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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food & Farm Worker Patients

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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food and Farm Worker Patients

Migrant Clinicians Network continues to receive questions from our clinical network on preparing for vaccine distribution to their migrant, immigrant, and farmworker communities. While vaccines have been declared available for all in the US, ages 16 and up, in reality, COVID-19 vaccines remain inaccessible for many people. The dynamic situation does not belie the underlying mantra: everybody deserves a chance to get vaccinated against COVID-19. We encourage our constituents to continue to strongly and vocally advocate for the most underserved populations, who have frequently found themselves deemed “essential workers” in this pandemic while they remain among the most at risk of illness. 

This FAQ was last revised April 29, 2021. Information and data are changing rapidly. For more updated information, please visit our blog: www.migrantclinician.org/blog.

 



How do I talk to my migrant patients about the Johnson & Johnson/Janssen (J&J) vaccine?

Migrant Clinicians Network recommends the J&J vaccine to male migrant patients and female migrant patients over the age of 60. (Please see the next question for more.) If a patient was already feeling hesitant toward vaccinations, the pause on this vaccine that occurred in April 2021 may worry patients and further their hesitation.

  • Validate patients’ concerns. Reassure them that it is normal to have such concerns.

  • Update patients if needed on the CDC and FDA’s decision to make the pause and to resume the distribution and use of the J&J.

  • Make sure all their questions are answered to the best of your ability.

  • Be honest about the unknowns.

  • Point out the benefits of the pause. 

    • Efficacy of public health and vaccine safety systems: “The public health authorities were able to track six people out of 6.8 million who had an adverse outcome, one to three weeks after the vaccination, in various parts of the country -- that is remarkable that the systems could pick up such a small percentage.”

    • Benefit to providers: "The pause gives the health authorities time to make sure our health systems are ready to recognize and treat the very rare blood clot issue that they are seeing.”

    • Low risk: “This is the only serious adverse reaction that they’ve discovered, out of 6.8 million people receiving the vaccine, and mostly among women ages 18 to 49.”

    • Continued lessening of risk of COVID-19 through vaccination: “More than 6.8 million people who received the Johnson & Johnson vaccine are now protected from death and severe illness from COVID-19, which has claimed the lives of over half a million people in America.” 

  • Migrant women require specific considerations. See the following question.

 



Should migrant women take the J&J vaccine?

MCN recommends that migrant women between 18 and 60 avoid the J&J if an alternative (Pfizer or Moderna) is available. This eliminates the risk of TTS, as both Pfizer and Moderna, as mRNA vaccines, do not share the same vaccine mechanisms as the J&J or AstraZeneca that have the TTS risk. Migrant women in particular have serious barriers to access health care, including transportation, language barriers, work limitations, rural and isolated locations, and limited integration into their new communities to understand health care options. These barriers may make access to emergency care needed for TTS even more difficult.

Most cases of TTS have been seen in women between 18 and 49, with a small number in women between ages 50 and 58. In an abundance of caution, MCN is recommending the avoidance of J&J for migrant women up to age 60.

If a migrant woman prefers the J&J or if the J&J is the only vaccine available, make sure the patient knows the signs and symptoms of TTS and typical window of onset of symptoms.

For women 58 and over and for men of any age, MCN recommends to get vaccinated with the vaccine that is available in their area, whenever they first have the opportunity to do so. Do not delay vaccination.

Read more about these recommendations on Johnson & Johnson COVID-19 Vaccine: Care for Migrant Women Requires Adjusted Approach.

 



What do I do if a patient is partially vaccinated with a non-FDA approved vaccine, AstraZeneca or Synovax?

Some migrant patients are arriving in the US with partial vaccination. AstraZeneca and Synovax are two vaccines that are not available in the US, but are widely used in other countries. Both require two vaccinations. If a patient arrives with documentation indicating only one vaccination of the two has been administered, MCN recommends the following.

For migrant women between the ages of 18 and 60, and if Pfizer or Moderna are available, MCN recommends that the patient begin the Pfizer or Moderna two-shot series. (Learn more about why MCN recommends this here.)

For migrant women over the age of 60 and migrant men of any age, MCN recommends the administration of one dose of J&J if available. 

Read the CDC’s recommendations here.

 



How do I respond to my patients’ basic questions about the safety of vaccines?

This critical basic question is very important to answer fully, with respect and patience, and in a culturally competent manner. Some basic points to consider:

  • During clinical trials, tens of thousands of Americans of all ethnicities received the vaccination, after which researchers followed them for months to assess reactions.

  • Since its release, almost 50 percent of the US population, including millions of health care workers, leading scientists, politicians, and community leaders, have received the shot themselves. Many of your doctors, nurses, and health care staff, those who work tirelessly to care for you, have taken the shots to protect themselves and in turn their communities, showing another vote of confidence in the safety of the vaccines.

  • Like all vaccinations, there is a risk of minor side effects, most commonly pain at the site of injection, fatigue, muscle or joint pain, and headaches, all of which clear up in a matter of days.

  • The J&J vaccine may cause a very rare but serious effect of cerebral venous sinus thrombosis combined with thrombocytopenia. (See the first question in this FAQ.) 

It is important to remember that some vulnerable populations who would best benefit from the COVID-19 vaccine are also the populations that have been grossly mistreated historically during vaccine trials or forced into state-sponsored medical procedures without consent.  The racist underpinnings of our public health systems continue to traumatize our patients today.

Practical Resources from MCN

 Other Resources

For Further Reading

Migrant Clinicians Network has two statements on the need for equity and cultural competence in vaccine distribution:

Other Articles of Note


  



My patient asked about “breakthrough cases.” How do I respond?

  • The CDC states: “Vaccine breakthrough cases are expected. COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control. However no vaccines are 100% effective at preventing illness. There will be a small percentage of people who are fully vaccinated who still get sick, are hospitalized, or die from COVID-19.”

  • Vaccine breakthrough is very rare. As of mid-April, out of 78.5 million people who have received the vaccine, approximately 5,800 cases of vaccine breakthrough have been recorded, which is about 0.0074%. The vaccine itself has prevented severe illness and death in unknown millions of people around the world.

  • There is some evidence that vaccination may make illness less severe in the very rare occurrence of vaccine breakthrough.





When will farmworkers or other essential workers get access to a vaccine?

Thousands of farmworkers around the country have already received their vaccine where they have been prioritized. In other areas, vaccines remain unavailable to workers who encounter barriers (including technological, linguistic, transportation, and work-related) to schedule an appointment and/or to attend a vaccine appointment.   

  • Farmworkers need your continued advocacy. Clinicians need to loudly and regularly speak up on behalf of their patients. Make connections, stay informed of when vaccinations are arriving, insert yourself into the discussions on distribution, communicate regularly with the larger farmworker community.

  • Encourage essential workers to keep checking in with your local community health center and/or health department, as localized distribution is rapidly changing.

  • Develop a health center team to coordinate vaccination for farmworkers and other essential workers. Create a detailed workplan and workflow to clearly prepare for all aspects of vaccinations, from paperwork burdens to appointment confirmations to the vaccination provision itself. Include community advocates. Be prepared for poor distribution communication and interruptions in deliveries by preparing and executing a transparent communication plan with essential workers, that anticipates the many bumps and hiccups in vaccine provision and distribution. Build in flexibility and contingency plans when possible, recognizing the changes in farmworker populations as the seasons progress.




The Moderna and Pfizer-BioNTech vaccines require two shots. What if a patient is moving? Should the patient wait to get the one-shot vaccine when/if it is again available, or to get a two-shot vaccine in the next location?

Due to ongoing limited supply, we recommend that farmworkers get vaccinated when they have the opportunity to do so.  Encourage your patient to take a photo of the vaccination card and to send that photo to a family member or trusted person, so that if the card is lost (or even the phone), there is evidence of the first dose of vaccination.
If a patient isn’t sure if they can make a second appointment, sign them up with Health Network.  Migrant Clinicians Network operates Health Network, a virtual case management system that assists migrants with ongoing health needs in finding health care at their next destination. Clinicians are strongly encouraged to enroll patients who may need to migrate before they can receive the second vaccination. After enrollment, a Health Network Associate will follow up with the patient and assist in finding a health facility in the migrant’s next location so the patient can access the correct second dose. Health Network’s services are without cost to the health facilities or patients.

Due to ongoing limited supply, we recommend that farmworkers get vaccinated when they have the opportunity to do so.  Encourage your patient to take a photo of the vaccination card and to send that photo to a family member or trusted person, so that if the card is lost (or even the phone), there is evidence of the first dose of vaccination.

If a patient isn’t sure if they can make a second appointment, sign them up with Health Network.  Migrant Clinicians Network operates Health Network, a virtual case management system that assists migrants with ongoing health needs in finding health care at their next destination. Clinicians are strongly encouraged to enroll patients who may need to migrate before they can receive the second vaccination. After enrollment, a Health Network Associate will follow up with the patient and assist in finding a health facility in the migrant’s next location so the patient can access the correct second dose. Health Network’s services are without cost to the health facilities or patients.

Learn more about Health Network here:
https://www.migrantclinician.org/services/network.html

Learn more about Health Network enrollment here:
https://www.migrantclinician.org/services/network/enrollment-in-health-network.html 

Contact Theressa Lyons-Clampitt for more information: tylons@migrantclinician.org.




What about the COVID-19 variant? How does that affect the efficacy of the vaccine?

The science around the vaccine and the COVID-19 variants is moving quickly. At present, we recommend that food and farmworkers get the vaccine when they have access to it. We cannot predict whether a booster will be needed, and if a booster is needed, when that will be available, but we can encourage patients to get the best protection presently available, through the vaccines that have been approved. 




Are some vaccines more effective than others?

Clinical trials have shown that all presently approved vaccines have a remarkable  prevention of COVID-19 death and severe disease, the marker of a highly effective vaccine. Some people still contract COVID-19, although less severe. The three approved vaccines vary slightly in their efficacy rates. Millions of people have now taken the COVID-19 vaccine, preventing an unknown number of deaths. At present, one death (from blood clots that may be related to the administration of the Johnson & Johnson vaccine) has been attributed to vaccine provision.  Overall, due to very low deaths and millions of doses administered, the vaccines have proven effective and safe. Consequently, we strongly encourage patients to not delay on receiving a vaccine if given the opportunity, regardless of manufacturer. Learn more about the Johnson & Johnson vaccine, in English and Spanish, here, and about the recent pause on the Johnson & Johnson vaccine, in English and Spanish, here.




What do I tell a patient about post-vaccination mask wearing and distance? 

It's very important that vaccinated people continue to wear masks and maintain physical distance in public. The CDC’s guidance for fully vaccinated people notes that it is low risk for fully vaccinated people to gather, such as family members, without masks or physical distance. However, those vaccinated will still need to observe distancing, mask, sanitation, and ventilation precautions when with unvaccinated people, for the protection of those unvaccinated people.

According to the CDC, COVID-19 vaccines prevent severe illness, but may not prevent infection -- we don't yet know, because we don't have enough information yet. Getting vaccinated against COVID-19 will help prevent your patient from getting very ill, needing hospitalization, or dying from COVID-19, as the research indicates. But we don't yet have the science to understand how effective the vaccines are at preventing individuals from spreading the virus. 




What patients should I be particularly concerned about?

Migrant patients encounter numerous and overlapping barriers to accessing health care. This results in some migrants experiencing ongoing health concerns that go unaddressed. Some of these health concerns, including asthma and diabetes, increase the patients’ risk of severe COVID-19 disease, if they become infected with the virus. Indeed, clinicians in our network have encountered the results of unaddressed diabetes in the hospital. “If I have a seemingly healthy young person in the ICU with COVID-19, more often than not, they have an underlying but unaddressed concern like uncontrolled diabetes. One patient’s A1c was 13 – and I had to tell him, ‘you’re not just struggling with COVID-19. You have diabetes,’” said Laszlo Madaras, MD, MPH, MCN’s Chief Medical Officer. 

More than ever, outreach workers, community health workers, and other clinicians working closely within migrant and immigrant communities need to reach out to community members who may be overlooked and make sure their underlying health needs are being met.

Read more about the link between diabetes and severe COVID-19 on this FAQ from the American Diabetes Association.

Utilize MCN’s low literacy Spanish language comic book, available to print and download: Mi salud es mi tesoro.  




What if a patient who has received both COVID-19 vaccine shots has been exposed to COVID-19? Is quarantine required?

According to the CDC, patients who have received both COVID-19 vaccine shots are NOT required to quarantine if exposed to someone with COVID-19.




What if a patient who has received one shot of the Pfizer or Moderna (and therefore is only partially vaccinated) has contracted COVID-19?

Patients who fall ill after their first vaccination must follow all precautions as those without any vaccination: get tested and isolate while waiting for results. After recovering from COVID, patients should discuss the timing of the introduction of the second dose with their physician. A second vaccination sooner than 90 days after infection may give increased side effects, compared to severity of side effects in those who did not contract COVID-19 after the first vaccination.




If a patient had COVID-19, do they still need to be vaccinated?

The CDC notes that patients who have had COVID-19 (and therefore have antibodies) should wait 90 days from the end of their infection before receiving a COVID-19 vaccine. Read more about why in this Health article.

The CDC recommends that after those 90 days, a patient who has recovered from COVID-19 should receive the full vaccine amount, meaning two shots of the Moderna or Pfizer, or one shot of the J&J when once again available.




What do I do if my patient has lost the vaccination card?

Patients who say they have already received a vaccine but do not have evidence may need assistance in contacting the location of their vaccination to verify their vaccination status – social workers and outreach workers may be helpful here. If the patient has migrated since they got vaccinated, determine any details the patient remembers – location, time and date, type of vaccination – and contact the vaccination site. Each location has a different process in terms of recording and providing vaccine records to the local health department. Each state has a vaccination registry that contains records of all vaccinations provided in the state. Depending on the location, the patient’s information may already be registered with the state. The CDC’s Immunization Information Systems gives contact information for each state here.




Should a patient get a mammogram after getting the COVID-19 vaccine?

It is recommended to wait at least two weeks after the provision of a COVID-19 vaccine before receiving a mammogram or other diagnostic imaging exam. This is because the COVID-19 vaccines may cause swollen lymph nodes, which may be interpreted as cancer in such imaging exams. Read more here. As a precaution, if the patient is not migrating and can delay the imaging exam, clinicians may recommend that the patient wait six to ten weeks after the second COVID-19 dose. If a patient needs to move before that six to ten week period is over, clinicians can enroll the patient in Health Network, and we can assist in guiding the patient in the new health system in their next location to schedule a mammogram or other diagnostic imaging exam. 




What do I do if my patient or my patient’s community is encountering misinformation about the vaccine?

Patients are concerned about the safety of the vaccine and much misinformation is circulating around. Help the patient understand the safety of the vaccine and how to deconstruct conflicting or confusing health messages that may be misinformation through our interactive guide, “Deconstructing Health Misinformation”.




How can I help my fellow clinicians be informed?

It is clear that some clinicians continue to be concerned about the safety of the COVID-19 vaccines – not just the larger community. Considering the speed of their development and the limited communication efforts, this hesitancy is expected. Thousands of clinicians – many within our network – have shared their COVID-19 vaccination selfies on social media, many with notes on their elation of having the opportunity to be vaccinated. This message is important for both clinical colleagues and the larger community to see. Sharing clinician-centered resources to better inform colleagues may also help ameliorate concerns:

Resources

Q&A: What PCPs Need to Know about COVID-19 Vaccines, article co-written by MCN’s Chief Medical Officer, Laszlo Madaras, MD, MPH

CHA Healthcare’s video, COVID Primer for Primary Care

The New Vaccines, Attitudes Toward Vaccination, and the Biden COVID-19 Task Force, Grand Rounds from UCSF

CDC’s Clinical Resources for Each COVID-19 Vaccine

 



How can I keep track of vaccination in my region?

Vaccination dashboards are developing. Resources vary in each community. Here are some early national resources:

Resources

Johns Hopkins provides a vaccine dashboard: https://coronavirus.jhu.edu/vaccines

MCN is part of a new initiative, Resilient American Communities, which is just getting off the ground and will be a resource to watch: https://resilientamericancommunities.org/




Other Resources

MCN has upcoming online seminars specifically on COVID-19 vaccinations. Watch our Upcoming Webinars page for registration when new seminars are announced: https://www.migrantclinician.org/trainings.html

 

 

 

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