As vaccination efforts ramp up and COVID-19 cases decline across the United States, it’s worth noting that the pandemic has brought to light significant inequalities in the nation. While the pandemic certainly didn’t give rise to these issues, it’s evident that the pandemic has exacerbated them, at the very least — and language access services are one such issue. Time and time again, since COVID-19 first made its way into our vocabulary, individuals with limited English proficiency have been left by the wayside during this pandemic.

While issues surrounding language access may not have been as prominent before March 2020, they’re now at the forefront of our minds — or at least, they should be. With roughly 25 million residents in the country being classified as having limited English proficiency, it’s imperative that we learn from the COVID-19 pandemic and work toward developing better language access services across the nation. 

The U.S. Census Bureau designates any individual above the age of five years old who speaks English less than “very well” as having limited English proficiency — according to a 2015 report from the Migration Policy Institute, the population of individuals in this category has been steadily on the rise since at least 1990. Most of them are adults who immigrated here later in life, though about 19% are children born to immigrant parents.

Access to multilingual public health and safety information has been shaky at best throughout the pandemic — back in January, MultiLingual reported on a translation mishap in which a local government agency in Virginia was caught using Google Translate to make a Spanish-language version of its webpage about the COVID-19 pandemic and vaccines against the virus. While the English version simply stated that vaccines weren’t “mandatory,” the Spanish version used the word “necesario,” suggesting that the vaccine was unnecessary or unimportant. 

While this is just a one-off error, it’s certainly emblematic of the sort of nonchalant attitude many in our government and healthcare system hold toward the population of individuals with limited English proficiency. Not to mention the fact that there’s more evidence to suggest that our COVID-19 response failed Latin American residents specifically: around the same time that the translation error occurred, it was also noted that only 9% of those vaccinated in Virginia were of Latin American descent, despite making up 21% of the state’s hospitalizations for the virus. One can’t help but wonder if more Latino residents of Virginia would have been vaccinated early on had the state worked with professional, human translators to make Spanish-language information on the vaccines available, rather than relying on a free machine translation service to save a little time and money.

Similar issues have been reported all across the country — a November report in the Sahan Journal noted that Latinos living in Minnesota often opened Spanish-language government websites looking for information on the COVID-19 pandemic, only to find that the information was weeks, or even months, out of date. Even for deaf and hard-of-hearing speakers of American Sign Language (ASL) — who aren’t typically considered to have limited English proficiency, as most can read English fluently as their second language — language access has been limited; it wasn’t until November that the White House finally hired an ASL interpreter to work at former President Donald Trump’s press briefings.

It’s no surprise, then, that a 2021 study published in JAMA Network Open linked limited English proficiency with higher incidences of COVID-19, alongside a higher death rate (this was just one of many other socioeconomic factors that researchers linked with the pandemic’s toll — other factors included race, disability, and poverty levels).

In August 2020, members of the Senate introduced the Coronavirus Language Access Act in an effort to address the language gap — the bill would have essentially required government agencies to provide more timely translations of COVID-19 related information, however it did not receive a vote before the previous Congress ended. Among numerous other provisions, the Coronavirus Language Access Act would have required the CDC to maintain a national phone hotline staffed with interpreters who could help provide public safety information, as well as provide $200 million to be distributed among local and state governments for improved language access services. 

Representative Grace Meng (D-NY) reintroduced the bill to the House in February 2021, however to this date, it has still not received a vote.

“COVID-19 continues to ravage our nation, especially communities of color. To help close the health disparities these communities face, federal agencies must translate COVID-19-related materials into additional languages,” Meng said. “This is a necessary — and lifesaving — step that will reach those who may not possess English proficiency. … As our nation prepares to ramp up vaccine administration for every American, we must make sure no one is left behind.”

Language access was officially recognized as a civil rights issue back in 1974, in the United States Supreme Court case Lau v. Nichols. At the time, San Francisco public schools had just undergone the desegregation process, however many of the city’s Chinese American students struggled with their English — instead of offering them supplemental English lessons, about 1,800 Chinese American students were placed in special education courses or even held back for years at a time. The Supreme Court ultimately ruled that this was a violation of the Civil Rights Act of 1964, which explicitly forbids discrimination “on the ground of race, color, or national origin in any program or activity receiving Federal financial assistance.” 

It was then that individuals with limited English proficiency first began to receive civil rights protections — still, there’s a long way to go toward truly achieving equitable outcomes for all residents of the United States, regardless of their English proficiency. COVID notwithstanding, individuals with limited English proficiency are still significantly disadvantaged, particularly when it comes to healthcare. A 2017 report in the AMA Journal of Ethics stated that patients with limited English proficiency are “among the most vulnerable populations,” and that many in the medical field hold a relatively apathetic attitude toward the issue, “tacitly accepting that substandard care is either unavoidable or not worth the cost to address.”

“[Patients with limited English proficiency] have been consistently shown to receive lower quality care than English-proficient patients on various measures: understanding of treatment plans and disease processes, satisfaction, and incidence of medical errors resulting in physical harm,” write medical researchers Alexander Green and Chijoke Nze. “These disparities are rooted in obvious communication barriers but also may reflect cultural differences, clinician biases, and ineffective systems.”

One of the best ways to address inequalities in health outcomes? Having a fully staffed team of medical interpreters on call at all times. But unfortunately hospitals and medical centers all too often forgo this critical element of their staff, in large part due to the large cost associated with hiring and paying interpreters, particularly in the case of interpreters who specialize in less commonly used languages.

Back in March, when Hawaiian state senator Dru Kanuha introduced his bill to improve medical interpretation services for Micronesian residents living in the state (many of whom speak little English), the bill was met with large outcry from hospitals across the state — particularly hospitals on the island of Oahu, the most populous and politically powerful island in the state, who viewed the financial burden of employing medical interpreters as too hefty. As a result, the bill now only requires hospitals on the island of Hawaii to provide medical interpretation services for Micronesian patients.

Medical interpreters play an especially crucial role in any hospital setting, because not only do they have the linguistic proficiency necessary to understand both English and the target language, they also receive training and certification which ensure that they are able to use terminology that is specifically geared for use in a medical context. As MultiLingual reported in May, bilingual doctors are often asked to double as interpreters for their patients — however this is by no means a sufficient replacement for a well-trained staff of medical interpreters. 

While doctors and nurses clearly have expertise in healthcare, their medical schooling typically does not train them on the intricacies of interpretation, and they are therefore not qualified to double as medical interpreters — nor should they. After all, being a doctor is hard enough work; adding “interpreter” to the job description is simply too much to ask for, and often compromises a patients’ understanding of their condition, or worse, leads to poorer health outcomes.

Aside from the Coronavirus Language Access Act, there are numerous other examples of public policy in the works that would improve language access on the local and federal levels. The California State Assembly recently passed Assembly Bill 1363, which, if passed by the State Senate, would require the state to collect information on dual-language learners in the state’s pre-school system, a move that will allow educators to keep better track of their students and create specialized educational goals to accommodate their unique needs. This is of course a far cry from the days of Lau v. Nichols, when students with limited English proficiency were neglected by the state’s public school system. 

Additionally, the state of New York has proposed a new policy requiring state government agencies to publish translations of their websites in the ten most commonly used languages in the state. Even housing is an area in which language access has been lacking historically — in May, the House Committee on Financial Services passed a bill requiring mortgage lenders to provide expanded language resources for buyers who don’t use English as their primary language.

While we’ve come a long way since language access first landed on the average politician’s radar in the 1970’s, it’s important to continue building upon these improvements, and make sure that we, as professionals in the language industry, work toward a future in which nobody faces needless troubles as a result of their proficiency level in English. Perhaps Meng explained it best in her announcement of the Coronavirus’ Language Access Act’s reintroduction:

“One’s grasp of the English language should never determine their ability and access to fighting against this pandemic,” she said.

Indeed, one’s grasp of the English language should never determine any aspect of their quality of life, especially in a nation as diverse, developed, and wealthy as the United States.