The good news is that the number of Covid-19 vaccinations in the United States is on the rise, while the number of new infections, hospitalizations, and deaths are declining. As of this week, more than 66 million doses have been administered to at least 42 million Americans, about 13 percent of the population.
But the disease is still spreading and there are not yet enough vaccine doses to meet the demand. And many who need a vaccine the most have the hardest time getting one.
From signing up for appointments to securing transportation to clinics, many of the people most at risk of serious consequences and death from Covid-19 – older adults, vital workers, and minority communities – have trouble getting vaccinated when it comes their turn is. At the same time, some wealthier or lower-risk people have used the vaccine registry systems to take charge.
“Many of my elderly patients have a hard time figuring out how to do it in general,” said Margot Savoy, chair of the family and community medicine division at Temple University in Philadelphia. “We’ve made it so complicated.”
Right now, scale is the priority for many states. Some are setting up massive vaccination sites in public locations such as stadiums to get as many weapons as possible in their arms as soon as possible. However, some health experts argue that communities should not only grow large, but also become small, working through local clinics and community groups to reach the most vulnerable. It may come at the expense of speed, but it would help ensure equality in who gets vaccinated against Covid-19.
Active contact is needed to vaccinate the most vulnerable people
No community or demographic has been spared from the Covid-19 pandemic. More than half a million Americans have died of the disease, and many more have become ill. But some groups are hit harder than others, and it’s not just the elderly.
“Throughout the pandemic, people of color have been consistently disproportionately ill and killed by the virus,” Youyou Zhou and Vox’s Julia Belluz wrote in a recent piece. They also died young: Of the Covid-19 deaths in people under 45, more than 40 percent were Hispanic and about a quarter were black. ”
These same groups are also less likely to interact with the existing health care system and are more likely to be hindered in the search for the vaccine. Technology is a barrier that has emerged in several states. For example, the online vaccine appointment booking system in Arizona seems to favor some groups over others.
“When appointments become available, it’s like a gold rush,” said Will Humble, executive director of the Arizona Public Health Association and a former state health officer. “If you work in a supermarket or don’t have WiFi, you have a big, big disadvantage.”
Arizona has set up massive vaccination sites around major metropolitan areas. That helps the state increase its numbers – about 15 percent of the population is now vaccinated – but many of the most vulnerable have been unable to sign up for the limited appointment times during the few short hours they are open. Some also cannot drive to these sites from their homes, according to Humble.
The effect of that [mass vaccination strategy] Yes, it did speed up the vaccine delivery, but it also disproportionately helped high-income people, ”said Humble. “What vaccinators tell me is they vaccinate Teslas and Tahoes all day long.”
According to a review by the Kaiser Family Foundation on Feb. 18, about 12 percent of Arizona’s white population has been vaccinated against Covid-19 so far, compared to 4 percent of black people, 3 percent of Hispanic people, and 9 percent of the Asian people.
Another problem for Arizona, as in many states, is that remote regions may not have the resources to administer both of the Covid-19 vaccines currently available in the US. While the Moderna vaccine has less stringent freezer requirements, the Pfizer / BioNTech Covid-19 vaccine requires ultra-cold storage, so it is mainly allocated to larger countries that have the facilities to store it.
Humble said one way to improve the system would be a single sign-on and then a weighted lottery to assign appointments so that people with fast fingers, fast Internet connections, and free time wouldn’t have such an overwhelming advantage. .
But getting to some of the most vulnerable also requires active help. “We’re doing a real grassroots approach, which requires us to go to the communities … literally knocking on doors,” said Tomas Ramos, the founder of the Bronx Rising Initiative, a group that helps vaccinate Bronx residents against COVID-19. . “What I get when I knock on the door and talk to an elder, they just don’t even know when to start. That’s where we come in. “
Bronx Rising Initiative is working to raise funds for local clinics to increase the capacity for Covid-19 vaccination, as well as to establish remote vaccination sites in public housing. In addition, the group is looking for seniors and other vulnerable people to sign up for vaccination appointments, follow up on reminders and help them arrange transportation if necessary.
Many of the initiative’s volunteers are also from the Bronx. And that helps build trust, combat vaccine misinformation, and persuade reluctant Bronxites to be immunized.
“We come from the community, so when [volunteers] to knock on the door, [residents] see someone living in the same community talking about it, ”said Ramos.
Local health clinics can fill gaps in vaccinations, but they need doses first
Many communities across the country have had months to set up their programs to administer Covid-19 vaccines. But stocks remain limited and there is a frustrating lack of information as to when they will be replenished.
“We have all the infrastructure to take care of it,” said Julie Vaishampayan, the public health officer for Stanislaus County, California. “We’re getting it in pretty good arms, but we’re not bringing it to every eligible arm and we’re not sure exactly who we’re missing.”
Another complication is that local health officials have to jump through hoops to order vaccines from the county, state, or federal government. And it’s not always transparent where these vaccines are going, so health workers on the front lines don’t have much time to prepare. When vaccines arrive, local health officials must identify eligible recipients, finalize them for appointments, give the injections before they expire, and keep track of patients to ensure they get their second dose. There can be overlap between different areas of health, so even if someone is a perfect candidate for a vaccine, it can be difficult to tell which group or agency is changing and giving them a shot.
“I can’t see the vaccine coming from the federal government or the state government,” Vaishampayan said. ‘I don’t know who it’s going to. I don’t know how many doses they received. I don’t know how many doses they gave. It makes it very difficult to set up a network or providers that will reach your population. “
A central information center telling local health officials how to allocate vaccines up to a week in advance would go a long way toward optimal distribution, according to Vaishampayan. Currently, many health departments are dealing with much shorter lead times for receiving vaccines.
One possible bit of good news is that the Covid-19 vaccine developed by Johnson & Johnson may receive an emergency permit from the Food and Drug Administration this weekend. Not only would a third vaccine help bolster stocks, the Johnson & Johnson vaccine only needs one dose instead of two and can be stored at normal refrigerator temperatures.
That vaccine would be particularly suitable for smaller family practices and community clinics, which are less likely to have ultra-cold freezers. These types of facilities may have a lower throughput of vaccinations (as they are equipped to treat fewer patients and may not have the facilities to store vaccines), but they may be able to handle the people most in need of a vaccine. Covid-19 vaccine.
Having a single dose of Covid-19 vaccine that can be stored in a regular medical refrigerator would allow these clinics to get involved and expand the scope of the vaccination campaign.
“When we get to that vaccine, all of a sudden there’s a real opportunity for the average family doctor or primary care provider,” Savoy said. “If we ever had a vaccine to actually distribute and one that we could have and stock in the field, we would have a whole network of people ready.”