Racial equity in access to vaccines

February 17, 2021
Ivan Pantic/iStock

By Michele Learner

We know that COVID-19 is not “equal opportunity.” People who contract the virus and people who die are disproportionately people of color, particularly Black people. The data available so far illustrate clearly how the pandemic affects different racial groups differently. 

A recent Bread for the World Institute resource, “Racially Equitable Responses to COVID-19,” explains how systemic racism causes such inequitable outcomes. Some of the aspects of racism that most affect both hunger and COVID-19 are job segregation, residential segregation, inequitable access to health care, and interpersonal racism.

Late in 2020, as the release of COVID-19 vaccines was on the horizon and then as the United States began the monumental task of vaccinating as many people as possible, several organizations began efforts to track data on access to vaccines and then use this information to develop ways to advance racial equity.

The National Academies of Sciences produced a consensus report, Framework for Equitable Allocation of a COVID-19 Vaccine, which emphasized the need to make specific plans to promote equity. The framework identified criteria to help set priorities—for example, communities with the highest rate of health inequities, people in jobs with high levels of contact with the public, and families who live in crowded spaces.

The report also includes detailed information on how to implement its recommendations. For example, one suggested strategy to help identify geographic areas most in need of priority access to vaccines is to use the CDC’s Social Vulnerability Index. 

Health Leads, a Boston-based organization focused on health equity, brought together several groups into a consortium aimed at promoting racial equity in COVID-19 vaccination efforts. Other members of the consortium include the National Association of Community Health Workers, Partners in Health, the Native Ways Federation, and the Community Health Acceleration Partnership.

The initiative has identified several of the most important challenges, particularly gaps in community trust and in resources both financial and human. But it also finds that change may be easier because, in the emergency conditions of the pandemic, the public health community has had to be open to newer, more equitable ways of doing things that were not previously part of mainstream thinking. This means that there may be “broader latitude to shift the narrative” toward placing higher priority on community health and public safety.

Initial indications are that racial inequities are likely present in access to vaccines, just as there are inequities in infection rates and death rates among those who become infected. According to preliminary data, the racial groups that have higher rates of death do not have a higher rate of vaccination.

Bread for the World emphasizes that disaggregated data are essential to making effective plans to advance racial equity. But as of January 19, 2021, only 17 states were publicly reporting COVID-19 vaccination data by race/ethnicity, making it more difficult to discern how to move past “colorblind” approaches to reach communities that should have priority access.

KFF, a health policy research organization, explains, “Together the data raise some early warning flags about potential racial disparities in access to and uptake of the vaccine, but it is difficult to draw strong conclusions given that the vaccines are not yet broadly available and due to data limitations.”

The Biden administration has said that racial equity will be at the core of its COVID-19 response. One example of efforts to make this a reality is a program that sends doses of vaccines directly to federally funded clinics in underserved areas. Dr. Marcella Nunez-Smith, a professor at Yale who leads the administration’s Covid-19 equity task force, says, “Equity is our North Star here.” But again, disaggregated data is essential to identifying where there are inequities and develop ways to correct them.

It is encouraging that policy analysts and others recognize the need for specific efforts to promote racial equity as vaccines are distributed. It is a step forward to try to correct inequities as they happen rather than just noting them with “20/20 hindsight.” But, of course, policy analysis and good intentions do not lead automatically to improved equity.

These must be combined with reliable data, careful tracking of which efforts are proving effective, and course corrections. 

Michele Learner is managing editor with Bread for the World Institute.

People who contract the virus and people who die are disproportionately people of color.

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