Covid-19 Vaccination

COVID-19 Vaccines. Too Critical for a Language Barrier

With the public release and administration of COVID-19 vaccines in the United States, there is much information for government agencies, businesses, and health care providers to share with people who likely have many questions:

  • Vaccine Availability
  • Vaccine Cost
  • Federal and state guidance for vaccination priority
  • Are vaccines mandatory?
  • Information about mandatory vaccination exemptions because of disability or religious accommodation
  • And much more

But what about people who cannot speak or read English? What about people who have visual and hearing disabilities? How do they obtain the information they need to protect themselves and their families?

COVID-19 and Language Barriers

The pandemic has already laid bare significant racial and linguistic disparities negatively impacting health and safety.

For example, according to the Houston Chronicle:

“…The Hispanic community is being disproportionately affected by the pandemic, and experts say language barriers and lack of translated health information are a big reason why. In response, hospitals and health departments are hastily launching marketing campaigns, increasing community outreach efforts and altering translation services to accommodate the surge in Hispanic patients.

When July Garza sought out a COVID-19 test in early July, the mother of eight had lost her sense of taste and smell and couldn’t catch her breath. Worried she might have the coronavirus, Garza spent two days trying to get tested at the Santa Clara Family Clinic off Telephone Road in south Houston. She paid $110 for a blood test that came back “negative,” the word circled and underlined twice. She was relieved.

The next day, she passed out in the shower.  It just got worse and worse, Garza, 29, said. I have eight children at home, three with medical conditions… and one already started getting symptoms.

Garza later discovered the test she had taken was for COVID-19 antibodies – not the virus. In hindsight, she said she had noticed multiple patients complaining in Spanish to a front desk employee about tests they had been given. She remembers seeing one bilingual staff member in the packed waiting room of mostly Hispanic patients and noticed all of the paperwork was in English.

I felt taken advantage of…I wasn’t the only one, Garza said. It was wrong, they should have explained, taken more time and used more safety precautions…”

Learning from Mistakes

Now, as the COVID-19 vaccination program begins, all involved in administering vaccines must learn from one of the pandemic’s myriad revelations  – the critical necessity of providing legally required information in languages that people can understand so they have access to health care and medicines that can save their lives.

Language assistance concerning pandemic and emergency information is clearly a matter of life and death, especially now with the complexity of material associated with the new vaccines. The amount of information connected to the nascent vaccination program is staggering, and is likely to grow as the Biden administration takes office and accelerates vaccine distribution and production.

New material from the U.S. Centers for Disease Control (CDC) also highlights the necessity to inform people about the vaccines and give them the salient facts they need to make informed decisions about their health care. The material can be accessed here:

For example, the CDC highlights these key facts for people to know about the COVID-19 vaccines:

The safety of COVID-19 vaccines is a top priority.

COVID-19 vaccination will help protect you from getting COVID-19. Two doses are needed.

CDC is making recommendations for who should be offered COVID-19 vaccine first when supplies are limited.

There is currently a limited supply of COVID-19 vaccine in the United States, but supply will increase in the weeks and months to come.

After COVID-19 vaccination, you may have some side effects. This is a normal sign that your body is building protection.

Can a COVID-19 vaccine make me sick with COVID-19?

Cost is not an obstacle to getting vaccinated against COVID-19.

The first COVID-19 vaccines are being used under Emergency Use Authorizations (EUA) from the U.S. Food and Drug Administration (FDA). Many other vaccines are still being developed and tested.

COVID-19 vaccines are one of many important tools to help us stop this pandemic.

In addition to the language barrier, cultural differences and illiteracy in the native language also negatively affect communication without necessary planning. Ensuring that people understand critical, life-saving health care information is always legally required and vitally important. Such understanding is exponentially more salient in a national emergency.

The Law

The Office for Civil Rights of the U.S. Department of Health and Human Services released guidance in March 2020 about language assistance during the pandemic for people who are limited English proficient and people with communication disabilities.

As HHS relayed:

“OCR remains in close coordination with federal partners to help ensure that the Nation’s response effectively addresses the needs of at-risk populations. To this end and as resources allow, government officials, health care providers, and covered entities should not overlook their obligations under federal civil rights laws to help ensure all segments of the community are served by:

  • Providing effective communication with individuals who are deaf, hard of hearing, blind, have low vision, or have speech disabilities through the use of qualified interpreters, picture boards, and other means;
  • Providing meaningful access to programs and information to individuals with limited English proficiency through the use of qualified interpreters and through other means;
  • Making emergency messaging available in plain language and in languages prevalent in the affected area(s) and in multiple formats, such as audio, large print, and captioning, and ensuring that websites providing emergency-related information are accessible;
  • Addressing the needs of individuals with disabilities, including individuals with mobility impairments, individuals who use assistive devices, auxiliary aids, or durable medical equipment, individuals with impaired sensory, manual, and speaking skills, and individuals with immunosuppressed conditions including HIV/AIDS in emergency planning”

The U.S. Department of Justice (DOJ) has been unequivocal about the heightened importance of legally required language assistance in public health emergencies and natural disasters.

AS DOJ advises:

“Title VI’s [Title VI of the Civil Rights Act of 1964] plain text and agency regulations clarify that discrimination based on race, color, or national origin (including limited English proficiency) is prohibited. Recipients of federal financial assistance are also prohibited from implementing facially-neutral policies and practices that have a disproportionate impact on protected groups. Additionally, Title VI requires recipients to ensure that LEP persons have meaningful access to programs or activities, benefits, services, and vital information.

To avoid violations of federal law, recipients must ensure that their actions do not exclude individuals because of their race, color, or national origin, including limited English proficiency. The prohibition against discrimination on the basis of race, color, and national origin can never be waived. Recipients of federal financial assistance engaged in emergency management activities, as well as recipients that provide emergency-related services, such as health providers and law enforcement agencies, must comply with Title VI at all times.

In fact, complying with these requirements becomes even more important during emergencies and disasters in order to ensure that no one is unjustly denied the services and support they need during times of crisis, when their physical safety or well-being are often at greatest risk, and when many of the resources they might otherwise have drawn upon for support may not be available. Proper planning to comply with Title VI requirements avoids complications imposed by the exigencies of emergencies and disasters.”

As the COVID-19 pandemic continues plaguing countries around the world, vaccines offer new hope for bringing the virus under control. The health emergency has tragically revealed that people who are LEP or who have communication disabilities have often been excluded because of language or disability when essential information was disseminated. Now, as vaccines provide a new level of optimism, ALL people must have the same access to information about these life preserving medicines. Inclusion now needs to replace exclusion so that the language barrier is breached and overcome.

© Bruce L. Adelson 2021. All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.  Mr. Adelson is a faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness.

Mr. Adelson’s blogs are a Bromberg exclusive