The news of two effective coronavirus vaccine candidates puts a spotlight on a key question looming since the early days of the pandemic: Who gets access to the vaccine first?
“There really needs to be intentional effort to get it to the communities that need it most,” said Dr. Uché Blackstock, CEO of Advancing Health Equity. “Because we don’t want to see these disparities reinforced in the vaccine distribution effort.”
The vaccine distribution process was already a dilemma. The Pfizer vaccine needs to be kept at ultracold temperatures, sparking concerns about adequate packaging and freezers needed to deliver and house it. Getting vaccine access to the populations that need it most makes the distribution process even more challenging.
Blackstock, a Yahoo News medical contributor, said the vaccine distribution “is really a time for us to get things right.”
She said the Centers for Disease Control and Prevention is considering a social vulnerability index to help prioritize vaccine access. The New York Times reported that a committee of experts, the Advisory Committee on Immunization Practices, is drawing heavily from the equity plan proposed by the National Academy of Sciences, which would reserve 10 percent of the total amount of vaccine available for people in hard-hit communities.
“[The social vulnerability index] consists of many different factors, from socioeconomic status of an area, housing, also using race and ethnicity,” Blackstock said. “It essentially is an index to determine how vulnerable a community is. It can be used in this pandemic, but it’s also used for different issues around food insecurity, housing insecurity. In this case, it would be used to target the communities that have been hardest hit by the virus.”
The National Academy’s recommended framework for equitable vaccine allocation involves four phases of distribution: high-risk health workers and first responders in the first group; those with serious preexisting conditions and elderly adults in crowded settings (i.e., nursing homes) in the second group; all essential workers, anyone with preexisting conditions, all older adults and the incarcerated in the third group; and young adults and children in the fourth group.
But even just one of the four phase groups in this proposed framework is composed of millions of Americans. With such a limited supply of vaccine doses available early on, which group gets to go to the front of the line?
The National Academy also noted the “moral imperative” that any vaccine allocation plan address the fundamental health inequities rooted in systematic racism and residential segregation, which has resulted in a higher COVID-19 burden in communities of color. Black and Hispanic Americans are more likely to live in overcrowded housing, work in public-facing essential jobs and have higher rates of preexisting conditions that put them at increased risk of coronavirus infection and serious health complications. The rate of coronavirus cases among Black and Hispanic Americans is more than two and a half times that of white Americans, and Black and Hispanic Americans are more than four and a half times more likely to be hospitalized, according to the CDC.
These disparities have already appeared in the distribution of COVID-19 tests. Testing centers are more likely to be located in historically white neighborhoods, while those located in predominantly Black neighborhoods are often understaffed or lacking in critical supplies. And early in the pandemic, one analysis found that doctors may be less likely to refer African Americans for COVID-19 testing when they present symptoms associated with the coronavirus.
The phases of vaccine distribution proposed by the National Academy don’t directly address these racial inequities, but the group says they do so indirectly, since Black and Hispanic Americans are heavily represented in essential fields and groups with preexisting conditions.
But while the CDC can make recommendations, ultimately it will be up to state and local governments to determine who gets vaccine access first. Yet for the process to be equitable, federal funding will be critical.
“What we don’t realize is that state and local government really are the key pieces in making sure this distribution effort is successful,” Blackstock said. “So it’s not going to be successful if they don’t have the funding for the process.”
She added that effort and funding need to be allocated not only to logistical concerns, but also to engaging with communities of color that have faced a long history of exploitation and abuse by racism in the U.S. health care establishment. A Yahoo News/YouGov poll in October found that only 27 percent of Black Americans plan to get a vaccine if and when one becomes available.
“A significant amount of the funding should really be going to messaging, campaigns, outreach around the vaccine,” Blackstock said. “Even being innovative, like using social media, or even using celebrities to help advertise the importance of taking the vaccine … so that when a safe and effective vaccine is delivered, community members will be willing to take it.”
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