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Broader vaccine eligibility may exacerbate racial inequities

Minority groups are less likely to get vaccinated due to challenges in distribution, data suggest

States and the federal government are trying to stop the COVID-19 vaccine equity gap from growing as vaccine eligibility opens up to all adults — but officials don’t have much time.

Black and Hispanic individuals are getting shots at a lower rate than white Americans, and polling indicates this is due more to challenges in getting the vaccine than a vaccine hesitancy problem. President Joe Biden has said states would open up vaccine eligibility for all adults by April 19, and public health experts say that could exacerbate the equity gap unless states work quickly to level the playing field.

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The Biden administration is taking some steps to deliver more vaccines to vulnerable underserved groups through its community health center vaccination program, and the president’s COVID-19 Health Equity Task Force is drafting recommendations to ensure an equitable rollout. But community health centers were allocated only 1 million doses in the initial rollout of the program, and Biden’s health equity group has yet to formalize recommendations to states.

Meanwhile, Black people represent just 8.4 percent of people who have received at least one dose, and Hispanic people represented 11.1 percent. In contrast, white people represented 65 percent of people with at least one dose of the vaccine, according to the Centers for Disease Control and Prevention.

Black and Hispanic people also represent the majority of COVID-19 cases, hospitalizations and deaths. For example, in Texas, Hispanic people make up 40 percent of the population but 45 percent of deaths and just 28 percent of vaccinations, according to Kaiser Family Foundation data.

In Washington, D.C., Black people make up 46 percent of the population but 69 percent of deaths and just 37 percent of vaccinations.

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Hemi Tewarson, a Duke-Margolis senior policy fellow who focuses on states’ responses to COVID-19, described the effort to increase vaccine equity as a race against time. Vaccine access will soon open up to everyone, and although supply is ramping up, the issues preventing minorities from getting vaccinated aren’t being fixed fast enough.

“We need to continue the speed,” Tewarson said. “We’ve all been locked up for over a year, and people need to get out.”

The Biden administration is working to combat vaccine hesitancy among people of color, but polling shows that Black people report slightly less vaccine hesitancy than people of other races.

Race and ethnicity don’t have an outsize impact on vaccine hesitancy so far, according to a recent poll from NPR and Marist. When asked if they would choose to be vaccinated when the shot becomes available to them, 77 percent of Black people, 70 percent of Hispanic people and 70 percent of white people said they’d like to get vaccinated or had already received a shot.

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The Biden administration recently kicked off a national effort to encourage COVID-19 vaccinations and launched ads to try to increase vaccine uptake among people of color. This effort comes after the administration announced nearly $10 billion to increase vaccine access and bolster vaccine confidence in the communities hit hardest by the virus.

Private organizations are also getting in on the action. A coalition of business, health care and civic engagement groups on Tuesday launched an initiative to help more minorities access vaccines. The coalition, called Made to Save, aims to supplement governmental efforts to support vaccination among communities of color.

Ashley Allison, a senior adviser to the coalition, said the most important thing states can do is meet people where they are both geographically and in terms of messaging.

“We want to make sure people know they are eligible. The other thing is you have to go where people are,” Allison said. She said states should ensure that vaccine centers are not too far away and don’t require multiple forms of public transportation to get there.

States’ efforts

Biden’s health equity task force met Friday afternoon and discussed a series of recommendations to states but has yet to vote on any. One issue that came up repeatedly was the need for more demographic data. States are not required to report race and ethnicity data for vaccinations, and as of April 8, the CDC had that data for only 55.3 percent of all vaccinations. That data can help federal resources get to the areas that need assistance most.

CDC Director Rochelle Walensky told reporters Monday that she considers racism a serious public health threat and her agency is working to alleviate the vaccine disparities that exist in Black and Hispanic communities.

“These disparities were not caused by the pandemic, but they were certainly exacerbated by” it, Walensky said.

Andy Slavitt, White House senior adviser for COVID-19 response, announced on Monday that 90 percent of all Americans would soon have a COVID-19 vaccination site within 5 miles of their homes.

But those federal efforts may not be enough, as each state faces unique challenges in vaccinating its underserved populations.

“Without extra effort, it’s likely we’ll still see low-hanging fruit in terms of who is vaccinated,” Jen Kates, a Kaiser Family Foundation senior vice president, explained.

Vermont made the unique decision to open up vaccine appointments to people of color a week before opening vaccinations to the rest of the general population. Republican Gov. Phil Scott first announced this as a way to decrease the gap in vaccination rates between people of color and white people.

Soon afterward, Scott issued a statement saying he received hateful, racist comments about the decision and defended his decision to open vaccinations early to people of color. So far, only 20.2 percent of people of color in Vermont have received at least one dose of the COVID-19 vaccine, compared with 33.4 percent of non-Hispanic white people, Scott said.

Montana and Utah both tried to include minorities in their vaccine priority groups as well, with Montana vaccinating American Indians and other high-risk people of color in Phase 1b and Utah including people living on tribal reservation communities in Phase 1c. Both states have since opened COVID-19 vaccinations to all adults in their states.

California aims to lift most pandemic restrictions and reopen its economy by June 15, as long as a sufficient amount of its population is vaccinated. The state is focusing on vaccine equity, said Mark Ghaly, the state’s health and human services secretary. Data shows that while Hispanic people make up 22 percent of California’s population, they only account for 9 percent of vaccinations.

At least 19 states established call centers to help facilitate appointment sign-ups for less internet-savvy residents, according to the Kaiser Family Foundation, and many states are deliberately locating vaccine clinics in underserved areas where people were hit hard by the pandemic. Alaska uses an area deprivation index to identify specific geographic areas within communities that may struggle to get vaccinated. The state offers targeted outreach and provides people alternative methods to schedule appointments to receive the vaccine.

A new National Governors Association report recommends that states collect and report race and ethnicity data and create incentives for vaccine providers to collect and report such data. The Virginia legislature recently enacted legislation requiring any person who administers a vaccination to collect data. North Carolina introduced strategies to increase vaccine supply for historically marginalized populations.

States can use the race and ethnicity data to allocate vaccines according to need, the governors association says. Many states already use this data to identify communities that receive increased vaccine allocations and located vaccination sites in hard-hit areas.

Marginalized communities often face systemic barriers, such as a lack of transportation or Wi-Fi, that make it harder to get vaccinated. California implemented mobile vaccination sites to reach people, and Michigan deployed emergency medical technicians to vaccinate immigrant communities. Kansas is also using mobile sites to vaccinate communities with high social vulnerability. North Carolina, Connecticut, Michigan and Massachusetts all offer state-sponsored transportation assistance to help people get to vaccination sites.

“If we continue to see inequities among people of color, it’s not necessarily because they are more reluctant. It really comes down to access challenges and not being able to get to a facility easily, not being reached. … That’s the biggest issue and thing to be cautioned about going forward,” Kates said.

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