Ever since Covid-19 vaccines have been in development, policy experts and activists have been concerned about equity in vaccine distribution. They have warned that without a deliberate effort to prioritize communities of color, the same disparities that have occurred with the the distribution of drugs, bailout funding, and masks will happen with vaccines.
Now, it is clear that in our haste to get “shots in arms,” we are leaving behind many people who are most at risk of Covid-19 infection and death. According to the Kaiser Family Foundation’s latest analysis of state-level data on race and ethnicity of Covid-19 vaccinations, Black and Hispanic/Latinx people are receiving fewer vaccinations proportionally compared to their shares of Covid-19 infections and deaths. In Texas, 20% of vaccinations have gone to Hispanic/Latinx people, even though they account for 42% of cases and 47% of deaths in the state. In Massachusetts, 81% of vaccinations have gone to white people, even though they only account for 49% of cases in the state.
Drivers of vaccine disparities
Why is this happening? The CDC’s recommendations to prioritize older people, essential workers, and those with multiple health conditions are well-targeted. Given that people of color make up a large share of the health care workforce and other essential workers, and have higher rates of chronic conditions, one would expect that they would be getting vaccinated at high rates. The continued disparities show that creating an order for distribution is not enough to ensure that distribution is actually equitable.
There are many other barriers that come between eligibility and actually receiving the vaccine. As Dr. Muriel Jean-Jacques, associate professor of medicine and associate vice chair for diversity, equity, and inclusion at Northwestern University and Dr. Howard Bauchner, editor-in-chief of JAMA, write in a recent viewpoint piece, the essential elements of “time, technology, and trust” that it takes to get access to the vaccines are very unevenly distributed in the US. People not only need to be eligible for a vaccine, they need internet access, ability to use technology, ability to understand English, time to be online refreshing appointment pages, and a car or other transportation to get to the appointment.
For people to receive the vaccine, they also have to have faith in the vaccine’s benefits, which takes outreach and time from health care workers and community leaders to address concerns, answer questions, and dispel misinformation. This outreach process is incredibly important, but it hasn’t been undertaken on a national scale. The result? Even when vaccine centers are set up in low-income communities, wealthier people from nearby suburbs are overly represented.
Potential solutions
What can we do to reverse these inequities? Jean-Jacques and Bauchner recommend prioritizing vaccine distribution in zip codes most severely impacted by Covid-19, partnering with local organizations for better outreach, simplifying registration, and prioritizing those with transportation barriers by using vans to deliver vaccine to homebound people or distributing vaccines near public transportation hubs.
Other health policy experts suggest going a few steps further. In a Washington Post op-ed, Dr. Uché Blackstock, emergency physician and founder of Advancing Health Equity, and Dr. Oni Blackstock, primary care physician and founder of Health Justice, recommend that the CDC specifically prioritize people of color for vaccinations, and that states bring the vaccine to where Black people are more likely to go, such as community centers, churches, and schools. “While there is urgency to vaccinate quickly, it cannot and must not be done at a cost to equity,” they write.
Data availability is also very important when it comes to equity in vaccinations. In the CDC’s national data, race/ethnicity was only known for about half of people who had received the vaccine. The CDC should mandate collection of these data, and make the data available on a public-facing website.
Global inequities
It is important to point out that disparities in who gets vaccines are playing out on a global, not just national, scale. In a recent article in the Washington Monthly, Lown senior vice president Shannon Brownlee and investigative journalist Jeanne Lenzer point out the irony of shaming Americans who skip ahead in line while the US hoards vaccines that could be given to other countries.
As of mid-February, just ten countries had administered 75% of the world’s vaccinations, and 130 countries had not received a single vaccine. At our current pace, we won’t vaccinate the world until 2023 at least. Millions will die, including health care workers who are already in short supply in many developing countries. Not only is it cruel to ignore the Covid-19 crisis in other countries, it is short-sighted, Brownlee and Lenzer write. The longer the world allows the virus to spread, the more mutations will appear, which could reinfect people across the world. No country is truly safe until the world is vaccinated.
The US needs to take leadership on making the vaccine available for all. Biden has indicated that he is using the Defense Production Act to boost Pfizer’s vaccine production. However, price is another huge factor, as many developing nations cannot afford the higher-priced mRNA vaccines. One potential solution is COVAX, a global effort to purchase vaccines on a large scale to negotiate lower prices.
Another solution, advocated by the People’s Vaccine Alliance, is to require pharmaceutical companies working on Covid-19 vaccines to share their intellectual property (IP) through the WHO’s Technology Access Pool. Because most Covid-19 vaccines and treatments have been developed with public funding, the People’s Vaccine Alliance urges governments to “impose conditions on their funding to demand the removal of patents and other intellectual property barriers, the open sharing of know-how, and the transfer of technology to as many manufacturers as possible.” Vaccine experts have recently pointed out that IP alone is not enough for companies to instantly start manufacturing vaccines. But even if it will take months for other companies to build up their manufacturing capacities, it is an important first step toward expanding the supply we need in order to vaccinate the world.