Vaccine rollout poses states with questions about race and access

Some states say they are targeting outreach, hoping to make sure people of color don’t lag behind as the vaccine is more widely distributed.

North Carolina has hired an advertising agency to conduct outreach to black and Latino communities. New York has convened a working group made up of clergy, health officials and civil rights advocates to aid the process by, for example, ensuring that the materials needed for an effective rollout – such as cleaning supplies and syringes – go to low-income areas.

Other states are taking it a step further, saying that the groups most affected by the virus should have earlier access to the vaccine.

Colorado has included a recognition of systemic racism in its vaccination plan – although officials have yet to say exactly what steps the state could take in response. The California plan lists racial and ethnic minority groups among the “critical population” who could receive the vaccine earlier than other groups.

States should target the first rounds of vaccination at those most at risk, said Georges Benjamin, executive director of the American Public Health Association. That would include minority groups, he said, although he advised against giving anyone earlier access to the vaccine simply on the basis of race.

Instead, he said, those most at risk – such as those with pre-existing conditions or who live in multi-generational households – should get the vaccine sooner; in practice, this would benefit racial minorities, which are over-represented in those groups.

“ You have to be race sensitive – you have to make sure you don’t ignore people who may be more at risk, ” said Dr. Benjamin.

The first challenge, officials in multiple states said, is simply getting information about the vaccine from minority groups, including those who don’t speak English. According to a report from the Centers for Disease Control and Prevention, black, Latino, and Native Americans get flu vaccines at lower rates than whites or Asians, in part because they are more likely to be uninsured.

The vaccines against the coronavirus are free, regardless of whether someone has insurance. But a history of discrimination has made some minorities reluctant to get it first. In one famous case, the US Public Health Service conducted a study of the effects of untreated syphilis on black men in Alabama from the 1930s onwards. Even after a cure for the disease was discovered, the men were not treated.

A survey by the Kaiser Family Foundation in August and September found that about half of black Americans said they probably or certainly wouldn’t want to get the vaccine, even if scientists had determined it to be safe. A majority of white people and Hispanics surveyed said they would take it.

“We have a significant problem in communities of color where people are reluctant to take the vaccination because of historical problems with experiments,” said Yves Duroseau, president of emergency medicine at Lenox Hill Hospital-Northwell Health in Manhattan.

Dr. Duroseau is now part of the campaign to overcome that skepticism. Last week, he and another health worker in New York, who are both black, received the first doses of the vaccine in the state at press events. The state’s major hospitals are in the process of drafting vaccination plans, including partnerships with community organizations to ensure communities of color are reached, Governor Andrew Cuomo said. The plans are pending state approval.

Mr Cuomo said on Monday that the state would also turn shipping containers into “community vaccination kits” with all the necessary equipment to hand out shots. They could be deployed in community centers, churches or public housing projects, he said.

North Carolina, meanwhile, is working with leaders in black and Latino communities – including social media influencers and church pastors – to publicize that the vaccine is safe and available.

“It’s about building trust,” said Goldie Byrd, director of the Maya Angelou Center for Health Equity at Wake Forest University, who co-chaired the North Carolina Vaccine Advisory Committee. “In some cases, we encourage those influencers to watch the vaccine take … to make sure people feel the vaccine is safe.”

On Sunday, the CDC released guidelines for phases 1b and 1c of the introduction of vaccines, with priority being given to the elderly; people with pre-existing high risk medical conditions; and non-healthcare workers, including supermarket employees and teachers.

While the CDC guidelines are not binding, officials in several states said this kind of prioritization would benefit racial minorities without explicitly considering race. Racial minorities are over-represented among key workers and those with pre-existing conditions, meaning that minorities would benefit disproportionately from vaccinating those groups earlier.

In California, some officials are pursuing more ambitious goals to bring the vaccine to black and Latino communities.

Richard Pan, a Sacramento-based physician and senator, said the communities most affected by the virus should be vaccinated earlier. “You could go to a neighborhood and prioritize delivering the vaccine to the specific zip codes or censuses where we know there are high percentages of people who are key workers,” said Dr. Pan, a Democrat. “Ultimately, that helps us all. If rates go down there, they are less likely to spread from their communities to other communities. “

Nadine Burke Harris, the surgeon general in California, said vaccine distribution does not include racial preferential treatment, “where it is, you are this racial group, you are the first in line.” But she said the state is investigating how it could use ‘equality statistics’ to determine who has access to the vaccine and when. California has already linked reopening in larger counties to the Covid-19 case numbers and positivity numbers in the most disadvantaged census stretches.

Dr. Burke Harris noted that black, Latino, and Native Californians have died faster than whites, saying, “We are definitely considering the risk of death … when we think about vaccine allocation.”

Write to Ian Lovett at [email protected] and Jimmy Vielkind at [email protected]