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Vaccine push may leave behind diverse communities

By Michael Macagnone
CQ-Roll Call/TNS

WASHINGTON - Federal data shows minority communities have gotten disproportionately smaller numbers of the coronavirus vaccines so far, and experts say that means it could take the nation longer to return to normal.

The inequitable vaccine distribution means fewer people in the communities hardest hit by the virus have received either of the vaccines available in the country. Both the Census Bureau and the Centers for Disease Control and Prevention have released data showing that the distribution is off even among the front-line worker population.

That means medical support staff and other health care workers are probably not getting vaccinated, said Samantha Artiga, vice president of the Kaiser Family Foundation’s Racial Equity and Health Policy program.

“The data so far that we’ve seen, showing that people of color have received smaller shares of vaccination, is at odds with what we know about the underlying racial ethnic composition of the health care workforce,” Artiga said.

The latest CDC data shows the national vaccine distribution at about 60% white, 11% Hispanic or Latino, 5% Black and 6% Asian. The remainder are Native American, Pacific Islander or two or more races. However, the data does not include complete demographics for almost half of patients, since less than half of all states report the demographics for their vaccine rollout.

The Census Bureau’s Household Pulse Survey is self-reported but includes nationwide data. According to the most recent figures through mid-January, white respondents made up about two-thirds of the vaccinated population, a full 10 percentage points more than the general population.

While Bureau of Labor Statistics data shows that those who work in health care directly are about 70% white, other professions like home health aides, nursing assistants and orderlies are much more ethnically and racially diverse.

Broad distribution recommendations from the CDC have not addressed the problem, nor have recent Biden administration decisions on vaccine centers and appointment management. Artiga and other researchers have said that decisions about where to place vaccine distribution sites, how to handle appointments and other hurdles may have made it more difficult for underserved populations to get vaccinated.

Some local health officials are using online portals like Signup Genius or the CDC’s web-based vaccine management system. But that can be confusing for the elderly, people with poor technical skills or those with limited English proficiency, said Lori Freeman, CEO of the National Association of City and County Health Officials.

Local health authorities are already strapped trying to handle the deluge of vaccine demand and don’t have the time or support to set up more equitable infrastructure, Freeman said. That means more affluent areas with additional resources will be better equipped to handle outreach and vaccine distribution.

“That is really kind of a failure of our government to really shore up the infrastructure of these systems over time, so what we are facing in a pandemic is cobbling together technology solutions that don’t really work and don’t really do the things we need them to do,” Freeman said.

White House COVID-19 response coordinator Jeff Zients told reporters on a call Tuesday that “equity is core to our strategy” for combating the pandemic, and he announced a new program to help reach underserved communities through federally recognized community health centers.

Over the past few weeks, the administration has announced three such plans to distribute vaccines more equitably - through community sites run by the Federal Emergency Management Agency, through direct partnerships with pharmacies and now the health centers. Zients said the federal government plans to distribute 11 million doses weekly starting later this month, up from 8.5 million in January.

Marcella Nunez-Smith, head of the White House COVID-19 equity task force, said the program would provide 1 million total doses to 250 community health centers across all 50 states.

She acknowledged the potential for structural problems in vaccine distribution but didn’t say how health care providers will ensure that underserved communities will be among those receiving vaccinations.

Just pushing out more vaccines doesn’t solve the equity problem, Freeman said. Direct federal distribution may keep the information siloed and may hamper local communication efforts.

“There are a lot of public health nuances to this that cannot be solved by throwing vaccines out into every place they can reach,” she said.

Creating so many different vaccine distribution pathways - local vaccination sites, pharmacies and now community health centers - may mean the use of different platforms and tracking methods, Freeman said.

Earlier in the pandemic, the distribution through pharmacies targeted one population, the elderly in long-term care facilities, which Freeman said helped. Strapped public health authorities could focus on other high-priority groups like health care workers.

Now, with so many ways to distribute vaccines, public health officials don’t know where to invest their limited resources at the local level.

“The more direct channels there are, the more supply coming in, the less visibility we have into who we are missing. We have to reach those really hard-to-reach populations, the really vulnerable populations,” Freeman said. “We can’t afford to go down this path we have gone down in the past.”