Addressing these disparities while increasing the supply of vaccines will be a crucial initial test for President Joe Biden’s administration. He signed an executive order on his second day in office to combat racial equality 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 flaws in our health system,” said Rep. Raul Ruiz, (D-Cal.) A doctor who represents a district with many Latin farmers with limited health care. “We cannot count on this health system to deal with equity … We will just continue to fail. And we see that now with the distribution of the vaccine. “
The federal government does not explicitly order vaccines to be distributed or administered equitably “so you have states like Michigan that are well-intentioned and considerate, but did not have a comprehensive plan,” Debra Furr-Holden, public health expert at A Michigan State University, which serves on the racial disparity task force against the state’s coronavirus, said in an interview.
“In the absence of a mandate, our natural tendency is towards inequality,” she added.
An initial obstacle was the lack of data. In theory, the CDC required states to report race and ethnicity data from the start. But the rule was not enforced rigorously, and some states did not initially require providers to collect information, leaving major gaps in efforts to identify unmet needs.
By mid-January, only 17 states had publicly released race and ethnicity data on who is being vaccinated – often with caveats that the data is incomplete. Other states are collecting the information, but have refused to release it, citing similar quality problems. The CDC says that 47% of vaccination data does not contain information on race and ethnicity – a flaw that public health experts say needs to be corrected as the pandemic enters a new and dangerous phase.
“We can’t go on kicking the can. We can’t go on saying that we don’t have the data, the data isn’t good, ”said Cara James, a former CMS director at the Office of Minority Health who now leads the Grantmakers In Health organization.
Marcella Nunez-Smith, chairman of Biden’s net equity task force Covid-19, said at a meeting at the White House on Monday that gaps in the registry “don’t just harm our statistics, they hurt the community that is under greatest risk and it has been the most difficult blow. “
Data in the states that collected them reveal stark racial disparities, with white residents being vaccinated at more than twice the rate of black residents. In Pennsylvania, which has one of the largest disparities, the ratio is more than three to one.
“We have had very weak federal leadership so far. At this stage of the pandemic, it is scary that there are no standardized reporting systems, ”said Jeffrey Levi, professor of health management and policy 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 the interim HHS secretary, Norris Cochran, urging the department to collect and release more comprehensive data on race and ethnicity.
Public health experts say vaccine hesitation is driving part of the racial divide, citing research that suggests that black Americans are more concerned with getting vaccines when vaccines are still so young.
Age is another factor. At the initial launch of the vaccine for healthcare professionals, younger employees – who also tend to be more racially diverse – were less likely to volunteer for vaccines, officials say.
“It is more the elderly who want the vaccine,” explained Ayne Amjad, commissioner and state health officer in the West Virginia Department of Public Health. Younger people tend to see more misinformation about vaccines online, she added. West Virginia has one of the most successful vaccine implementations in the country.
Some experts argue that focusing too much on hesitation misses a broader point – that much more needs to be done to bring the vaccine to these hard-hit minority communities, at times and places where residents can access them.
“Vaccine hesitation is a real concern, but I am concerned that the focus on vaccine hesitation is a way of shifting responsibility for equitable distribution on the front end,” said Anne Sosin, director of the Dartmouth Center for Global Health Equity .
Even in cities and states without comprehensive data, racial disparities can still be seen clearly on maps that show where the doses went.
In the District of Columbia, residents of predominantly black neighborhoods in the east had the highest death rates in Covid-19, but are now receiving fewer doses of vaccines.
Although the city has sought to open many vaccination posts in these neighborhoods, the online registration system has allowed residents to sign up for office hours, regardless of where they live.
With vaccines missing, vacancies were disproportionately filled by residents of other parts of the city, on a first-come, first-served basis. Elderly residents, in particular, also struggled with the computer-based system, and telephone lines configured as an alternative were quickly overloaded.
“We were inundated with calls and messages from constituents, and we observed anecdotally ourselves after going to some of the locations to see, visibly, that the vaccine distribution was overwhelmingly unfair, favoring white and wealthier communities,” said the adviser. by Kenyan McDuffie. “They traveled from the richest wings to the poorest wings in the city.”
Experts also argue that hesitation about the vaccine plays a more important role when residents need to compete for scarce places. If they are not sure about the safety of the vaccine, they are not as motivated to keep trying to make an appointment.
“If you just say that we are giving the vaccine to the first in line, it hurts people who have doubts,” said Joshua Sharfstein, vice president of public health practice and community involvement at Johns Hopkins University, who previously served as Maryland’s chief health officer and as FDA deputy commissioner during the Obama administration.
DC also worked with providers to distribute doses outside the central appointment system, making them make appointments directly with patients, but minority populations are less connected to the health system in general.
McDuffie has successfully forced the city to reserve part of the vaccine supply for people living in the hardest hit zip codes. He also secured more telephone teams for residents who could not use the online system.
“They should be prioritized and you can’t expect these people to come to the city and ask,” said McDuffie.
Michigan won praise early in the pandemic for focusing on equity, including the creation of a task force dedicated to racial disparities in the coronavirus. But the first signs show that she also faces injustice in the distribution of the vaccine.
Officials said they are working to correct data gaps and hope to make them publicly available next week. But, like other jurisdictions, a map of the region’s vaccination efforts suggests that disparities are emerging.
Rural and predominantly white municipalities, especially along the state’s high peninsula, lead the group, with more than 10 percent of its population 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 their first dose.
As in other states, Michigan officials expect the first round of direct demographic data to show substantial disparities when it is finally released.
In an interview, the state’s chief medical officer, Joneigh Khaldun, said the initial disparity was caused by the prioritization of health professionals and also by the hesitation of the vaccine. 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 are using an equity lens for how we are allocating doses across the state,” explained Khaldun.
The state health department is also working directly with the city of Detroit – allocating extra doses to the city, in addition to formula-based allocations distributed throughout the state. And they are partnering with local providers for targeted access in communities of color, using federally qualified health centers, mobile clinics and community vaccinators.
“The best public health happens when you go to neighborhoods, work with communities and address people who do not have access to transportation or who are stuck at home,” said Khaldun.
The state has set an explicit goal of zero disparities in vaccine distribution, similar to its efforts in Covid cases and deaths. But there is no specific deadline and Khaldun hopes to reach the goal “as soon as possible”.
Furr-Holden, who also serves as director of the Flint Center for Health Equity Solutions, said she is confident that Michigan will eventually close the gap, but fears that simply allocating more vaccines in vulnerable areas is not enough without a mandatory equity mandate.
“Flint is predominantly an African American city. I recently received my first dose of vaccine in the city of Flint, at an administration site, and I was the only African American who received the vaccine. ”Said Furr-Holden.