Blue Ridge Health Pharmacist Gwen Ernesty prepares a COVID-19 vaccine dose in Western North Carolina. Courtesy Blue Ridge Health

Last summer, COVID-19 cases surged among North Carolina’s farmworkers.

In July, the Farmworker Advocacy Network estimated outbreaks at more than 30 farms. Bottomley Evergreens & Farms in Alleghany County had one of the largest outbreaks among farmworkers in the state, with more than 100 positive cases in August among the business’s 400 employees.

Now, COVID-19 vaccines could provide relief for the North Carolina farmworker population, and a patchwork of Western North Carolina community health centers, local health departments and nonprofit organizations is working to vaccinate farmworkers in the mountainous region before cases rise again. 

“As the summer went on and our migrant numbers increased (last year), we also started to see infections increase,” said Marianne Martinez, executive director of Vecinos, a nonprofit organization that provides health care and advocates for about 1,000 farmworkers in the eight westernmost counties of North Carolina. “We don’t want to have to go through that again. So, we’re trying to get in front of it with the vaccines.”

Vaccinating a transient population can be difficult even in more populous and urban areas. N.C. Department of Commerce data showed North Carolina was home to about 72,000 migrant and seasonal farmworkers during peak season in 2020, Elizabeth Freeman, director of the N.C. Farmworker Health Program, said.

To offer vaccines to farmworkers, providers need to not only track the doses but also determine the size and location of the population yet to be vaccinated — an especially tricky task in western parts of the state. 

Tracking moving targets

Last year, during the peak season of late summer and fall, about 22,000 workers were employed through an international H-2A visa for temporary agricultural workers. But like other workers, the visa numbers fluctuate throughout the year. 

Richard Hudspet, CEO of Blue Ridge Community Health Services, a federally qualified health center serving eight Western North Carolina counties from Swain to Rutherford, sees timing as crucial.

“Everything has to be related to time,” Hudspeth said. “We’re working with those who are here now, but we’re going to see a lot of our seasonal workers coming in the summer months. They’ll arrive in May, June, July, August.”

For a worker to come to the United States on an H-2A visa, an employer must submit a work order to the state Department of Commerce. The department approved requests for 6,724 H-2A workers to begin work during March.

The state has already approved requests for about 5,000 workers to arrive in both April and May, meaning an estimated 16,500 H-2A workers will be in the state by the end of May. Work orders for the remaining months of the year have not yet been approved, but based on previous years, several thousand more work orders will likely be confirmed over the summer.

In the state’s eight westernmost counties, most migrant workers are employed through H-2A visas, according to Martinez, and the documentation allows Vecinos to see when and where workers are expected to arrive and to be able to plan for their vaccinations. 

“We’re communicating with growers, and as soon as farmworkers are coming into town, we are getting them tested at least and then setting them up with a vaccination opportunity as those are available,” she said. 

But the H-2A pipeline is only one way farmworkers are employed in the state. 

Between 20% and 30% of all farmworkers are considered “seasonal” workers, or individuals who live in North Carolina year-round and work in agriculture seasonally. The largest segment of the farmworker population, making up nearly half of North Carolina’s agricultural employees, are migrant workers who typically travel from Southern states like Texas, Florida and Georgia into North Carolina, following crop seasons

Data is much more limited for those two groups of farmworkers, making it difficult for health providers who want to offer COVID-19 vaccines. Inoculating this vulnerable and moving population is a different process in the western region than in other parts of the state. 

“Western North Carolina is just different from other parts of North Carolina,” Martinez said. “Out east there are counties that have 7,000 farmworkers. For us, it’s much smaller. It’s a much more one-on-one kind of situation that we have.”

Because farms in the region tend to be smaller and more spread out than those in other parts of the state, health organizations face additional hurdles to identify who is not yet vaccinated and to offer access to the shot. 

“Around here, there are a lot of farms that employ 15, maybe 20 people at most,” said Kenett Melgar, vulnerable populations manager at Blue Ridge Community Health Services, which serves Henderson County, home to an estimated 150 apple producers and the largest number of farmworkers of any county in the west. 

Communication among providers, assistance organizations and employers is critical.

“We try to maintain open communication with local health departments and various vaccine distributors in the area so that we all know what each other is doing,” Melgar said. “That way we’re spreading the resources as much as possible in an equitable fashion, instead of trying to do it all by ourselves, in our little silos and probably doing redundant things.”

The small number of farms in a close-knit community can be an asset for vaccine providers.

Farmers are often also integral members of their communities, Martinez said, so organizations like Vecinos are able to cultivate personal relationships with many of the growers and seasonal employees who work at the same farms year after year. 

“I think any health center would say that having relationships over time helps build trust so when something like a pandemic happens, you already have that goodwill already established,” Hudspeth said.

Providing doses is just one part of assisting farmers and farmworkers. Both Vecinos and Blue Ridge Health collaborate with other local providers and offer appointment scheduling and transportation to vaccine sites. 

Meeting people where they are

In addition to barriers such as lack of transportation to health clinics or lack of internet access to book appointments, some migrant workers do not have access to accurate information regarding the vaccines since most migrant workers do not speak English as a first language. 

The Farmworker Health Program and the N.C. Department of Health and Human Services provide videos and educational materials in both Spanish and English to combat misinformation and educate people about vaccination against COVID-19, but information gaps still persist.

Melgar said some farmworkers believe misinformation from their home countries— narratives of a sinister goal behind the vaccines or inaccurate information that one vaccine is not as good as another. 

“It’s interesting how even across borders, some of the same things that you see here also pop up in other countries … depending on where they are coming from and how they got their initial information,” Melgar said.

One way to overcome both physical and information barriers to vaccination is to bring doses and Spanish-speaking staff directly to the recipients. Danny McConnell, owner of McConnell Farms in Hendersonville, hosted one such clinic on his farm. 

“Blue Ridge Health came, and not only did they vaccinate myself and my employees, they also vaccinated workers from about six other farms that were in the county at the same time,” McConnell said. “In total, I think they vaccinated about 50 people that day.”

Of those farms, McConnell’s was the largest, with seven employees vaccinated. Other farms brought two or three employees to the clinic. 

“We concentrated kind of on the smaller farmers,” said McConnell. “It would have been hard for them to have taken time off from work, and they might’ve had to drive to somewhere far away. This was pretty convenient for them. They just came right in and got it done, and then they’ll come back, and they know where to go in two weeks for the second dose.”

Organizations like Blue Ridge Health, which have a long history of serving migrant workers, can sometimes bypass employers, reaching out directly to workers.

“We definitely have migrant camps year to year which tend to be occupied by migrant farmworkers. So, we tend to check up on those places as soon as we know that the season is starting to see when they arrive,” said Melgar. “We know there are migrating streams because of our history here. We know what to expect and when and where to expect them.”

Nearly 4,000 farmworkers have received at least one vaccine dose statewide, according to weekly survey data provided by county vaccination teams established by the N.C. Farmworker Health Program.

This number is likely an undercount of the total number of vaccinated farmworkers in the state, Freeman said, because vaccine team reports likely do not account for doses provided to farmworkers by pharmacies, mass vaccination sites or other providers. 

“Without having a lot of data, it’s hard to make any confident claim,” Freeman said. “Anecdotally, we are hearing that migrant workers who are coming into the country are accepting vaccines at very high rates, and, again anecdotally, we’re hearing there’s some more hesitancy among workers who live here year-round.” 

Martinez of Vecinos said some seasonal workers may be hesitant due to religious reasons, but she also said that the amount of vaccine hesitancy in seasonal workers seemed roughly equivalent to hesitancy levels seen in the general population, a sentiment echoed by other leaders in Hispanic communities.

Workers coming from Mexico accept vaccines at high rates because of the lack of vaccine availability in Mexico as well as workers’ experiences dealing with COVID-19 last year, Freeman said. 

“Many of the H-2A workers are returning,” she said. “They were here last year. They were here living in congregate housing, maybe seeing the risks. Maybe going through an outbreak, seeing people get sick. Having that experience may influence them towards wanting it (vaccination) more.” 

Most farmworkers became eligible for vaccination under the state’s plan on March 3, when essential workers became qualified. Those 65 and older were eligible earlier, but few farmworkers are in the senior age group. 

Martinez estimates that Vecinos has played a role in about 1,500 vaccinations by connecting workers with local health organizations and vaccination events. Vecinos has directly vaccinated about 200 migrant farmworkers, she estimated, but the group does not have data on the number of seasonal workers vaccinated. 

“In our area, we’re able to reach the people that want it,” Martinez said. “I think that now we’ve gotten the low-hanging fruit and we’re having to really get into the more difficult work now of finding people that are either on the fence or hesitant.”

By early April, Blue Ridge Health had vaccinated roughly 600 agricultural workers by bringing vaccines to seven different sites.

Blue Ridge Health is encountering some hesitancy and is working with those individuals, Hudspeth said, but the main focus remains providing vaccines to those who want them. 

“When we open up our appointment slots, they may take a little bit longer to get filled than they had initially, but they’re still getting filled,” Hudspeth said.

“There’s a lot of work yet to be done. And I think the state and the federal government and our local communities are really working hard to figure out those pieces to the puzzle.”

Christian Green

Christian Green is the lead Carolina Public Press contributing writer reporting on healthcare and health policy in North Carolina. He obtained a master’s degree in neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks. He is based in Raleigh. Contact him at cgreen@carolinapublicpress.org.

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  1. Yes, it’s important for farm workers. But hotel workers, who are predominantly immigrants, were completely left hanging by North Carolina. They worked all year, for the most part, and many worked in great fear. North Carolina let hotel workers fall through the crack. And it’s a damn shame!