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The good news is that the Covid-19 vaccination rate in the United States is increasing, while the rates of new infections, hospitalizations and deaths are slowing. As of this week, more than 66 million doses have been given to at least 42 million Americans, or about 13% of the population.
But the disease continues to spread and there aren’t enough doses of the vaccine yet to meet demand. And many of those who need a vaccine the most have the most difficulty getting one.
From signing up for appointments to securing transportation to clinics, many of those most at risk of serious consequences and dying from Covid-19 – the elderly, essential workers and minority communities – have trouble getting vaccinated when it’s their turn. At the same time, some wealthier or lower risk people have played on vaccine registration systems to lead the way.
“A lot of my older patients have a hard time figuring out how to do it in general,” said Margot Savoy, director of the department of family and community medicine at Temple University in Philadelphia. “We made it so complicated.”
The top priority for many states right now is scale. Some are setting up mass vaccination sites in public places like stadiums to get as many arm shots as possible, as quickly as possible. However, some health experts argue that in addition to getting big, communities should also get small, working through local clinics and community groups to reach the most vulnerable. This can come at the expense of speed, but it would help ensure fairness between people who get vaccinated against Covid-19.
Vaccinating the most vulnerable people requires active awareness
No community or demographic has been spared by the Covid-19 pandemic. More than half a million Americans have died of the disease and many more have fallen ill. But some groups are hit harder than others, and it’s not just the elderly.
“Throughout the pandemic, people of color have always been disgusted and disproportionately killed by the virus,” Youyou Zhou and Julia Belluz of Vox wrote in a recent article. “They also died young: Of Covid-19 deaths in people under 45, more than 40% were Hispanic and about a quarter were black.
These same groups are also less likely to interact with the existing health care system and are more likely to encounter barriers when finding the vaccine. Technology is a barrier that has emerged in several states. For example, the online reservation system for vaccine appointments in Arizona appears to favor some groups over others.
“When appointments become available, it’s like a gold rush,” said Will Humble, executive director of the Arizona Public Health Association and former public health official. “If you work in a grocery store or if you don’t have wifi, you are at a great disadvantage.”
Arizona has set up mass vaccination sites around major metropolitan areas. This is helping the state boost its numbers – around 15% of its population has now been vaccinated – but many of its most vulnerable people have not been able to sign up for limited appointment slots during the months. a few short opening hours. Some are also not able to visit these sites from their homes, according to Humble.
“The effect of this [mass vaccination strategy] was yes, it sped up the administration of the vaccine, but it also served high income people disproportionately, ”Humble said. “What the vaccinators tell me is that they vaccinate Teslas and Tahoes all day.”
According to a February 18 Kaiser Family Foundation assessment, around 12% of Arizona’s white population has so far been vaccinated against Covid-19, compared to 4% of blacks, 3% of Hispanics and 9% of Asians. .
Another issue for Arizona, as in many states, is that remote areas may not have the resources to administer the two Covid-19 vaccines currently available in the United States. While the Moderna vaccine has less stringent freezing requirements, the Pfizer / BioNTech Covid-19 vaccine requires ultra-cold storage, so it is primarily allocated to larger counties that have the facilities to store it.
Humble said one way to improve the system would be to have a one-time registration and then a weighted lottery to assign appointments, so that people with fast fingers, fast internet connections, and free time do not. would not have such an overwhelming advantage. .
But reaching some of the most vulnerable also requires active outreach. “We take a real grassroots approach to this, which requires us to go to communities … literally knock on doors,” said Tomas Ramos, founder of the Bronx Rising Initiative, a group that helps vaccinate. Bronx residents against Covid-19. “What I get when I knock on the door and talk to an Elder is that they don’t even know when to start. This is where we come in. “
Bronx Rising Initiative is working to raise funds for local clinics to increase vaccination capacities against Covid-19, as well as to set up remote vaccination sites in public housing. Additionally, the group is looking for older people and other vulnerable people to sign up for vaccine appointments, following up with reminders and helping them organize transportation if needed.
Many of the initiative’s volunteers also come from the Bronx. And it helps build confidence, fight vaccine misinformation, and convince reluctant Bronxitis to get vaccinated.
“We are from the community, so when [volunteers] Knock on the door, [residents] seeing someone who lives in the same community tell them about it, ”Ramos said.
Local health centers can fill immunization gaps, but they need doses first
Many communities across the country have had months to set up their Covid-19 vaccine delivery programs. But supplies remain limited and there is a frustrating lack of information on when they will be restocked.
“We have all the infrastructure to give it away,” said Julie Vaishampayan, public health manager for Stanislaus County in California. “We are distributing it in very good arms, but we are not distributing it in all eligible arms and we do not really know who we are missing.”
Another complication is that local health officials face hurdles to order vaccines from the county, state, or federal government. And it’s not always transparent where these vaccines go, so frontline health workers don’t have a lot of time to prepare. When the vaccines arrive, local health officials should identify eligible recipients, gather them for appointments, administer the vaccines before they expire, and monitor patients to ensure they receive their second dose. There can be an overlap between different areas of health coverage, so even if someone is a perfect candidate for a vaccine, it can be difficult to tell which group or agency is changing by giving them an injection.
“I can’t see the vaccine that is coming from the federal government or the state government,” Vaishampayan said. “I don’t know who it’s going to. I don’t know how many doses they received. I don’t know how many doses they gave. It is very difficult to set up a network or suppliers that will reach your population. “
According to Vaishampayan, a central clearinghouse telling local health officials how vaccines will be allocated up to a week in advance would go a long way in optimizing distribution. Currently, many health services face much shorter delays in receiving vaccines.
Potential good news is that the Covid-19 vaccine developed by Johnson & Johnson could gain emergency approval from the Food and Drug Administration this weekend. Not only would a third vaccine help boost supplies, the Johnson & Johnson vaccine only requires one dose instead of two and can be stored at room temperature in the refrigerator.
This vaccine would be particularly suitable for small family practices and community clinics, which are less likely to have ultra-cold freezers. These types of facilities may have a lower throughput of vaccinations (because they are equipped to treat fewer patients and may not have facilities to store vaccines), but they may be able to better identify those who have the disease. no need for a Covid-19 vaccine anymore.
Having a Covid-19 vaccine in a dose that can be kept in a regular medical refrigerator would allow these clinics to join the vaccination campaign and expand the reach of it.
“When we get to this vaccine, all of a sudden there’s a real opportunity for the average family doctor or primary care staff,” Savoy said. “If we ever had a vaccine to distribute and we could have one in the office and store it, we would have a whole network of people ready to go.
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