Vaccine inequity prompts calls for federal response

More than 35 million doses of COVID-19 vaccine have been administered across the country, but it is becoming increasingly clear that vaccinations have not been equitable for communities of color that have been hardest hit by the pandemic. 

Several members of Congress have taken notice of the disparity in the past week, with three sets of the lawmakers urging the Biden administration to address the situation.

The pandemic has exposed layers of inequity throughout the U.S. health care system and other infrastructures, making building a fair distribution system an uphill battle.

Several overarching issues have been identified.

Convenience and confidence

The biggest problems are access to the vaccine and trust in the vaccine.

“Vaccine confidence, and vaccine convenience, those two [things] in particular, are what’s driving these differential rates,” a senior Biden administration official told The Hill.

Lack of vaccine confidence in communities of color, especially Black communities, is rooted in a deep mistrust of the government that spans generations. 

The mistrust isn’t surprising; the trauma inflicted by the federal government upon Black Americans in just the past 100 years resonates loud and painfully clear in Black communities today.

From the early to mid-20th century, tens of thousands of nonwhite women were sterilized by the government. 

For four decades, the government ran what is known as the Tuskegee Syphilis Study in the deep South exclusively on Black men; it wasn’t stopped until 1972.

In 1951, doctors at Johns Hopkins Hospital in Baltimore removed tissue samples without consent from Henrietta Lacks, a Black woman who was being treated for cervical cancer. Part of the tissue sample became the first immortalized human cell line and is still widely used in cancer research today.

While the federal government, civil rights and numerous other advocate organizations have launched considerable efforts to rebuild trust and dispel vaccine misinformation within communities of color, weariness from past wounds remains a potent roadblock.

Compounding on top of this lack of trust is access, which the Biden official described as a “huge challenge.”

The issue of access to the vaccine is multifaceted, beginning with the absence of equitable health care in many communities of color — a reason why people of color have suffered the most from COVID-19.

Manuel Pastor, sociology professor and director of the University of Southern California’s Equity Research Institute said disparities in vaccine distribution mirror the disproportionate affect COVID-19 has had on minority communities.

“This disparity could have and should have been anticipated,” Pastor told The Hill. “If you look at the patterns that we’ve seen since the beginning of the coronavirus crisis with higher death rates in Black and Latino and Pacific Islander communities … we’ve known for a while that there’s a pattern of disparity and that disparity is linked to multiple factors.”

Even when a vaccination site is in a community, underlying societal problems get in the way.

For example, Hispanic and Black Americans are less likely to have internet access to make an online appointment for a vaccination.

“You got to have a job where you’re on the computer all the time so when the [spots become available], you can immediately jump in and grab an appointment,” Pastor, a Los Angeles resident, explained. “That’s not a system that’s designed to protect an 80-year-old Black woman in South L.A.”

This has led to a concerning communication gap that is resulting in health centers within Black communities giving vaccinations to white people who live outside their neighborhoods.

Pastor emphasized the need for grassroots “trusted messengers” within these communities and more robust phone centers for people without internet access to schedule appointments.

Data deficit

Health officials at the local, state and federal level have struggled to collect race and ethnicity data, which can make it harder to deliver vaccines to underserved populations. 

“Without robust demographic data, policymakers and researchers cannot fully address the disparate impact COVID-19 continues to have on communities of color or address vaccine hesitancy among communities that have had their trust broken by the medical system,” Sen. Elizabeth Warren (D-Mass.) and Reps. Ayanna Pressley (D-Mass.) and Ed Markey (D-Mass.) pointed out in a letter to the Department of Health and Human Services last Thursday.

Initial vaccine distribution data from the Centers of Disease Control and Prevention (CDC) shows the agency has sex and age information for 97 percent of all patients, but that percentage falls significantly for race and ethnicity, at only 51.9 percent.

Racial disparity is still apparent in the partial data. Of those vaccinated, only 11.5 percent were either Hispanic or Latino, 5.4 percent Black, 2 percent American Indian/Alaska Native and 0.3 percent Native Hawaiian/Pacific Islander.

The shortage of demographic information shines through at the state level too. A recent study by the Kaiser Family Foundation revealed that in every state where race and ethnicity demographics were available, the percentage of Black and Hispanic people who had been vaccinated trailed the percentage of total COVID-19 cases of Black and Hispanic people.

However, only 23 states had such data.

FEMA’s role

In part of his national COVID-19 response strategy, President Biden delivered a call to action for federal agencies to work together to help provide support to local and state governments.

The Federal Emergency Management Agency (FEMA), the Department of Defense and the Department of Health and Human Services have taken the lead on meeting Biden’s goal of opening 100 additional federal community vaccine sites by the end of the month.

White House coronavirus response coordinator Jeff Zients on Wednesday announced the first two of these sites, both of which will be in California.

“The federal government will partner with the state of California to launch two new community vaccination centers: one in East Oakland and the second in the east side of Los Angeles — two of the communities most hard hit by this pandemic,” Zients said, explaining that the CDC’s Social Vulnerability Index had been one of the barometers used to assess where the vaccination sites should be placed.

On a press call Friday, acting FEMA Administrator Robert Fenton the sites would open Feb. 16. 

During the call, the agency head talked at length about the current lack of equity surrounding vaccine distribution. He noted that collecting race and ethnicity demographic data was “critical” in achieving more equitable vaccine distribution, and that the FEMA was working to help all states improve their data collection, in some cases sending personnel.

The disaster relief agency head also said that a civil rights advisory group had been formed to “ensure equity in the allocation of scarce resources, including future vaccine allocation.”

To this point, Fenton acknowledged the communication gap, saying that it was something that FEMA was “actively working” to narrow.