The Covid-19 vaccine is a struggle for those who have no connection to a hospital

Many states chose to distribute the vaccine first to hospitals, which then became the main distributors of the vaccine to their own health care and other qualified professionals. In many cases, people need to have a primary care physician affiliated with the hospital, or receive care from the hospital, to receive an injection there.

This means that people living in poorer communities, without large hospitals, often face even more difficulties in finding access to the still scarce vaccine. The problem highlights one of the challenges that authorities face in the effort to vaccinate people equitably.

When Texans aged 65 and over and with certain medical conditions became eligible for Covid-19 vaccines, Jovana Sanchez-Melendez, a technology director at a 35-year-old university near Dallas who has an autoimmune disease, received an email from your doctor to sign for an appointment.

Ms. Sanchez-Melendez received the vaccine quickly. But she said she was unable to make an appointment for her parents, who work first-rate jobs as janitors and construction workers and have health problems that make them at high risk for Covid-19. His parents were not patients at a hospital that had doses.

“You have to know someone who knows someone who knows how to get it, and even then, it is not a certain thing,” said Sanchez-Melendez. Her parents finally found doses, with her father receiving her first injection on Wednesday, about a month after she received hers.

Similar dynamics have been reported across the country, in states as diverse as California, New York, Iowa and Alabama. The situation has improved slightly in recent weeks, as more hospitals are beginning to make room for non-patient records, health officials said. In addition, in some states, major retail pharmacies, such as CVS, are now distributing doses, expanding access.

Dennis Andrulis, a senior researcher at the Texas Health Institute, said that nationally 27% of white men, 31% of black men and 41% of Hispanic men do not have a primary care physician. He said hospitals also tend to be located in more affluent areas, leaving poorer neighborhoods with fewer options.

“You have a history of steroid neglect,” said Dr. Andrulis. “If people have access to a doctor in their community and insurance, the door will be more open for them.”

Dr. Georges Benjamin, executive director of the American Public Health Association, said that some of the people who need the vaccine most – workers in dangerous public jobs – are less equipped to fight for doses if they don’t have a connection to a doctor. Bus drivers, janitors, grocery workers and others cannot spend their days updating computer screens looking for doses of vaccine, in the same way as people who work at home on computers, he said.

Many doctors and clinics without ties to a large hospital have been left out of initial efforts to distribute the vaccine, said Dr. Benjamin. On Wednesday, he said the situation was evolving. “There is certainly an increase in availability, but many of the community medical providers still do not have easy access,” he said. “Retail pharmacies should help the situation a little.”

In Texas, facilities that give priority to their own patients include some designated by the state as vaccine centers. Hospitals said they expanded access as they were able to do so. A spokesman for UT Southwestern Medical Center, where Sanchez-Melendez received his vaccine, said he treats extremely sick patients and tried to give priority to those most likely to be hospitalized if they contracted the virus. The hospital allowed periodic access to non-patient registrations and set up a vaccination site in an area of ​​southern Dallas that has historically been poorly served by health services.

John DeFilippo, 72, from Houston, signed up for vaccination appointments in January, at the same time as his wife, Marylyn. Your doctor at the Memorial Hermann Health System sent you an email with the link for an appointment. A few days later, he received a call from a hospital representative asking who his doctor was. Mr. DeFilippo had been treated at Memorial Hermann before and recovered from back surgery there, but his primary care physician was not directly affiliated. He said the hospital canceled his appointment.

A health system spokeswoman said the vaccine supply is so limited and the skilled population is so large that it needs to move in waves. “Like many health systems across the country, we started offering vaccination to active and established patients,” said the hospital. “However, in mid-January, we were hosting several mass vaccination clinics around greater Houston.”

Mr. DeFilippo said he was surprised, not only at the hospital’s policy, but also that he would devote resources during the pandemic to tracking and eliminating outpatients.

“I’m not a stranger at the hospital, but I don’t think I’m a customer enough,” he said. “She must have researched me and my doctor – everything for a patient.”

He said he later managed to get the vaccine at another hospital.

Write to Elizabeth Findell at [email protected]