How Hispanic Texans embraced vaccines and flipped the script on COVID deaths

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In the summer of 2020, death engulfed Texas’ Rio Grande Valley.

Delia Ramos recalls the eerie prevalence of freezer trucks lining hospital parking lots to store the bodies, as a novel virus battered the mostly Hispanic region. When her husband Ricardo eventually fell ill, he entered the hospital alone, and she never got to see him again.

The demand for services for the dead was so high, she had to place her name on a waiting list to have him cremated.

“People were passing away left and right,” said Ramos, 45, of Brownsville.

By that summer’s end, it was clear: Texas Hispanics were dying at a rate faster than any other ethnic group. In 2020, Hispanics made up nearly half of all COVID deaths in Texas. White Texans — whose share of the state’s population is the same as Hispanics — made up only 38% of all deaths that year.

In the Valley and in several Hispanic communities, many Texans like Ramos’ husband, who was a driver for a transportation contractor, worked in jobs outside the home, exposing them to the deadly virus. They often lived under the same roof with children and grandparents, increasing the risk of spreading the infection.

“What we're seeing really is historic decimation among the Hispanic community by this virus,” said Dr. Peter Hotez, Texas’ reigning infectious disease expert and physician, to the Congressional Hispanic Caucus on Sept. 30, 2020.

It has been five years since Gov. Greg Abbott issued a series of orders reopening the state for business in May 2020 — a move that accelerated a disproportionate amount of deaths for Texas Hispanics in the immediate months that followed. Today, COVID deaths have fallen dramatically.

An analysis of COVID mortality data by The Texas Tribune reveals the trends have flipped since the beginning of the pandemic: White Texans are the most likely to die of COVID compared to other race and ethnic groups, while the proportion of Hispanics dying of the disease has plummeted. In 2024, Hispanics made up 23% of COVID deaths in Texas, while white Texans made up 63%.

That staggering reversal comes as Hispanic Texans were among the most likely to get immunized when the COVID vaccine became available. By 2023, Texas’ border counties had some of the highest levels of vaccination rates against the virus in the state.

Experts who reviewed the Tribune’s findings said that the frontline devastation that Hispanic Texans endured and witnessed in early 2020 pushed them to seek out vaccines at rates 10 percentage points higher than their white counterparts three years later.

“Most people, if they have been around that level of death…it’s not abstract,” said Elizabeth Wrigley-Field, the associate director of the Minnesota Population Center at the University of Minnesota who has been studying racial health inequities during the pandemic. “The fears you might have, like having something new and unknown [such as a vaccine] might seem small compared to something you’ve actually seen killing people.”

In 2020, no level playing field

In Hidalgo County — where 92% of the population is Hispanic — the funeral homes were filling quickly in 2020.

“I was going into my neighborhood funeral homes and seeing three sets of people literally lying on the floor on top of each other, 100 dead people in a cooling freezer because you couldn’t get them buried within three weeks,” said Dr. Ivan Melendez, a family physician and the Hidalgo County Health Authority.

During the 2020 summer wave, more than a third of all COVID deaths in the state were Hispanics who were 65 years and older. Many of those who died had chronic conditions and were falling ill in multigenerational households, where one in five Hispanics live, according to Melendez.

“In our community, we had a lot of very, very frail people,” Melendez said. “And that population was immediately wiped out.”

Infections also hit younger adults, like Ramos’ 45-year-old husband, who didn’t have the ability to work from home and went to jobs ill-equipped with protective equipment and sanitation practices.

“Did we do anything to make those jobs safe?” Wrigley-Field said. “It’s so telling that it's line cooks and not nurses who are at the greatest risk.”

Hispanics are among the most underinsured in the state, lowering their access to health care. In 2023, more than a quarter of Texas Hispanics were uninsured, according to the U.S. Census.

Combined with the fact that they are at a higher risk for obesity and diabetes, factors that made people more susceptible to severe COVID illness, the population became a target for the virus, said Dr. Robert Rodriguez, a Brownsville-born emergency medicine physician who was an adviser to former President Joe Biden’s COVID task force.

“It was not a level playing field,” said Rodriguez, who teaches at the University of California San Francisco School of Medicine.

The inequity bled into the health care system that surrounds them. Hispanic communities have less access to hospitals with “surge capacity,” or the ability to quickly add more patient beds and more personnel when an emergency occurs.

Compared to San Francisco where there were some 200 intensive care doctors, only about 10 were available in the Rio Grande Valley at the time, Rodriguez said.

When those units in rural hospitals got overwhelmed, more people died, Hotez said.

“One of the things we learned early on in the pandemic was mortality rates really shot up when ICUs got overwhelmed and unfortunately, the smaller rural hospitals in our state, particularly in South Texas, that's exactly what was happening,” Hotez said.

Hispanic Texans embrace vaccines

After months of bearing witness to so much death, many Hispanic Texans were eager to get immunized against COVID once the first vaccines became available in December 2020.

Ramos got the shot as soon as she could. She said she owed it to her husband who died before it was available.

“I felt if we didn’t, it’s a dishonor to him,” she said. “I didn’t want his death to be in vain.”

By the end of 2021, about 47% of Hispanics in Texas were vaccinated, second only to Asian Texans at nearly 58%. By May 2023, nearly 56% of Latinos in Texas were vaccinated compared to nearly 46% of white Texans.

The border counties had the highest percentages of total residents who got vaccinated. In total, seven Texas counties achieved 100% vaccination for COVID by January 2023 — all near or along the Southern border.

The COVID death toll resonated so deeply within the Hispanic community that their COVID vaccination rates eclipsed the rates of white and Black Texans in 2022 and 2023. In contrast, the flu vaccine rates among Hispanic Texans has been lower than their white or Black peers for the past six seasons.

Rio Grande Valley’s Hispanic residents lined up for vaccines because of the need to keep working and because the shots were so readily available, Melendez said.

“There's just a general feeling that perhaps people in the Valley were not getting the same resources as other areas of the state that were more affluent,” he said. “We did a good job explaining to them the distribution of the vaccine was not based on affluence, but it was based on the [infection and death] numbers.”

Another reason the region saw such high vaccination rates, experts say, was that locals could see the vaccine working as the number of deaths and hospitalizations started to fall.

“The community was educated, and a lot of the Hispanic community responded to this call to get vaccinated,” said Dr. Jose Ernesto Campo Maldonado, an infectious disease physician who teaches at the UT Health Rio Grande Valley. ”Some of the changes that we saw in the mortality happened simultaneously with more access to vaccination by the Hispanic communities.”

Death rates for Hispanics begin to fall

By November 2021, Hispanic Texans becoming fully vaccinated against COVID would edge out white Texans.

That’s also when the share of deaths among Hispanics began to decline.

“In South Texas, the deaths halted, and the deaths switched to the unvaccinated in the conservative rural areas of West Texas and East Texas,” Campo Maldonado said.

By the time the federal government declared the COVID emergency over in May 2023, more than 92,000 Texans were dead. Of those, 41% were Hispanic, just one percentage point above their population share in Texas.

Another contribution to the lowered death rate over time was that so many of the most vulnerable Hispanic Texans had already been killed by the virus. Those who were left and had been exposed may have developed herd immunity faster, especially as COVID mutated and became less deadly, Melendez said.

Since 2021, as Hispanics’ share of all deaths fell, the share of white Texans dying began to grow. Part of the reason, health experts say, is there are more older white residents in the state than any other ethnicity — 60% of Texans age 65 and older are white.

In 2024, according to the latest data available, at least 1,891 people died of COVID. Of those, 1,187 were white and 439 were Hispanic. Most of them —1,676 — were over the age of 65.

“What you're seeing is actually really consistent with something that's been true throughout the whole pandemic, which is that in the periods where COVID deaths are low, they tend to be in very old populations, very sick populations,” said Wrigley-Field. “A lot of deaths are in long term care.”

The waning trust in vaccines

In 2020, Maya Contreras of Houston and her daughter became ill with COVID while working for Walmart. Both felt as if they had been hit by a truck.

“We couldn’t even move,” said Contreras, who also lost a brother-in-law to COVID during the first deadly wave in the summer of 2020.

However, Contreras, who would get COVID two more times before she got the shot in 2022, recalls how some of her friends were suspicious of the vaccines, telling her, “‘I’m not putting that inside my body.’”

Today, many still don’t think the vaccine for COVID is necessary.

Earlier this year, Melendez attended a gathering of about 300 health professionals to deliver a presentation. He asked the group how many were current with their COVID vaccinations.

“About 10 raised their hands,” he said.

Once the initial threat of death from COVID subsided, the urgency diminished, and interest in other vaccines dipped to dramatic lows in pockets of the state.

Since 2018, the requests to the Texas Department of State Health Services for a vaccination exemption form for childhood vaccinations doubled from 45,900 to more than 93,000 in 2024. There are several bills before the Texas Legislature that would make those exemptions even easier to obtain.

This year, measles, a childhood disease once virtually eliminated, is now back in Texas with an outbreak that began in Gaines County where the vaccination rate of kindergarteners is 82%, among the lowest across Texas counties. The disease has resulted in more than 660 infections statewide, dozens of hospitalizations and deaths of a 6-year-old and an 8-year-old, who were both unvaccinated.

Experts blame the declining vaccination rates on the COVID-era fatigue over mandates, such as stay-at-home orders and mask requirements, and the inconsistent messaging about the effectiveness of vaccines from politicians. That resentment has transformed into the mistrust of public health experts and the exhaustive research that backs them up.

As frustrating as it is to see for Melendez, he understands the decline in vaccination comes as the memories of COVID tragedies become more distant. The public believes the dangers of COVID have passed, and so have other diseases like polio, smallpox and even measles. But they forget that it was vaccines that have and will keep diseases at bay, and that worries Melendez as he reads weekly reports of measles cases rising statewide.

“They don’t think that disease is impactful to them, and so people don’t see it as a threat,” Melendez said. “So they don't vaccinate.”

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