
“I got vaccinated. I was not afraid and did not get affected by social media posts,” Chamorro remarksed when asked if his active engagement in social media affected his discretion to take the COVID-19 vaccine.
Distrust in vaccine efficacy and safety
Despite extensive exposure to misinformation on social media, some middle-aged Filipino Americans, especially those who work in the medical field, are sharing different perspectives.
Though Tatum David, a registered nurse (RN) at Liberty Healthcare, acknowledgeed the existence of “myths” around COVID-19, she said her family’s judgment with regard to taking any vaccine, medication and getting treatment for the virus was and has always been completely thought of.
“I heard some myths surrounding the COVID-19, like the vaccine affecting reproductive system and menstrual cycle, but my own judgment as a parent and as a person in the medical field has almost always prevailed,” said David, pointing out that her family are all vaccinated, especially her children.
Data from the Los Angeles County Department of Public Health Services showed that as of April 2023, Asian American children got the highest vaccination rate at 84.1% and 81.5% for 5+ years old and 12+ years old, respectively.
“I am aware that like any other vaccines and some medicines, there could be a lot of side effects,” explained David, who is also certified corrections health care professional and psychiatric mental health nurse practitioner.
Being in the medical field for more than 17 years, David, a mother of three children with ages 7-10 years old, pointed out that, “I always see to it that I educate my family especially my children (with regard to COVID-19 vaccination and treatment).”
David, 41, also believes that her long-time experience as a health worker has helped her become more discerning about COVID-19 related issues.
“I always believe in the power of science and medicine,” she added.
A loss of trust in health authorities has been a reported key determinant of vaccine confidence, with misconceptions about vaccine safety being among the most common reasons for low confidence in vaccines.
Husband and wife Jerome and Jam Libiran, both RNs from Santa Clarita, were among the first to take chances on the COVID-19 vaccine.
Jam, 33, who works at a dermatology clinic in Santa Monica, and Jerome, an RN at Ronald Reagan UCLA Medical Center and Kaiser Permanente Thrive, know that during those trying times, they need to completely trust the system.
“The moment the vaccine became available for frontliners, we didn’t hesitate to grab the opportunity to be protected as we know we would need it to have a fighting chance to survive the virus, just in case, we’ll catch it. We didn’t hesitate to get the vaccine because we trust the process. We’re briefed on how it has been tested and proven effective. We believe that it will be our first line of defense during the battle of COVID,” the couple, who has a two-year old son, said.
Jerome recalls that during the onset of the pandemic, they would have monthly staff meetings on new protocols and updates on COVID-related cases.
“These regular updates and information sharing from the hospital management on the vaccines’ development have greatly helped us in appreciating the importance of being protected from the virus,” he noted.
Of the 4.2 million Filipino Americans in the United States, around 506,000 are based in Los Angeles, according to the 2019 data of Washington-based polling firm Pew Research Center (PRC).
An estimated 4%, or about 150,000, of nurses in the U.S. are Filipino.
An earlier study showed that over 30% of the 205 nurses who have died are Filipino American, though the group makes up just 4% of the nursing workforce. In California, where about 20% of nurses identify as Filipino, they account for 11 of the 16 COVID-19 deaths in the profession, or nearly 70%, according to the California Nurses Association.
Among health care workers as a whole, the outsized impact of the virus on Filipino Americans is likely much greater.
In California — where more than 39,000 health care workers have contracted COVID-19 and 191 have died — Filipino Americans comprise about 12% of all health care workers and 11% of health care support jobs, like assistants in nursing homes.
A National Nurses United (NNU) report released in September 2020 entitled, “Sins of Omissions”, indicated that at least 329 RNs have died of COVID-19 and related complications since the beginning of the pandemic. The data collection tracked deaths up until February 11, 2021, and also found that at least 3,233 health care workers, including RNs, have died from the virus.
Of the 329 deaths, 83 individuals were of Filipino descent, according to the NNU report.
“Eighty-three (26.4 percent) of the 314 registered nurses, for whom race/ethnicity data is available, who have died of COVID-19 and related complications are Filipino. They make up four percent of registered nurses in the United States,” the report said.
Among the 170 RNs of color who have died, nearly half (48.8%) have been Filipino. The data comes from 314 registered nurses for which race and ethnicity data is available.
In Los Angeles alone, about 23.1% of the total employed registered nurses are Filipinos, based on a study by University of California (UC) San Francisco (UCSF).
Historical trauma, religion
In a study entitled “The Role of Religions in the COVID-19 Pandemic: A Narrative Review,” the authors recognized that “culture, religion and health are closely intertwined, profoundly affecting people’s attitudes and behaviors as well as their conception and experience of illness and disease.
Wherever in the world they live, most Filipinos — especially those who grew up mostly in an environment full of myths, superstitious beliefs and strong religious ties — are still somewhat governed by these cultural and ancestral influences.
But Roy Caballero, an elder at Rosewood Methodist Church in Los Angeles, dismissed these influences and pointed out that he has not encountered any form of misinformation at churches, at least within his own congregation.
When asked if religious leaders in his place of worship have, in any way, influenced his decision to get inoculated, Caballero said, “No, my church just informed us about safety protocols.” “Our church observed all government directives. Yes we closed for a while but continued our worship services online. We opened as soon as the government said it was safe,” he added.
The 70-year-old Caballero, who lives in Glendale, admitted that he previously had no plans of getting the vaccine because he believed that following the safety protocols would protect him against COVID-19.
However, his hospitalization in 2021 necessitated the administering of the vaccine.
“I had a back injury for surgery and they required me to get vaccinated along with other vaccines like pneumonia and flu. And it was okay by God’s grace,” he recalled.
With a bit of knowledge on medications having worked with pharmaceutical companies before, Caballero said, “personally, I try to avoid all of them including vaccines. But I wouldn’t be a stubborn old man and refuse doctor’s orders,” he opined.
Caballero’s decision to be vaccinated, he said, is likewise influenced by close family ties.
“My sister and daughter are nurses and they’ll be the first ones who will scold me if I don’t cooperate,” he added.
Lerma Silo, 73, who migrated to the U.S. when she was in her late 60s, said she never considered taking any other forms of medication in lieu of vaccine since she really got scared when she heard a lot of elderly people dying because of COVID-19. “My daughter told me not to take any chances. The moment the vaccine arrived and ready, I got it,” she said.
Silo, a devout Catholic from Gardena, was convinced that fervent prayers and early vaccination saved her life when she got exposed to the virus.
In her late 60s, Letty (not her real name) from Torrance, had a long compelling time before her daughter, who is a doctor, could persuade her to get vaccinated.
“With all the news coming out in social media saying this is just a simple case of flu but became a conspiracy theory, and a money making plot by pharmaceutical firms, and targeting and getting rid of elderly and sick people to save on pension funds and health care benefits were really just too much to bear then,” said Letty.
But with her daughter’s assurance, she eventually agreed to get the Moderna vaccine.
Asian American seniors aged 65 and older were on top of the vaccination rate chart of LA County Department of Public Health at 86.5%.
Preliminary observations from The FILLED Project (FILipino Lived Experiences during COVID-19) published by the International Journal of Environment Research and Public Health revealed that “health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans.”
From April to August 2021, the FILLED Project launched a cross-sectional online survey between among Fil-Am adults in Southern California to document community issues and outcomes during the pandemic.
Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic.
Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider.
Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4 %).
On COVID-19 impact, participants reported moderate[1]severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%).
This study was believed to be the first community-driven effort highlighting Fil-Am community experiences with the vaccine in Southern California, where the highest proportion of Fil-Ams in the United States reside.
The FILLED-commissioned survey noted that the observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address Fil-Am and sub[1]Asian group health disparities at grassroots to societal levels.
Despite being one of the largest and most-rapidly expanding ethnic groups, the Fil-Am community’s needs are poorly understood.
The survey further noted that “often aggregated with other Asian American groups, the social and economic diversity among Asian sub-ethnic groups is masked and overlooked compared to other racial and ethnic groups. Systemically, the pervasive ‘model minority myth’ harms sub-ethnic Asian groups as it universally stereotypes Asians as healthy and smart, erasing the diverse and unique sociopolitical, migration experiences, and/or cultural histories distinguishing Asian Americans across generations.”
The FILLED survey likewise pointed out that “such biases contributes to the lack of in[1]language and/or culturally appropriate health services and prevention material for immigrant Asian Americans whose primary language is not English; this exclusionary action skews surveillance reports with an abundance of not only English proficient individuals, but with higher income or education attainment, and more likely to utilize services or participate in research.”
“The COVID-19 pandemic thus revealed and exacerbated existing disparities among ethnic minority and marginalized groups, especially with the allocation of resources, funding, culturally appropriate outreach, and community utilization of preventative services (e.g., screening, vaccinations, etc.) Specifically, individuals with pre[1]existing health conditions were at increased risk of COVID-19 infection, hospitalization, intensive care, and death,” the survey added. (By Donnabelle Gatdula Arevalo/AJPress)
This article is a two-part reporting series on the COVID-19 misinformation’s impact on the Filipino American community in Los Angeles County. The Asian Journal is commissioned by the Ethnic Media Services under California Department of Public Health (CDPH) COVID-19 Myth Buster Initiative II
