This summer, while many Californians went to work in their pajamas at their kitchen tables, Vicente Reyes went to work in the grape fields of the Central Valley.

“Other Americans have been able to shelter in place at home, we still keep working,” he said. “And without our work, there wouldn’t be any food.”

California produce, meat and dairy gets shipped all over the country and the world. This is why Reyes believes agricultural workers should be next to get the COVID-19 vaccine.

“If there would be a shortage of food, then there would be more chaos,” he said.

While doctors, nurses and other health care workers began to receive the new COVID-19 vaccine this week, the state is still actively debating which essential workers will be next in line. Officials are using a framework of risk, equity and societal impact to decide who should be prioritized — meat packers, teachers, those who manage wastewater or electrical supply — and based on discussions so far, they appear to be giving deep consideration to agricultural workers.

Studies show farmworkers are at higher risk of contracting the coronavirus than the average population because they earn lower wages that force them to live in crowded conditions or drive to work sites in crowded trucks. There have been multiple outbreaks at Foster Farms’ poultry processing plants in the state. And when agricultural workers do get sick, Reyes says, they can’t afford to take time off work or go to the doctor.

“We try not to, because we would have to pay,” he says. “We just try to walk it out or try to find home remedies to get better.”

About 50% of farmworkers are undocumented, and without legal status they have been systematically left out of U.S. labor protections, like overtime and sick pay. Under the Affordable Care Act, undocumented immigrants were prohibited from getting health insurance through the state’s Medicaid program or from buying it through the state’s marketplace.

Without health coverage, advocates say farmworkers are paying the price with their lives: Latinos are almost three times more likely to die from COVID-19 than white people.

“We’re seeing these structural inequities that are now being exacerbated because of a pandemic,” says Diana Tellefson Torres, executive director of the United Farm Workers Foundation, adding that all the barriers they face in getting care is another reason farmworkers should be prioritized for the vaccine.

“This is definitely an opportunity to redress a lot of the inequities that farmworkers have experienced, not only for decades, but for centuries,” she says.

Different Counties, Different Priorities

The state has made clear that it’s taking equity considerations like this very seriously in its vaccine plans. But it will be up to individual counties to implement the state plan, balancing equity concerns with the complicated logistics of shipping vaccines that need to be stored at minus 94 degrees Farenheit to rural areas.

Some counties already have a plan.

“In Riverside County, we have a large farmworker population,” says Kim Saruwatari, director of public health for Riverside County. “So we know that once you take it out of the deep freeze, it’s good for five days. So, take a smaller amount, take it out to those farmworking communities, administer everything we have, get more, and take it out and keep going until we get everybody covered.”

But smaller counties with less money may find this daunting — even impractical. For Eric Sergienko, public health officer for Mariposa County, it doesn’t make sense to vaccinate farmworkers first because the first vaccines endorsed by the Food and Drug Administration — the Pfizer-BioNTech and Moderna vaccines — each require two doses: the primary shot followed by a booster.

“So if it were just a single shot, I think we would be able to wrangle with logistics fairly easily,” Sergienko says. “But seeing as we have to find that person either 21 days or 28 days later, that adds a layer of complexity.”

Farmworkers are mobile, he adds. They could be working or living in a different place one month later. He says the most effective strategy could be to wait.

“Don’t let the perfect be the enemy of the good,” he says. “Hold us as closely to those equitable measures as possible, but recognize that it’s not going to be perfect.”

Sergienko is concerned about equity, but he needs to use an equation that works for his region. His county has just one hospital and no intensive care unit. If someone gets really sick and needs an ICU bed, they get flown or taken in an ambulance to a tertiary care facility, usually in Fresno or Modesto.

But hospitals in those regions are running out of beds. The San Joaquin Valley region had less than 2% of its ICU beds available as of Dec. 14, meaning patients have to wait longer, and get care from staff members who are stretched thin. To Sergienko, it makes sense to vaccinate frail, elderly people first because they’re most likely to need critical care.

“The more people I keep out of the hospital, the better the people that are actually hospitalized will do,” he says.

Inequity cuts across ethnicity, age and geography, Sergienko says. He hopes the state’s final vaccine plan will somehow account for this: Who needs the vaccine most in Mariposa County may be very different from who needs it most in San Diego or San Francisco.