The good news is that the rate of Covid-19 vaccinations in the United States is increasing, while rates of new infections, hospitalizations and deaths are decreasing. As of this week, more than 66 million doses have been administered to at least 42 million Americans, about 13% of the total population.
But the disease is still spreading and there are still not enough vaccine doses to meet demand. And many of those most in need of a vaccine are having a harder time getting it.
From registering for appointments to obtaining transportation to clinics, many of the people most at risk for serious outcomes and death from Covid-19 – older adults, essential workers and minority communities – are having trouble getting vaccinated when their turn comes. . At the same time, some wealthier or less risky people have created vaccine registration systems to get to the top of the line.
“Many of my older patients are struggling to figure out how to do this in general,” said Margot Savoy, head of the department of family and community medicine at Temple University in Philadelphia. “We made it very complicated.”
At the moment, the priority for many states is scale. Some are setting up mass vaccination sites in public places, such as stadiums, to get as many shots at the guns as possible. However, some health experts argue that, in addition to growing, communities should also shrink, working through local clinics and community groups to reach the most vulnerable. It can happen at the expense of speed, but it would help to ensure the equity of those being vaccinated against Covid-19.
Vaccination of the most vulnerable people requires an active outreach
No community or demographic group has been spared the Covid-19 pandemic. More than half a million Americans died of the disease and many more became ill. But some groups are being hit harder than others, and not just the elderly.
“During the pandemic, people of color were systematically sick and killed by the virus disproportionately,” wrote Youyou Zhou and Julia Belluz of Vox in a recent article. “They also died young: of Covid-19’s deaths in people under 45, more than 40 percent were Hispanic and about a quarter were black. ”
These same groups are also less likely to interact with the existing health system and are more likely to face impediments when seeking a 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 consultations become available, it’s like a gold rush,” said Will Humble, executive director of the Arizona Public Health Association and a former state health officer. “If you work in a supermarket or don’t have wi-fi, you’re at a big, big disadvantage.”
Arizona has set up mass vaccination sites in major metropolitan areas. This is helping the state to increase its numbers – about 15 percent of its population has already been vaccinated – but many of its most vulnerable people have been unable to apply for limited hours during the few hours they are open. Some are also unable to drive to these locations from their homes, according to Humble.
“The effect of this [mass vaccination strategy] yes, it accelerated the vaccine administration, but it also disproportionately served high-income people, ”said Humble. “What vaccinators tell me is that they are vaccinating Teslas and Tahoes all day.”
According to a Kaiser Family Foundation assessment on February 18, about 12% of Arizona’s white population has so far been vaccinated against Covid-19, compared with 4% of blacks, 3% of Hispanics and 9% of Asians. .
Another problem for Arizona, as in many states, is that remote regions may not have the resources to administer both Covid-19 vaccines that are currently available in the United States. Although the Moderna vaccine has less stringent freezing demands, the Pfizer / BioNTech Covid-19 vaccine requires ultra-cool storage, so it is being allocated mainly to larger counties that have facilities to store it.
Humble said that one way to improve the system would be to have a one-time registration and then a weighted lottery to allocate appointments, so that people with fast fingers, fast Internet connections and free time would not have such an overwhelming advantage.
But reaching out to some of the most vulnerable also requires active reach. “We are taking a real grassroots approach to this, which requires us to visit communities … literally knocking 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, they just don’t know when to start. That’s where we come in. “
The Bronx Rising Initiative is working to raise funds for local clinics to increase vaccination capacity against Covid-19 and also to create remote vaccination sites in public housing. In addition, the group is looking for the elderly and other vulnerable people to sign up for vaccination appointments, following up with reminders and helping them arrange transportation, if necessary.
Many of the initiative’s volunteers are also from the Bronx. And it helps to build trust, combat misinformation about the vaccine and persuade reluctant bronxites to become immunized.
“We are from the community, so when [volunteers] knock on the door, [residents] see someone who lives in the same community talking to them about it, ”said Ramos.
Local health clinics may close the gaps in vaccinations, but they need the doses first
Many communities across the country have had months to establish their Covid-19 vaccine administration programs. But supplies remain limited and there is a frustrating lack of information about when they will be replenished.
“We have all the infrastructure to offer this,” said Julie Vaishampayan, a public health officer in Stanislaus County, California. “We are putting it in very good arms, but we are not distributing it in all eligible arms and we are not sure who we are losing”.
Another complication is that local health authorities have to make an effort to request vaccines from the municipal, state or federal government. And it’s not always transparent where these vaccines are going, so health workers on the front lines don’t have much time to prepare. When vaccines arrive, local health officials need to identify eligible recipients, assemble them for consultations, administer vaccines before they expire, and monitor patients to ensure they receive the second dose. There may be overlap between different areas of health coverage; therefore, even if someone is a perfect candidate for a vaccine, it can be difficult to tell which group or agency is changing to give the vaccine.
“I can’t see the vaccine that comes from the federal government or the state government,” said Vaishampayan. “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. This makes it very difficult to set up a network or providers that will reach your population. “
A central information center that informs local health authorities how the vaccines will be distributed up to a week in advance would be a major step towards optimizing distribution, according to Vaishampayan. Today, many health departments have to deal with much shorter waiting times to receive vaccines.
Potential good news is that the Covid-19 vaccine developed by Johnson & Johnson could obtain emergency approval from the Food and Drug Administration this weekend. Not only would a third vaccine help increase supplies, the Johnson & Johnson vaccine requires only one dose instead of two and can be stored at normal refrigerator temperatures.
Such a vaccine would be particularly suitable for smaller family practices and community clinics, which are less likely to have deep-frozen freezers. These types of facilities may have a lower rate of vaccine transfer (since they are equipped to handle fewer patients and may not have facilities to stock vaccines), but they may be able to better identify those most in need of a vaccine Covid-19 .
Having a single-dose Covid-19 vaccine that can be stored in an ordinary medical refrigerator would allow these clinics to participate and expand the scope of the vaccination campaign.
“When we get the vaccine, suddenly there is a real opportunity for the average family doctor or primary care person,” said Savoy. “If we ever had a vaccine to actually distribute and we had one that we could have at the clinic and store it, we would have a whole network of people ready to go.”