Vulnerable groups still falling behind in vaccination effort

'We should be chasing this population, not having them chase this vaccine,' says an expert

A sign notifies customers that vaccine status at a Harris Teeter grocery store in Washington in February.   (Bill Clark/CQ Roll Call)
A sign notifies customers that vaccine status at a Harris Teeter grocery store in Washington in February. (Bill Clark/CQ Roll Call)
Posted March 5, 2021 at 1:48pm

The Biden administration has argued it can distribute the coronavirus vaccine both quickly and equitably, but federal data shows little progress in getting doses to minority communities as states prioritize getting shots into as many arms as quickly as possible.

Health care providers in Minnesota, for instance, must use 90 percent of their coronavirus vaccine doses within a 72-hour window — or risk of having their next shipment reduced. Nneka Sederstrom, chief equity officer at Hennepin Healthcare, said the hospital system has to find a balance between appointment-based signups that favor wealthier, whiter residents and active outreach to the minority populations they serve, all within three days of receiving each dose.

“It is hard to be contentious when everyone believes it is the right thing to do,” Sederstrom said. “It is a funky dance in order to make sure we hit the numbers.” 

Georgetown Law School professor Lawrence Gostin said people should not be surprised the default method for distributing vaccines — online signups for centralized locations with fixed hours — gives an unequal result.

“Our system favors the well educated, people with good technology skills and Wi-Fi access and the ability to wake up early and navigate multiple websites to get an appointment,” Gostin said. 

“We have done little to actually go into communities and talk with community members and talk with influencers there to get people on board. We should be chasing this population, not having them chase this vaccine.”

Centers for Disease Control and Prevention data through Wednesday shows white Americans still get a disproportionate share of vaccinations. The vaccinated population has actually gotten slightly more white over the last month, from 60 to about 65 percent white.

According to data from the Kaiser Family Foundation, the Black and Hispanic percentage of vaccinations lagged behind the percentage of the total population in all 50 states and the District of Columbia. But only about half the CDC and Kaiser data includes race or ethnicity information, said Samantha Artiga, vice president of the Kaiser Family Foundation’s Racial Equity and Health Policy program.

“There remain challenges in the data to really get that complete picture of who is and who may be getting left out of vaccinations,” Artiga said.

A separate Kaiser Family Foundation poll found that Black and Hispanic adults had the highest percentage of any racial or ethnic groups who wanted to “wait and see” before trying to get the vaccine.

[Vaccine push may leave behind diverse communities]

Sederstrom and other public health workers are taking steps to get more doses out to immigrant, Native American and other communities hit hard by the coronavirus, but it takes time. 

Sederstrom said staff have been reaching out to people not served by online portals available in only English and Spanish — such as Minnesota immigrant communities that speak Somali, Oromo or Hmong — or those who don’t have access to transportation.

“Those messengers go out into the community and say ‘Hey, we're going to get access to this vaccine. You trust me, and I won't hurt you, so come to my place and I'll get you the vaccine,’” Sederstrom said.

Her hospitals also started doing community outreach events — they vaccinated 115 people Thursday at a local church — but in Minnesota they’re always up against that 72-hour clock.

Speeding deployment

The Biden administration has consistently said it intends to distribute the vaccine both quickly and equitably, even as the data for the first month of the administration shows little improvement in this area.

Administration efforts to speed distribution, such as partnering with federally qualified health centers and setting up FEMA distribution sites, have added to state-based distribution to local health officials and hospitals.

Boosting the pipeline to federally qualified health centers is a “smart and necessary strategy right now” for equitable distribution of the vaccine, said bioethicist Nancy Berlinger, a research scholar at the New York-based think tank, the Hastings Center. The health centers have relationships with their patients that can bring hesitant people forward, and they can connect with local leaders to serve as messengers in their communities.

“They're very focused on patients having a medical home, that this is a trustworthy place where you're going to see the same doctors and the nurses and the social workers and you can come to them with issues in your life,” Berlinger said. “They're very used to doing community outreach in many languages.” 

CCI Health and Wellness in suburban Maryland is trying to do just that, according to Dr. Sonya Bruton, the clinic’s CEO. Bruton said during an online roundtable Wednesday with Sen. Chris Van Hollen, D-Md., that the clinic has done “in-reach” to their most vulnerable patients, sending out Uber and Lyft credits to them as well as kits with masks, alcohol gel and sanitizing wipes.

Bruton said the clinic serves about 60,000 people in Maryland’s most populous areas, Montgomery and Prince George's counties.

The group doesn’t always know who to reach among its own patients, though; Maryland’s state guidelines currently prioritize professions like people in health care or front line workers, but the clinic’s records don’t include people’s jobs. Bruton said many of their patients are among the most vulnerable populations, but don’t meet the state guidelines for vaccination yet.

“We can vaccinate 1,000 of our patients next week. If we have the ability to release ourselves from the mandates that the state currently has on what priority group can get those vaccinations,” Bruton said, “we could have all of our patients vaccinated by the end of the summer.”

Congressional help

Van Hollen said during Wednesday’s roundtable that during a meeting with President Joe Biden and Vice President Kamala Harris, he sought more equitable distribution of the vaccine.

“These numbers are unacceptable and they need to change,” Van Hollen said.

He pointed to the coronavirus aid package working its way through the Senate as a potential relief valve. The current version of the bill includes $7 billion for community health centers, $3 billion for the Indian Health Service and other funds meant to help make recovery from the coronavirus more equitable.

However, it doesn’t include some of the most recent proposals to make vaccine distribution more equitable. Sens. Benjamin L. Cardin, D-Md., and Bob Menendez, D-N.J., introduced a bill to mandate the Department of Health and Human Services target vaccine outreach to minority communities. Sen. Elizabeth Warren, D-Mass., has a bill to provide grants to states along with a mandate they report coronavirus vaccine demographics.

In a speech earlier this week, Biden moved up the timetable for delivering enough vaccines to cover the entire U.S. population to the end of May.

Congressional leaders aim to have the relief bill passed by mid-March, but it could take precious weeks after that to get funds out the door — and potentially leave minority communities last in line for the vaccine.

“By the time the money flows to solve the equity problem, they will be the last ones vaccinated,” Gostin said. “It is too little too late, because a lot of people will have died in the interim.”