• Kavya Menke

Worth a Shot: Improving Vaccine Equity

Although vaccine rollout plans differ by state, one alarming trend continues to appear: racial minorities are being left out, again.

Sandra Lindsay receives the first vaccine in the US. Four months later, only 7% of Black Americans have too (NYT).

Historically, America has always struggled with—if not outright opposed—healthcare equity among minority racial groups. Wounds such as the Tuskegee Syphilis Study have left many distrusting of federal healthcare and aid. The coronavirus pandemic has exacerbated this problem; minority groups are disproportionately contracting and dying from the disease. Now, however, is the time for America to break this cycle of medical disparity. With rapid vaccine distribution occurring in all 50 states, vaccine equity is an increasingly prominent issue. Although vaccine rollout plans differ from state to state, alarming trends continue to appear: people within racial minority groups are getting vaccinated at much lower rates than their white counterparts. States must take definitive steps to reduce such inequality while it is still early enough to make a difference. Fortunately, there are multiple routes available for states to increase vaccine equity among their residents.

Explicitly using race as a basis for vaccine distribution

Currently, 47 states have published their vaccine distribution plans. Of these, only 25 address racial equality as a possible factor in determining priority groups for the vaccine. Many states instead rely on the CDC’s Social Vulnerability Index, which uses 15 US census data points to determine priority communities. While the SVI includes race/ethnicity as a factor, the Index does not emphasize race as its primary consideration for vulnerability. Because of this, states such as California, Washington, and Maine have explicitly made racial equity a central concern in their vaccine distribution plans. The plans detail communication and outreach programs designed specifically for minority groups.

Explicitly equity-oriented plans have the potential to make a significant difference in the struggle to increase vaccine distribution equality, simply because it is their primary purpose. Such purpose, however, lends itself to criticism. Some states are reluctant to adopt similar policies because of possible ethical and legal concerns about using race and ethnicity as a central basis for vaccine rollout. As of now, the explicit distribution plan remains the most extreme—but also direct—method of improving vaccine equity at the state level.

Collecting racial/ethnic data from vaccine recipients

Interestingly, the simplest way to increase vaccine distribution equity is by aggregating large amounts of racial/ethnic data from those who register for the vaccine. Forty-one states were reporting racial data from their vaccine programs as of March 1, 2021, underscoring this method’s relative popularity compared to the explicit distribution plan. The racial data collected by these states helps reveal disparities in vaccine distribution and allows for timely and precise corrections at a more local level.

Rather than merely contributing to national statistics, the demographic information amassed will most likely stay within the state it was collected in because of differences in survey mediums and survey categories across state lines. Even at the state level, however, this data is vital to vaccine equity. As Dr. Marcella Nunez-Smith, the Chair of President Biden’s Covid-19 Equity Task Force, stated, “we cannot address what we cannot see,” highlighting how this information will serve to help states pinpoint specific communities and areas with vaccine inequity. Accurate statistics also offer further credibility to those with vaccine disparity concerns, particularly in the 22 states that do not even mention racial equality as a factor in their vaccine priority distribution plans. Although more indirect than explicitly equity-centered vaccination plans, the collecting of racial and ethnic data allows states to receive real-time updates about vaccine equity and where to address it.

Creating more local-level distribution infrastructure

One of the most significant battlegrounds in the fight for vaccine equity is also one of the most overlooked: vaccine registration. In many places, vaccines are distributed to minority communities only to have wealthy white people sign up for them instead. In Dallas, Texas, vaccine centers on the poorer south side (given priority by none other than the SVI) consistently saw people from the wealthier, whiter north side of Dallas come down to receive the vaccine. As it turned out, city councilmen from the north had spread shared registration links via a newsletter, and thousands of their constituents (eligible or ineligible) had signed up for appointments. The Dallas situation reveals a myriad of problems with current methods of vaccine registration. Within poorer communities, particularly those with large minority populations, access to high-speed internet and wifi is often limited, reducing locals’ ability to register for the vaccine online. Relatively low median ages of many minority populations leave many outside priority groups, even if they are statistically more vulnerable than the older white population.

Our own analysis indicates that many of the same issues in Dallas carry over to Atlanta (TFMG).

In this case, improving vaccine equity lies not only with states but also with local communities. As long as vaccines are being given out, a community will continue to receive vaccines from its state; whether or not the people receiving the vaccine are locals matters less than how many are being vaccinated. Therefore, to increase vaccine equity, more local people must register for the vaccine. This is where community involvement comes into play. Volunteers and staff at local community and vaccine centers can engage in door-to-door vaccine registration campaigns, raising awareness and the number of local registrations (masked and socially distanced, of course). Physical registration sites in prominent locations are also a must, offering another alternative to online booking. Mass community engagement is necessary to promote local-level distribution equity, but, when done right, it is one of the most effective methods.

Perhaps the most telling factors in predicting vaccine equity are the states themselves. In the constant competition for federal resources, states often fail to address issues of inequality in their own distribution plans, opting instead for policies that will be more successful in the eyes of the federal government. Racial and ethnic data consists of different categories in different states, resulting in a lack of standard baselines to measure equity. State policies focused on vaccinating as many people as possible can lead to the suppression of minority groups even within their local communities. These state-level problems, however, can be solved by state-level solutions. At the end of the day, the states are the ones responsible for improving vaccine distribution equity; it is time for them to do right by their residents.

Cover: UVA Cooper Data; Metropolitan Atlanta by Race

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