Just one month into the COVID-19 vaccine program, glaring disparities have emerged.
Doses of the coronavirus vaccine are slowly rolling out across the country, and those that need it the most are having challenges getting to the front of the line. At present, 23 states report vaccination data by race. And the numbers so far are alarming.
As we have already discovered, the pandemic has disproportionately impacted Black, Latino and Indigenous communities, resulting in higher case rates, death rates and more severe illness. Though there was anecdotal evidence of this early in the pandemic, we now have data to support this health disparity differential. As of Jan. 5, 1 in 595 Indigenous Americans and 1 in 735 African Americans have died of COVID-19.
But instead of targeting those most at risk for vaccination, states appear to be following a different path. Among the 23 reporting states, 16 are vaccinating white residents at two to five times the rate of Black residents. In Texas, where Latinos represent 40% of the population and nearly half of COVID-19 deaths, only 15% of this demographic have been vaccinated to date.
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As a Black physician of Canadian-Jamaican descent practicing in a largely Latino community, these numbers cause concern. I see vaccination disparities as a fundamental example of how we are only as healthy as the most vulnerable among us. In this article, I share what went wrong and how the healthcare industry can course-correct.
Barriers to vaccination
Vaccination disparities share common roots with other healthcare disparities. Perhaps the most visible factor is access. About a quarter of Black and Latino Americans live in areas without access to primary care resources.
A deeper issue that leads to lower vaccination rates in some communities is trust. Many people are understandably skeptical of coronavirus vaccines, which were developed and approved on a stunningly short timeline. However, Black, Latino and Indigenous communities have additional reasons to distrust the healthcare system that stretch back hundreds of years.
Many of us remember the Tuskegee syphilis experiment, in which patients were outrageously denied simple antibiotics and other lifesaving treatments. Following a 1920s Supreme Court ruling, thousands of people of color were forcibly sterilized. And in the 1960s, authorities silenced civil rights leaders by diagnosing them with psychotic disorders and forcing them into institutions.
When you consider the history, it’s not surprising that 35% of Black adults say they probably won’t get vaccinated. What’s more, 48% percent of Blacks and 36% of Latinos say vaccine developers aren’t taking their respective communities’ needs into account.
Positive steps
If Tuskegee taught us anything, it’s that the healthcare standard should be built on a foundation of equality and fairness. And today, that means everyone should have equal access to a vaccine that could very well end this devastating pandemic. So how do we make it happen?
Some health systems are focusing on mobile clinics to bring vaccines directly to minority communities and workplaces. Others are using data to improve vaccination equity.
For example, Washington, D.C., health officials have reduced disparities by prioritizing residents in diverse ZIP codes for vaccine appointments. And in San Francisco, healthcare organizations are taking the lead by setting up online question and answer sessions to assuage vaccine fears and myths.
Of course, merely making vaccines available does little to dispel distrust in the healthcare system. It is critical to remember that empowerment and choice are the best antidotes to distrust. To this end, I advocate the following actions to build confidence in our communities that the vaccine is a safe and effective choice in the fight against COVID-19:
- Communicate a consistent message. Patients must be reassured that coronavirus vaccine development followed the same proven processes that produced our HPV, chickenpox and seasonal flu vaccines—the most diverse vaccine trials in history.
- Employ influential voices in places of trust. Demonstrate the medical community cares with engaged champions, especially minority providers, religious leaders, teachers and other respected figures in the community. They can play a pivotal role in educating communities and combating misinformation.
- Partner up. Health systems and public health agencies must work directly with local minority communities to design distribution programs to work specifically within their community, from the ground up. We need to find out how, where and when people feel most safe and available to access the vaccine and adapt accordingly.
- Model the behavior. As healthcare leaders, we need to set a good example. Perhaps the most powerful thing we can say when patients express vaccine concerns is, “I am so sure that this vaccine is safe and necessary that I got it myself and helped my family do the same.”
Imamu Tomlinson, M.D., MBA, is CEO of Vituity and president of the Vituity Cares Foundation.