Each of us lives in one of two Americas

The notion that our nation is divided into at least two unequal parts is often attributed to the powerful oratory of Dr. Martin Luther King Jr., who remarked in his speech “The Other America” on growing economic and social chasms that undergird racial inequality in the U.S.

Three weeks ago, the Centers for Disease and Control and Prevention (CDC) released new guidelines that seemed to center on one America, the one disproportionately benefitting from the most effective, life-saving resource at the globe’s disposal — vaccination. They did so at the expense of the other America — the one that as Dr. King noted, contains, “many people of various backgrounds, [like] Mexican Americans, Puerto Ricans, Indians… many of them are Appalachian whites, [and] the American Negro.” This is the America that has faced the worst of this national scourge because it had the least protection. This is the America that still stands to benefit from universal public health precautions — like masking and distancing — to create a culture of protection around those who lack access to vaccination. Up until recently, that America included most of our nation’s children.

“In a sense,” Dr. King noted, “the greatest tragedy of this other America is what it does to little children.” This is particularly true for Black and Latinx children who have suffered inordinately over the past year.

Between February and July 2020, data from the CDC revealed that Black and Latinx children and youth made up 73.5 percent of COVID-19 deaths among people aged 21 and younger. While 41 percent of those deaths occurred in young people aged 18-20 — an age group long-approved for COVID-19 vaccination — almost one-third occurred in youth aged 10-17, a group that includes children who have only recently been approved to receive the Pfizer-BioNTech vaccine.

Similarly, during nationwide surges of COVID-19 cases between March and July 2020, Black and Latinx children and youth bore the brunt of the disease’s severity, accounting for over 75 percent of COVID-19 hospitalizations among youth aged 18 years and younger.

During that same time period, CDC data also revealed that Black and Latinx children accounted for the vast majority — an estimated 73.6 percent — of known cases of the rare COVID complication known as “Multi-Inflammatory Syndrome in Children” or MIS-C. MIS-C causes full-body inflammation, multi-organ dysfunction and requires hospitalization. While racial inequities in COVID-19 cases have since narrowed, a more recent analysis found that Black and Latinx children continue to make up over 68 percent of MIS-C cases.

In addition, Black and Latinx adults are currently the least vaccinated groups in the U.S. Only about a quarter of these groups have received at least one dose of a COVID-19 vaccine. When compared to the national average of 46 percent of adults who have received at least one dose of a COVID-19 vaccine, the lack of vaccine uptake among Black and Latinx populations reveals the persistence of our two Americas. While much has been made of purported “hesitancy” among these groups, access to COVID-19 vaccination has been the real difference maker. And although COVID-19 vaccines are now considered “widely available,” availability and access are not the same thing. 

For example, low-income workers are less likely to have paid sick leave to take time off work for commonly experienced side effects (a leading concern for populations who remain unvaccinated is missing work due to side effects). Lack of flexible work hours, affordable child care, broadband internet and reliable transportation continues to shape who can and cannot freely choose vaccination. And continued concerns about the costs of COVID-19 vaccination — despite it being free — underscores persistent information gaps that shape vaccination acceptance rates across racial and ethnic groups in the country.

To equitably distribute COVID-19 vaccines to children, leaders can learn from what worked and what didn’t in the effort to equitably vaccinate U.S. adults.

Early in the nation’s vaccination rollout, most states missed opportunities to vaccinate families. At a time when many of the elderly were accompanied to their vaccination appointments by younger adult caregivers, the focus on age-based prioritization criteria excluded those caregivers from vaccine access. Vaccinating busy caregivers at the same time as their aging parent or grandparent could have increased vaccine uptake among adults, made obtaining vaccination more convenient, and allowed for second-dose appointments to be a family affair.

For children, we can fix that. Children will also be accompanied to their vaccination appointments by caregivers and siblings. Rather than asking families to make multiple online appointments, vaccination sites should have walk-in access, where families can get vaccinated all at once. This may improve uptake in communities for which a sizable proportion of adults still lack COVID-19 vaccination. 

Many children also fell behind on their regularly recommended vaccinations last year and will need to receive their booster doses to be ready to enroll in school come fall. Utilizing back-to-school events as a way to coordinate, publicize and staff COVID-19 vaccination sites can increase uptake among families most impacted.

During the pandemic, mobile vaccination sites located in convenient and frequently utilized community locations — like church parking lots — were effective for vaccinating Black and Latinx adults. Mobile sites in locations frequented by children, like schools, parks and community centers can make access more convenient for families.

Finally, parents will have questions and concerns about vaccinating their children, just as they had questions about being vaccinated themselves. These concerns are valid and should be addressed with the data showing that the vaccines prevent serious illness and death among the ages it’s approved for. Information campaigns around the intersecting concerns of caregivers, who are thinking about their own vaccination needs, and that of their children, can help increase interest in vaccination among families.

As Dr. King observed, “In [one] America, children grow up in the sunlight of opportunity. [Yet] in the other…millions… find themselves perishing on [an] island of poverty in the midst of [an] ocean of material prosperity.” Right now, in the other America, too many children find themselves and their caregivers unvaccinated in the midst of a nation that seems to be willing to move on without protecting them.

But child health equity is vital for public health. And as the COVID-19 vaccines become increasingly available for children, focusing on racial and ethnic equity in vaccine distribution and uptake will be critical to protecting those most affected, their families, communities and the nation at large.

Rhea Boyd MD, MPH is a pediatrician, public health advocate and scholar. Boyd writes and teaches on the relationship between structural racism, inequity and health. In partnership with the Kaiser Family Foundation, the Black Coalition Against COVID, and Unidos US, she co-developed THE CONVERSATION: Between Us, About Us, a national campaign to bring information about the COVID vaccines directly to Black and Hispanic communities.