February 17, 2021 at 7:13 pm #100001651zpodiumKeymaster
Addressing these disparities while ramping up vaccine supply will be a crucial early test for President Joe Biden’s administration. He signed an executive order on his second day in office aimed at tackling racial equity, and he has named advisers to specifically focus on disparities in health. But solving the problem will require more than good intentions.
“This pandemic has really exposed the failures of our health care system,” said Rep. Raul Ruiz, (D-Calif.) a physician who represents a district with many Latino farmworkers with limited health care. “We cannot rely on this health care system to address equity. … We are only going to continue to fail. And we see that now with the vaccine distribution.”
The federal government doesn’t explicitly mandate vaccines be distributed or administered equitably “so you’ve got states like Michigan that are well-meaning and thoughtful but didn’t have a comprehensive plan,” Debra Furr-Holden, a public health expert at Michigan State University who serves on the state’s coronavirus racial disparities task force, said in an interview.
“In the absence of a mandate, our natural drift is to inequity,” she added.
An early stumbling block has been a lack of data. In theory, the CDC required states to report race and ethnicity data from the start. But the rule was not strictly enforced, and some states did not initially require providers to collect the information, leaving major gaps in efforts to identify unmet needs.
As of mid-January, only 17 states had publicly released race and ethnicity data on who is getting vaccinated — often with caveats that the data is incomplete. Other states are collecting the information, but have declined to release it citing similar quality issues. The CDC says 47 percent of vaccination data is missing information on race and ethnicity — a flaw public health experts say needs to be corrected as the pandemic enters a new, dangerous phase.
“We can’t keep kicking the can. We can’t keep saying we don’t have the data, the data isn’t great,” said Cara James, former CMS director of the Office of Minority Health who now leads the organization Grantmakers In Health.
Marcella Nunez-Smith, chair of Biden’s Covid-19 equity task force, said at a Monday White House briefing that holes in the record “don’t just hurt our statistics, they hurt the community that are at the highest risk and have been the hardest hit.”
Data in those states that have collected it reveal 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 largest disparities, the ratio is more than 3 to 1.
“We have had such weak federal leadership up to this point. At this stage of the pandemic, it is appalling that there are not 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 acting HHS Secretary Norris Cochran urging the department to collect and release more comprehensive data on race and ethnicity.
Public health experts say vaccine hesitancy is driving some of the racial gap, referencing polls suggesting Black Americans are more worried about getting the shots when the vaccines are still so new.
Age is another factor. In the initial vaccine rollout to health workers, younger staff — who also tend to be more racially diverse — have been less likely to volunteer for shots, officials say.
“It’s more the elderly wanting the vaccine,” explained Ayne Amjad, commissioner and state health officer for West Virginia’s Bureau for Public Health. Younger people tend to see more disinformation about vaccines online, she added. West Virginia has has one of the nation’s more successful vaccine rollouts.
Some experts argue that focusing too much on hesitancy misses a larger point — that a lot more has to be done to get the vaccine into these hard-hit minority communities, at times and places where residents can access them.
“Vaccine hesitancy is a real concern, but I worry that focus on vaccine hesitancy is a way to deflect responsibility for equitable distribution on the front end,” said Anne Sosin, program director for the Dartmouth Center for Global Health Equity.
Even in cities and states without comprehensive data, racial disparities can still be seen clearly on maps showing where doses have gone.
In the District of Columbia, residents in predominantly Black neighborhoods in the east have had the highest Covid-19 death rates, but are now receiving fewer doses of the vaccines.
While the city did seek to open many vaccination sites in these neighborhoods, the online registration system let residents sign up for appointment slots regardless of where they lived.
With the vaccines in short supply, the slots were disproportionately taken by residents from other parts of the city on a first-come, first-served basis. Elderly residents in particular also struggled with the computer-based system, and phone lines set up as an alternative were quickly overwhelmed.
“We were inundated with calls and messages from constituents, and we observed it anecdotally ourselves after going to some of the sites to see, visibly, that the vaccine distribution was overwhelmingly inequitable, favoring wealthier and white communities,” said D.C. Council member Kenyan McDuffie. “They traveled from the wealthiest wards to the poorest wards in the city.”
Experts also argue vaccine hesitancy plays a larger role when residents have to compete for scarce slots. If they are unsure about the vaccine’s safety, they aren’t as motivated to keep trying to get an appointment.
“If you just say we’re giving the vaccine to whoever’s first in line, then it disadvantages people who have questions,” said Joshua Sharfstein, a vice dean for public health practice and community engagement at Johns Hopkins University who previously served as Maryland’s top health official and as the deputy FDA commissioner during the Obama administration.
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