The 500,000 COVID-19 related deaths reflect our nation’s failure to reduce and prevent public health crises. As COVID-19 rampaged across the globe, several research teams raced to develop a vaccine, a technology that humanity has relied on for decades to reduce the transmission of infectious diseases. At the time of this writing, 15.8% of the total U.S. population are fully vaccinated—that includes the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccine. Despite the Biden administration identifying vaccine equity as a priority, each U.S. state varies in prioritizing equity in their vaccine guidelines. Furthermore, each state has a different definition of who constitutes a frontline worker. Creating guidelines with strict criteria complicates the process of vaccine rollout and is counterintuitive to equity prioritization.
As health professionals who worked on the frontlines during the peak of the SARS-CoV-2 pandemic, we witnessed longstanding pathologies of power play a significant role in testing, hospitalization, and death rates related to COVID-19 complications. The disease burden of this pandemic has disproportionally impacted communities of color. According to the CDC, Black people who tested positive for COVID-19 are three times more likely to be hospitalized than their white counterparts. Moreover, Black, Hispanic, and Indigenous people are twice as likely to die from coronavirus-related complications when compared to white people. These statistics are not reflections of biological factors particular to a specific racial or ethnic group; instead, they are manifestations of countless years of oppressive and racist policies that have made communities of color vulnerable—socially, economically, and politically.
The reproduction of these same policies within vaccine planning and rollouts may serve as an explanation of the stark disparities among COVID-19 vaccine distribution. Although vaccination rates have increased across the U.S. due to several states opening up more vaccination sites and relaxing their eligibility criteria, vaccination rates among communities of color remain low. As of March 30, 2021, 96 million people had at least one dose of the vaccine administered. Among this group, 65.9% were non-Hispanic whites, 8.2% were Black, 9.3% were Hispanic, 4.9% were Asian, and 1.4% were Indigenous people. In cities like Detroit, where the Black population reaches almost 80%, about 14% of Black Detroit residents have received the vaccine against COVID-19. In the District of Columbia, Black people have received 31% of the COVID-19 vaccine despite comprising 46% of the total population and 76% of coronavirus-related deaths. There are multiple factors behind these trends, including vaccine hesitancy and obstacles to vaccine access.
While convenient for major media outlets and public health officials to focus on vaccine hesitancy, especially within the Black community, as the primary cause for low vaccination rates among communities of color, it is imperative to understand the role of systemic racism. The medical and scientific community has a longstanding history of experimentation and exploitation of Black people: from the Tuskegee syphilis case, the immortal cells of Henrietta Lacks, the non-consented XYY genotype screenings in the 1970s, the alarming rates of Black maternal and infant mortality, to the continuation of health professionals ignoring the health concerns of the Black community.
Although hesitancy does play a role in low vaccination rates, our focus should expand to the root causes behind them. For example, laws and policies such as redlining, gerrymandering, voter suppression, poorly funded education, employment discrimination, and mass incarceration, to name a few, have collectively contributed to health disparities among communities of color. Black and Hispanic people have a shorter life expectancy than their white counterparts, placing them at a higher risk of dying before they reach their state’s COVID-19 vaccine eligibility criteria. At the peak of the pandemic, Black and Hispanic people were shown to constitute the majority of the essential workers for some of the lowest paying industry sectors. However, Black and Hispanic people in the U.S. are less likely to have a flexible work schedule to occupy any open spots in vaccine distribution. Moreover, Black and Hispanic people are less likely to have a reliable transportation source to arrive at their vaccination site and are also less likely to have internet access to receive vaccine education and make online vaccination appointment. It is evident that the laws that have shaped and continue to shape the ecology of these communities also form very the foundation for the social determinants of health.
Prioritizing equity in vaccine rollouts means identifying and understanding the nuances of structural racism in the formation of new policies and policies that already exist. States must relax their criteria on vaccine eligibility and open community clinics in neighborhoods that were hit the hardest during the pandemic. As temperature storage becomes less of a concern with newer vaccines like Johnson & Johnson, the creation of mobile vaccination sites and vehicles may provide a new opportunity to meet community members where they are. Community-based organizations are the backbone of communities; thus, allowing them to lead vaccine distribution is essential in this effort. For example, in Detroit, the Detroit Association of Black Organizations (DABO), spearheaded by Reverend Horace Sheffield, has partnered with Quest Diagnostics and other sponsors to educate Detroit residents on the COVID-19 vaccine and prioritize them in the administration of the vaccine. Health professionals, public health officials, and lawmakers must learn from the failures highlighted by the pandemic. It is our responsibility to rewrite equity and construct new tools that reach out to the most vulnerable and ensure their holistic wellbeing.
Ira Memaj is a public health educator and researcher. Joshua Anthony is a psychiatry resident. Robert Fullilove is a professor of sociomedical sciences.
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