The coronavirus highlighted healthcare disparities in ways impossible to ignore. Over the course of 2020, we watched and experienced that many people of color contracted and were gravely ill from COVID-19 at a disproportionate rate.
According to the Centers for Disease Control and Prevention (CDC), “Underlying health and social inequities put many racial and ethnic minority groups at increased risk of getting sick, having more severe illness and dying from COVID-19.”
Although we are aware of these inequities, we have seen the same trends occur during the early vaccine rollout. Black, indigenous and people of color have had less access to the coronavirus vaccine than their white neighbors.
Recent articles have highlighted these disparities in the District of Columbia, Mississippi and Boston to name a few. Of the states who have submitted this data to the CDC, this alarming trend is seen across the board.
What Do We Do About It?
First and foremost, we must identify the roadblocks preventing an equitable vaccine distribution.
Technology is clearly a barrier. Many states have relied on web-based appointment scheduling as vaccinations became available to the general population (or those at highest risk by age or condition status). Relying on online forms and appointment scheduling means that those without internet access or who need assistance with online forms are missing out on appointments.
In addition, timing and location of vaccine administration should be considered. Vaccines must be offered where and when people are available, which includes nights and weekends, in all neighborhoods and potentially in partnership with churches, community centers and other public locations. Furthermore, transportation services should be made available for those who need assistance getting to and from their appointments.
Many have noted the disorganized rollout as a culprit; with the new Biden administration at the helm, many are cautiously optimistic that vaccine access disparities will be tempered, if not reversed, in the coming weeks and months. On his first day in office, President Biden signed an executive order titled “Ensuring an Equitable Pandemic Response and Recovery”.
That being said, vaccine rollout plans must include more voices at the table to ensure an interdisciplinary approach, as noted by two Black healthcare leaders, Dr. Vernon Rayford and Dr. Eric Lewis of Mississippi’s Project ELECT. Community members, clergy, teachers, social service organizations and “everyday” people like you and me have experience meeting people where they are in real life, outside the four walls of the doctor’s office. Like many of the oppressive systems and structures we currently live in, we must do things differently if we want things to be different.
We must employ mobile vaccination sites in neighborhoods, work with churches and community centers to ensure that our most vulnerable populations have access to the vaccine.
What about Vaccine Hesitancy?
Vaccine hesitancy is not a primary influence on healthcare disparities, but it does deserve mention. Healthcare providers, payers and community-based organizations can encourage people to accept the vaccination when it is made available. All parties must acknowledge that there are reasons for people of color to be cautious and often avoidant of the healthcare system, with good reason. Providers must commit to uncovering their implicit bias and how these biases are seen in healthcare practices and access issues.
In addition, Kaiser Family Foundation recently identified barriers to care and vaccine administration for immigrant populations in the United States. Health Plans and providers must consider the populations they are serving, and identify and deploy effective communications to those individuals to ensure they have access to the care they need.
Focus and Measure for Sustainable Change
Lastly, we must realign our incentives and goals to ensure health equity. Yes, we want vaccines rolled out quickly, but the quick (online appointment scheduling) rollout approach has costs associated with it. Performance indicators must include race and ethnicity, income and employment status and other variables.
We cannot unsee what is seen. It is up to us to make a positive change in our healthcare system and to provide access to quality care, and life-saving vaccines, to all.
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