On a recent Saturday morning, Karla, a farmworker from Mexico, didn’t wake up early to weed fields around Morrow County, Oregon. Instead, she went to a regional tourism center to get her first dose of the COVID-19 vaccine.

“It took a weight off my shoulders,” she said. Karla came to the U.S. in February to find work and to save money for her son, who just started college. “I went there because they didn’t ask for documents,” Karla said of the tourism center. She was afraid a local clinic might ask for information that immigration authorities could use to track her.

Karla is one of 2.4 million farmworkers in the U.S. — at least half of whom are undocumented, according to the U.S. Department of Agriculture, and all of whom should be prioritized for COVID-19 vaccines, according to the Centers for Disease Control and Prevention (CDC).

What’s more, the CDC recommends that vaccinations for farmworkers be offered near their worksites or in their communities. “Minimizing barriers to access vaccination for frontline essential workers, such as vaccine clinics at or close to the place of work, are optimal,” the CDC statement said. The agency included all agricultural workers in phase 2 of its vaccine-priority recommendations, along with police officers, to “preserve functioning of society.”

Despite the CDC’s guidance, only three of the five states with the most farmworkers, according to the U.S. Census Bureau — California, Washington and Oregon — prioritized farmworkers for vaccinations ahead of the general population. And only two — California and Oregon — have established policies that provide vaccination clinics for farmworkers on worksites or in their communities.

Texas and Florida did not prioritize vaccinations for farmworkers ahead of the general population. And although officials from Washington and Texas said they were targeting or planning to target farmworkers, neither has issued a state policy prioritizing vaccine events on farms or in farmworker communities. 

In states lacking aggressive vaccination campaigns, farmworkers — deemed “essential” to the nation’s food supply by the Trump administration and reaffirmed by President Joe Biden — are again at risk of COVID-19 outbreaks.

“Without true access to vaccination, I fear that we will see a dramatic increase in COVID-19 mortality … as the harvest season ramps up, similar to 2020,” sociologist Alicia Riley told FRONTLINE. Riley coauthored a University of California San Francisco study published in January that found the mortality rate among farmworkers increased 55% from March through September 2020, compared to the same period in previous years.

In total, some 9,100 farmworkers have died of COVID-19 in the U.S. since the beginning of the pandemic, out of 554,000 infections, according to Jayson Lusk, a professor of agricultural economics at Purdue University.

That grim death toll has repercussions beyond the workers themselves. “It’s not just the workforce. It’s their families, because we know that they live in overcrowded living conditions,” said Dr. Max Cuevas. Featured prominently in the July 2020 FRONTLINE documentary COVID’s Hidden Toll, Cuevas is the CEO of Clinica de Salud del Valle de Salinas, which has been at the center of vaccine distribution in California’s Monterey County.

“Without those workers, we don’t eat,” he said.

With Targeted Clinics

Oregon — which the U.S. Census Bureau estimates has around 86,000 farmworkers — began prioritizing vaccines for farmworkers on March 29, ahead of all adults becoming eligible May 1. At the first state-held event targeting farm- and food-processing workers in late March, some 1,000 people in Morrow County were vaccinated.

“They were suggesting that folks schedule an appointment ahead of time, but they were also welcoming walk-ins. That’s a really beneficial option,” said Zaira Sanchez, emergency relief coordinator for the farmworker-focused nonprofit UFW Foundation, which helped organize the event. “Some folks just don’t have access or skills to navigate online registration systems.”

The next step is coordinating with the state to bring mobile vaccination clinics to farms, Sanchez said. “We are hoping that, doing mobile clinics on worksites, we are getting to the folks who don’t have time or don’t have the ability to travel to their appointment or to the event.”

Beyond improving access and eliminating the need to take time off work or to register online, on-site events give clinicians the chance to thoroughly explain the importance and safety of vaccinations.

“Delivery of these services by trusted entities is important, given the mistrust, as well as misunderstanding, around COVID and vaccines in general,” said Brenda Eskenazi, the director of the Center for Environmental Research and Children’s Health at University of California Berkeley, who tracked COVID-19 infections among farmworkers in California’s Salinas Valley.

Even so, many are wary. At an April 3 event organized by LUPE, a farmworker union, targeting agricultural workers in Texas’ Rio Grande Valley, clinicians successfully delivered about 700 vaccinations, but “Half of the people we were asking said, ‘No, thanks,’” said Daniel Diaz, LUPE’s director of organizing.

Texas — which has 143,763 farmworkers, according to the U.S. Census Bureau — now has the second highest COVID-19 infection rate in the country, after California.

Maria, a 39-year-old farmworker in the Rio Grande Valley, said she is hesitant to get vaccinated because she has lingering side effects from a previous bout with COVID-19: “I want to see what happens to others.”

Without Targeted Clinics

To date, vaccine rollout for the general U.S. population has bested the Biden administration’s initial timeline, but that has not been true for people of color, including undocumented workers. Advocates worry that, as states open up vaccines to all adults, farmworkers will be locked out. And vaccinating now is critical, many told FRONTLINE, because the peak agricultural season starts soon.

And yet, many farmworkers have avoided offsite vaccinations due to fear of providing information that could be used to deport them. While a social security number or a state-issued ID is not required to receive a shot, none of the five states with the largest numbers of farmworkers issued guidelines to vaccinators, instructing them not to request this information.

In a statement, the Department of Homeland Security said it won’t perform raids on vaccination sites and “encourages all individuals, regardless of immigration status, to receive the COVID-19 vaccine.” The CDC said vaccines are “free of to all people living in the United States, regardless of their immigration or health insurance status.”

And yet, 14 people in Texas were denied vaccines at a University of Texas Rio Grande Valley (UTRGV) clinic, near the border with Mexico. A LUPE report released April 12 found that, out of 20 private providers in the state’s Cameron, Hidalgo and Starr counties, four asked for social security numbers or a Texas ID to register for vaccinations. UTRGV ultimately issued an apology, and the 14 were vaccinated.

By contrast, Colorado, which has around 36,733 farmworkers, issued a letter advising providers not to request IDs and threatening to cut vaccine access if they did.

In Florida — which has 96,247 farmworkers, according to the Census Bureau — many people don’t want the vaccine, because they don’t think it’s safe, said Maria Martinez, a coordinator with the nonprofit Farmworker Association of Florida.

Most of the state’s farmworkers weren’t eligible for vaccines until April 5, along with the general population. In the meantime, Martinez said, farmworkers were “harvesting potatoes and planting chili, tomatoes. They are working. Despite bringing their mask, they are still close to each other at work.”

The Florida Department of Health didn’t respond to questions from FRONTLINE.

Challenges Remain

Even with worksite events, it’s hard to reach everyone — or to avoid line jumpers. “In the initial rollout, clearly there were some disparities: a lot of confusion, a lack of transparency about who was receiving the vaccine and why,” said California State Assembly member Robert Rivas (D-30), who emphasized the need for workplace safety measures in COVID’s Hidden Toll.

Together with nonprofits and mobile clinics, California has delivered more than 15,000 vaccine doses to farmworkers and has allocated 40,000 doses for food and farmworkers. But that covers a fraction of the state’s 1 million farmworkers, as estimated by the state’s Department of Public Health.

At the rate Monterey County is presently receiving vaccines from the state, it would take six more weeks to fully vaccinate farmworkers — “and that’s only one of the groups that currently are eligible for the vaccine,” said Jimenez of the county’s Health Department.

All of this is before California’s peak harvest begins in late April. As the high season moves across the U.S., it brings an influx of new migrants, who travel through Arizona, California, Michigan and beyond.

Leticia, a 35-year-old fruit picker who lives on the outskirts of Prosser, Oregon, is concerned about more unvaccinated workers arriving. Getting sick would affect her ability to feed her kids.

“They say we are essential workers, but they don’t give us the same rights. If we are not protected, we will keep working, with the virus or not,” she said. “We can’t stop and we can’t stay home.”

Watch COVID’s Hidden Toll in its entirety below.

This story has been updated to include the name of Morrow County. 

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