It’s Time to Boost Vaccine Equity
Understanding the unique challenges some communities face in getting vaccinated
“My husband couldn’t get the vaccine, but I’ll be darned if I’m not going to get every human being around me vaccinated,” said Carla Brown, a nurse in Baton Rouge, Louisiana. For months, Carla has worked tirelessly to get the members of her community vaccinated so they can avoid the same fate as her husband, who died of the virus in July. She spends her days knocking on doors, making phone calls, and giving rides to pop-up sites — whatever she can do to build trust and convince her neighbors to get the vaccine. Carla understands how to reach community members because these are her friends, family, neighbors, and coworkers. And with less than 20 percent of people having gotten their booster or third shot, we need to follow an equitable distribution strategy based on the insights and cultural knowledge of local leaders like Carla to be successful.
Black, Latino, and other communities of color across the country have been ravaged by the pandemic, recording disproportionately higher infection and death rates from the virus. Instead of prioritizing individuals and communities facing the highest risk, states focused their initial vaccine rollouts on specific age groups. While age is certainly an important risk factor, it isn’t the only one that contributes to hospitalizations. For instance, research from Rhode Island shows that Black and Latino individuals ages 35–44 are three times more likely to be hospitalized than older white individuals ages 74–85.
The initial vaccine rollout provided a clear picture of the barriers that communities of color face in accessing vaccines and the health system writ large, with early data from the Rockefeller Foundation showing that 72 percent of people of color in five major U.S. cities wanted to get the vaccine, but 63 percent didn’t know how to get it. The good news is that strategies that have been adjusted to meet these challenges are working. For example, disparities in vaccination rates have narrowed over time and have nearly closed for Hispanic people.
As doctors, pharmacists, nurses, and other medical professionals administer boosters, there are two lessons to heed from the initial rollout a year ago: first, that we make sure that the boosters are easily accessible specifically for communities of color, and second, that we continue the important work of getting people their first shots. To do this, it’s essential to address the challenges that communities of color face directly, including:
1. Information Gaps and Misinformation
If information is power, a lack of information or the infiltration of misinformation can leave communities spinning and powerless. One of the biggest barriers is simply a shortage of sources for credible information. Too many people in vulnerable communities don’t have a local health clinic, pharmacy, or doctor to get answers to health-related questions. This lack of access makes it difficult to keep families healthy, pandemic or not. Black communities, in particular, are frequently overlooked when it comes to investments in community development, which W.E.B DuBois concluded directly affected health outcomes… back in 1906. Systemic racism has long driven underinvestment in basic physical necessities in Black communities such as housing, grocery stores, and hospitals. These same problems persist in 2021. To help combat these issues, it is critical to engage trusted and familiar local leaders — like Carla — to serve as ambassadors, providing accurate and timely information and guidance to their communities.
2. Cultural Barriers
The pandemic has revealed to the world what Black Americans have known for generations — that the US health care system is deeply plagued by systemic racism. From grotesque early medical experiments to the current Black maternal health crisis, the disparate and unethical treatment that communities of color have experienced has understandably sowed an ingrained sense of distrust. “If you look back at our history, we have been lied to, and there has been a lot of racial pain, so it’s all about building trust,” Carla Brown said. Furthermore, marginalized communities are more likely to see health care like vaccines as resources that are available to the wealthy — not them It’s commonly accepted in lower-income areas that access to health care correlates with wealth and that it’s just part of American life, and there’s little they can do to improve the situation. While it will ultimately take a prolonged cultural shift and deep systemic change to dispel these views, we can start simply by making health care services widely available to communities of color. When a resource is scarce, it can foster perceptions that it’s too valuable for everyone to afford. But when a resource is easily — and consistently — accessible, it can become an ingrained part of the community that can benefit future generations.
3. Physical Barriers
Research consistently shows that many underserved communities — both urban and rural — are health care deserts where residents can’t easily access practitioners or any kind of medical facilities such as hospitals, clinics, or even pharmacies. An estimated 30 million Americans live at least 60 minutes away from the nearest trauma care facility. According to a study published by the University of Southern California earlier this year, one in three neighborhoods in the 30 most populous U.S. cities were determined to be pharmacy deserts, affecting an estimated 15 million people. “Limited access to pharmacies disproportionately impacts racial/ethnic minorities — 8.3 million Black and Latino residents of these cities live in deserts,” said Jenny S. Guadamuz, one of the study’s authors. But it’s not just major metropolitan areas that are isolated from these resources. In 2019, the government designated 80 percent of rural America as “medically underserved.” It costs residents of these communities money and time to receive care, which many just can’t afford. These areas show greater rates of chronic conditions that go untreated, putting them at even greater risk for COVID. A huge problem that sustains these barriers is the consistent underinvestment in marginalized areas. We need to prioritize investing in these communities to revitalize existing infrastructure, establish new resources, and build more technological capabilities — like establishing robust broadband — to keep vulnerable populations connected.
As we continue to collect data around vaccination rates, we can’t read the numbers from a broad view. Instead, we need to develop booster distribution strategies that increase access to vaccines and work directly with communities to better acknowledge and tackle the obstacles affecting underserved populations. The answers are in front of us, and we have a real chance to support Carla, her community and other communities like hers across the country, now and into the future.
