Immokalee is a small, unincorporated farming community located just north of the Everglades in Southwest Florida, home primarily to migrant farmworkers. Perhaps best known as the location for Edward R. Murrow’s seminal documentary on farm labor exploitation, “Harvest of Shame,” or more recently as “ground zero for modern-day slavery” in the words of federal prosecutors, Immokalee has set the bar in this country for social and economic marginalization for generations, despite its residents’ essential contributions to Florida’s $131 billion agricultural industry.
So when late model luxury cars and expensive SUVs started rolling into the Winn-Dixie parking lot for the mass DOH COVID-19 vaccination event in Immokalee in early January, something was clearly amiss. Hundreds had assembled to receive the precious vaccine, but the entire cohort had signed up online and traveled there from Florida’s wealthy coastal communities, leaving no room for Immokalee’s impoverished residents in the queue.
Stories about underserved, majority Black and Brown communities drawing crowds of non-residents for vaccination events have become a national concern, reflecting not only the understandable desperation of vaccine seekers, but also the intractable fragility of access to health care for our most vulnerable citizens. Meanwhile, people in poor and marginalized communities continue to die due to COVID-19 at alarmingly disproportionate rates, reminding us that, for all too many Americans, poverty is the real disease.
But while Immokalee is not alone in its grinding poverty, its residents are, in fact, known in human rights circles for their extraordinary resilience and creativity in the face of seemingly insurmountable challenge. Exhibit A: the Presidential Medal-winning Fair Food Program, a human rights initiative born in Immokalee’s fields that has ended longstanding farm labor abuses ranging from forced labor to sexual harassment, and is being replicated today in industries beyond agriculture on three continents.
So it is perhaps not surprising that another promising initiative has taken shape in Immokalee in response to the COVID-19 crisis, as well. The unusual alliance behind the collaboration includes Partners In Health (PIH), an international non-governmental organization known for strengthening health systems in countries like Haiti, Liberia, and Kazakhstan; the Coalition of Immokalee Workers (CIW), the community organization behind the Fair Food Program; Healthcare Network (HCN), a community health center with decades of experience serving the local migrant worker community; and Mision Peniel, a faith-based social services organization with deep roots in Immokalee.
The group launched its partnership last summer with an initiative aimed at expanding testing. Together they built two new community health worker programs dedicated to education and outreach, mobilized public and private resources to significantly augment Immokalee’s rapid testing capacity, and massively expanded social supports for those affected by the virus, including food and cash assistance to encourage testing and allow low-income essential farmworkers the freedom to quarantine.
When vaccination efforts in Florida were launched in January and fell immediately into the contours of an already unequal health-care system, the alliance was ready to act. While many pointed to the much-publicized notion of “vaccine hesitancy” in communities of color to explain the event’s skewed demographics, the health center’s own staff, including its growing corps of community health workers, knew that their parents and grandparents wanted the vaccine but couldn’t access appointments. When HCN’s internal feedback was echoed in complaints heard by the CIW in the farmworker community, the message was clear: Immokalee’s elderly population wanted the vaccine just as much as seniors from the wealthier coastal communities, they simply couldn’t secure a place in line because the registration process — an online portal requiring English proficiency, reliable internet access, and leisure time to sign on over and over again until an appointment is made — wasn’t designed with the Immokalee community in mind.
In response, Healthcare Network re-purposed its staff overnight into an all-hands-on-deck call center and reached out directly to its patients, cutting the Gordian knot of confusion and frustration created by the online portal by reversing the registration process and using widely available technology — the telephone. The CIW used its popular community radio station to promote the next vaccination event in Spanish, Creole, and Mayan languages, and went door to door signing-up elderly farmworkers eager to be vaccinated, establishing a clear queue for future events. PIH and the health center’s COVID outreach team ramped-up home visits to answer questions, support registration and even escort community members without vehicles to vaccination centers. Within a week, the narrative had flipped — HCN, in collaboration with the Collier County Department of Health, vaccinated 460 Immokalee residents at the next event, and hundreds more are in line, ready for when the next shipment of vaccine hits town. Immokalee felt like itself again.
While this novel partnership is still in its infancy, the message from its early success is critical: Reaching underserved communities means not only “meeting people where they are,” but also avoiding easy assumptions like vaccine hesitancy to explain away inequities. With the farmworker community at the table, as equals, with health-care professionals, the alliance had both the insight and experience necessary to quickly identify bottlenecks, eliminate barriers, and expand access to the vaccine. To the degree that vaccine hesitancy exists — and it does, across all demographics — seeing friends and neighbors benefit from vaccination is the surest cure.
The pace of healing in Immokalee — and in countless communities across the country like Immokalee — will be dictated by the degree to which we reach those who need us most. And that is an invaluable lesson for our health care system as a whole, once the pandemic is behind us.
The opinion piece was jointly written with Dan Palazuelos, a professor of medicine at Harvard University Medical School and Director of Community Health Systems with Partners in Health (https://www.pih.org/), and Emily Ptaszek, CEO of the Healthcare Network of Southwest Florida. Greg Asbed is with the CIW.