The English-Only Nature of Vaccine Deservedness and Harms of Racialized Administrative Burdens

Despite extensive efforts to facilitate COVID-19 vaccine access and achieve a 70% vaccination rate, race-based disparities and barriers to vaccine access continue to persist in the United States. To investigate discrimination among Limited-English Proficient (LEP) populations, we conducted a paired audit test field experiment. Testers with identical gender and immigration status, but differing in racial and language profiles, inquired about vaccine access in all 50 states through the Department of Health and Major Vaccine Sites, using phone, email, and web-based chat communication. The results show that Spanish-speaking testers faced additional systemic barriers, were more likely to encounter overt racialized and judgmental language, and experienced heightened scrutiny regarding their identity. These findings highlight both macro-level communication infrastructure and micro-level interactions that contribute to ongoing disparities in healthcare access.