Addressing these inequalities during the build-up of the vaccine supply will be an important test for the government of President Joe Biden. On his second day in office, he signed an executive order aimed at tackling racial equity, and appointed advisers to focus specifically on health inequalities. But solving the problem requires more than just good intentions.
“This pandemic has really exposed the failures of our healthcare system,” Rep. Raul Ruiz, (D-Cal.), A physician who represents a district with many Latino farm workers with limited health care. “We can not rely on this healthcare system to address equity … We are just going to keep failing. And we see it now with the distribution of vaccines. ”
The federal government does not give explicit instructions to distribute or administer vaccines fairly, ‘so you have states like Michigan that are benevolent and considerate, but did not have a comprehensive plan,’ ‘Debra Furr-Holden, an expert for public health at Michigan State University, which serves on the state’s coronavirus task force, said in an interview.
“If there is no mandate, it is our natural injustice,” she added.
Lack of data was an early obstacle. Theoretically, the CDC requires states to report race and ethnicity data from the outset. But the rule was not strictly enforced, and some countries initially did not require providers to collect the information, leaving huge gaps in efforts to identify unmet needs.
As of mid-January, only 17 states have publicly released racial and ethnicity data on who is vaccinated – often with the proviso that the data is incomplete. Other states collect the information but refuse to disclose it, citing similar issues. The CDC says 47 percent of vaccinations lack information on race and ethnicity – a lack of public health experts says it needs to be rectified as the pandemic enters a new, dangerous phase.
“We can not keep kicking the can. We can not continue to say that we do not have the data, but the data is not good, ”said Cara James, former CMS director of the Office of Minority Health. The organization is currently the leader of the organization Grantmakers In Health.
Marcella Nunez-Smith, chair of Biden’s equity task force Bovid-19, said at an information session in the White House on Monday that holes in the record ‘not only hurt our statistics, but also the community at greatest risk and the hardest’. hit. ‘
Data in the countries that collected it show clear racial differences, with white residents usually being vaccinated more than twice as fast as the black residents. In Pennsylvania, which has one of the biggest differences, the ratio is more than three to one.
“We have had such weak federal leadership so far. At this stage of the pandemic, it is appalling that there are no standardized reporting systems, ”said Jeffrey Levi, professor of health management and policy at George Washington University.
Rep. Ayanna Pressley (D-Mass.) En Sens. Elizabeth Warren (D-Mass.) And Ed Markey (D-Mass.) Sent a letter to Acting HHS Secretary Norris Cochran on Thursday urging the department to raise and release more. comprehensive data on race and ethnicity.
Public health experts say that the hesitation of vaccines is causing the racial divide, citing polls that suggest black Americans are more concerned about the shots when the vaccines are still so new.
Age is another factor. In the initial vaccination for health workers, younger staff – who also tend to be more racial – were less willing to shoot, officials said.
“It’s more the elderly who want the vaccine,” explained Ayne Amjad, commissioner and state health officer of the Bureau of Public Health in West Virginia. Younger people tend to see more information about vaccines online, she added. West Virginia has one of the nation’s most successful vaccines.
Some experts argue that a bigger point is not concentrating too much on hesitation – that much more needs to be done to get the vaccine into these less affected minority communities, sometimes and in places where residents can access it.
“Vaccine hesitation is a real concern, but I’m concerned that the focus on vaccine vaccination is a way to divert the responsibility for fair distribution up front,” said Anne Sosin, director of the Dartmouth Center for Global Health Equity, said.
Even in cities and states without comprehensive data, racial differences can still be clearly seen on maps where the doses have gone.
In the District of Columbia, residents in the predominantly black neighborhoods in the East had the highest mortality rate of Covid-19, but now receive fewer doses of vaccinations.
While the city did try to open many vaccination sites in these neighborhoods, the online registration system allowed residents to sign up for appointments, no matter where they lived.
With the shortage of vaccines, the slots were taken excessively by residents from other parts of the city in the first-place spot. Older residents in particular have also struggled with the computer-based system, and phone lines set up as an alternative have been rapidly overwhelmed.
“We were inundated with calls and messages from voters, and we ourselves observed it anecdotally after going to some of the sites to see visibly that the distribution of vaccines was overwhelmingly unfair and benefited affluent and white communities,” he said. Kenyan McDuffie, DC board member, said. “They traveled from the richest wards to the poorest wards in the city.”
Experts also argue that vaccination against vaccines plays a bigger role if residents have to compete for scarce slots. If they are not sure about the safety of the vaccine, they are not so motivated to keep making an appointment.
“If you just say we’re giving the vaccine to whoever’s the first one, it’s hurting people who have questions,” said Joshua Sharfstein, vice dean of public health practice and community involvement at Johns Hopkins University, formerly known as Maryland. served top, said. health officer and as deputy FDA commissioner during the Obama administration.
DC has also worked with providers to distribute doses outside the central appointment system by having them arrange direct appointments with patients, but minority populations are generally less connected to the health delivery system.
McDuffie successfully pushed the city to book a portion of the vaccine supply for people living in the hardest-hit zip codes. He also provided more telephone staff for residents who could not use the online system.
“They have to be put first, and you can’t wait for these people to come down to town hall and ask,” McDuffie said.
Earlier in the pandemic, Michigan was praised for its focus on equity, including the establishment of a dedicated task force for racially diverse people in the coronavirus. But early signs show that it also faces inequalities in vaccine vaccination.
Officials have said they are correcting gaps in the data and hope to make them public in the coming week. But like other jurisdictions, a map of the vaccination efforts in the region indicates that differences are emerging.
Rural and predominantly white provinces, especially along the upper peninsula of the state, led the group, with more than 10 percent of their population already receiving the first dose. In Wayne County, which includes Detroit and where more than half of the state’s black residents live, only 6 percent received a first dose.
Like other states, Michigan officials expect the first round of direct demographic data to show significant differences when it is finally released.
In an interview, Joneigh Khaldun, state medical chief, said that the initial inequality was caused by the prioritization of health workers and also that the vaccine does not hesitate. For the next phase, Michigan uses the CDC’s social vulnerability index to determine where more doses should be allocated, in addition to the number of elderly residents and essential workers.
“We use an equity lens to allocate doses across the state,” Khaldun explained.
The state Department of Health also works directly with the city of Detroit – allocating extra doses to the city in addition to the formula-based grants distributed by the state. And they work with local providers for targeted access to color communities using federally qualified health centers, mobile clinics, and community-based vaccinators.
“The best public health occurs when you go to neighborhoods and when you work with communities and when you address people who do not have access to transportation or who are at home,” Khaldun said.
The state has set an explicit target for the inequality in the distribution of vaccines, similar to the attempts at 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 he was confident that Michigan would eventually close the gap, but worried that allocating more vaccine in vulnerable areas would not be enough without ‘ an enforceable mandate for equity. .
‘Flint is primarily an African-American city. I recently received my first vaccine dose in the city of Flint at an administration site, and I was the only African-American to receive the vaccine. said Furr-Holden.