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Correcting these disparities while increasing the vaccine supply will be a crucial first test for President Joe Biden’s administration. He signed an executive order on the second day of his tenure to fight racial equity and appointed advisers to focus specifically on health disparities. But solving the problem will require more than good intentions.
“This pandemic has really exposed the failures of our health care system,” said Representative Raul Ruiz, (D-Cal.), A physician who represents a district with many Latin American farm workers with limited health care. “We cannot rely on this health care system to deal with fairness… We will continue to fail. And we see it now with the distribution of vaccines.
The federal government does not explicitly require that vaccines be distributed or administered equitably “So you have states like Michigan that are well-meaning and thoughtful, but don’t have a comprehensive plan,” Debra Furr-Holden, expert in Public Health at Michigan State University, which is part of the state’s racial disparity coronavirus task force, said in an interview.
“In the absence of a mandate, our natural drift is towards iniquity,” she added.
One of the first stumbling blocks was the lack of data. In theory, the CDC has required states to disclose race and ethnicity data up front. But the rule was not strictly enforced, and some states did not initially require providers to collect the information, leaving significant gaps in efforts to identify unmet needs.
As of mid-January, only 17 states had released data on race and ethnicity on people getting vaccinated – often with reservations that the data is incomplete. Other states are collecting the information, but have refused to release it citing similar quality concerns. The CDC says 47% of vaccination data does not contain information on race and ethnicity – a flaw according to public health experts must be corrected as the pandemic enters a dangerous new phase.
“We can’t keep hitting the box. We can’t keep saying we don’t have the data, the data isn’t great, ”said Cara James, former CMS director of the Bureau of Minority Health who now heads the organization Grantmakers In Health.
Marcella Nunez-Smith, chair of Biden’s Covid-19 equity task force, said in a White House briefing Monday that the holes in the file “don’t just hurt our statistics, they hurt to the community that is most at risk and has been the hardest hit. “
Data in the states that collected it reveals stark racial disparities, with white residents typically getting vaccinated at more than twice the rate of black residents. In Pennsylvania, which has one of the biggest disparities, the ratio is over three to one.
“We have had such weak federal leadership so far. At this point in the pandemic, it is appalling that there are no standardized reporting systems, ”said Jeffrey Levi, professor of health policy and management at George Washington University.
On Thursday, Rep. Ayanna Pressley (D-Mass.) And Sens. Elizabeth Warren (D-Mass.) And Ed Markey (D-Mass.) Sent a letter to Acting HHS Secretary Norris Cochran urging the department collect and further publish comprehensive data on race and ethnicity.
Public health experts say vaccine reluctance is at the root of part of the racial divide, referring to polls suggesting black Americans are more worried about getting vaccinated when vaccines are still so new .
Age is another factor. When the vaccine was initially rolled out to health workers, younger staff – who also tend to be more racially diverse – were less likely to volunteer for vaccines, officials said.
“It’s more older people who want the vaccine,” said Ayne Amjad, commissioner and public health officer for the West Virginia Office of Public Health. Young people tend to see more misinformation about vaccines online, she added. West Virginia has one of the most successful vaccine deployments in the country.
Some experts say focusing too much on the reluctance misses a bigger point – that much more needs to be done to get the vaccine into these hard-hit minority communities, at times and places where residents can access it.
“The reluctance to vaccines is a real concern, but I’m concerned that the emphasis on vaccine reluctance is a way to deflect responsibility for equitable distribution early on,” he said. said Anne Sosin, director of the Dartmouth Center for Global Health Equity.
Even in cities and states without complete data, racial disparities can still be clearly visible on maps showing where the doses have gone.
In the District of Columbia, residents of predominantly black neighborhoods in the east had the highest Covid-19 death rates, but are now receiving fewer doses of the vaccine.
As the city sought to open many vaccination sites in these neighborhoods, the online registration system allowed residents to register for appointment slots, regardless of where they lived.
With vaccines scarce, slots were taken disproportionately by residents of other parts of the city on a first come, first served basis. Elderly residents in particular also struggled with the computer system, and the phone lines set up as an alternative were quickly overwhelmed.
“We were inundated with calls and messages from voters, and we observed it anecdotally ourselves after going to some sites to see, obviously, that vaccine distribution was extremely inequitable, favoring richer, white communities, ”said Kenyan McDuffie, DC Board member. “They traveled from the wealthiest neighborhoods to the poorest areas of the city.”
Experts also say vaccine reluctance plays a bigger role when residents have to fight for rare slots. If they’re not sure whether the vaccine is safe, they aren’t as motivated to keep trying to get an appointment.
“If you just say we give the vaccine to whoever is first on the list, that puts people with questions at a disadvantage,” said Joshua Sharfstein, vice dean of public health practice and engagement. community at Johns Hopkins University, which was previously responsible for Maryland. chief health officer and as deputy commissioner of the FDA during the Obama administration.
DC has also worked with providers to dispense doses outside of the central appointment system by requiring them to schedule patient appointments directly, but minority populations are generally less connected to the healthcare delivery system. health.
McDuffie was successful in pushing the city to reserve part of the vaccine supply for people living in the hardest-hit postal codes. It has also secured more telephone staff for residents unable to use the online system.
“They have to be prioritized and you can’t wait for these people to come to town hall and ask,” McDuffie said.
Michigan was praised earlier in the pandemic for its focus on fairness, including creating a dedicated coronavirus racial disparity task force. But early signs show that he also faces inequalities in vaccine deployment.
Officials said they were working to correct the data gaps and hope to release them publicly within the coming week. But like in other jurisdictions, a map of the region’s immunization efforts suggests disparities are emerging.
Rural and predominantly white counties, especially along the state’s upper peninsula, led the pack with more than 10% of their populations having already received the first dose. In Wayne County, which includes Detroit and where more than half of the state’s black residents reside, only 6% received a first dose.
Like other states, Michigan officials expect the first round of direct demographic data to show substantial disparities when it is finally released.
In an interview, state medical director Joneigh Khaldun said the initial disparity was due to prioritization of health workers and reluctance to get vaccinated. For the next phase, Michigan is using the CDC’s Social Vulnerability Index to determine where to allocate more doses, in addition to the number of elderly residents and essential workers.
“We use an equity lens for how we allocate doses across the state,” Khaldun explained.
The state health department is also working directly with the city of Detroit – giving the city additional doses in addition to formula-based allowances distributed statewide. And they partner with local providers for targeted access in communities of color, using federally trained health centers, mobile clinics, and community vaccinators.
“The best public health happens when you go to neighborhoods and when you work with communities and when you reach out to people who don’t have access to transportation or who are homebound,” Khaldun said.
The state has set an explicit goal of zero disparities in vaccine distribution, similar to its efforts on Covid cases and deaths. But there is no specific deadline, and Khaldun hopes to achieve the goal “as soon as possible.”
Furr-Holden, who is also director of the Flint Center for Health Equity Solutions, said she is confident Michigan will eventually close the gap, but fears that simply allocating more vaccines to vulnerable areas could will not suffice without a binding warrant for fairness. .
“Flint is primarily an African-American city. I recently received my first dose of vaccine in the town of Flint at an administration site, and I was the only African American to receive the vaccine. said Furr-Holden.
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