This is an excerpt from the February 23, 2021 edition of Medically Necessary, a health care supply chain newsletter. Subscribe here.
The problem: Americans of color are receiving the vaccine at far lower rates than white Americans, even though people of color are more likely to get COVID-19. The supply chain is part of the problem.
- “Our system of allocation assumes there’s a level playing field, but there’s not,” Monica Peek, University of Chicago Medicine physician and health care disparities researcher, said at a February webinar hosted by The American Journal of Bioethics. “Unless we purposefully wrench in mechanisms for equity, what we’re going to see are disparities in outcomes.”
The data: The Centers for Disease Control and Prevention reports that Black people have recieved about 6% of COVID-19 vaccine doses administered so far, but they make up about 13% of the total U.S. population. Hispanic or Latino people have received about 8% of vaccine doses and make up about 19% of the population.
- Bloomberg created a chart showing that, in nearly every state, Black and Hispanic people aren’t getting their fair share of the vaccine.
- The CDC has demographic data for only about half of the first doses administered so far. Right now, a Kaiser Family Foundation tracker shows that only 34 states are reporting race or ethnicity data about vaccine administration.
Why is this happening? The current eligibility requirements for vaccines tend to favor white people. In addition, people of color may run into more logistical challenges, such as transportation or connectivity issues.
Julia Raifman, a health researcher at Boston University, said vaccinating older people early leads to racial disparities. Black people have a lower life expectancy than white people, meaning people who are 75 and older — the initial cutoff for vaccine eligibility in many states — are disproportionately white.
- In Memphis, Tennessee, the average life expectancy for a Black person is about 73 years old and vaccines were first offered to residents 75 and older, according to ProPublica.
- “Fewer people who are Black or Native American end up living to those ages, and they’re at a higher risk at an earlier age,” University of Denver bioethicist Govind Persad told FreightWaves.
People of color are also less likely than white people to have broadband internet at home and less likely to have access to a car, according to the Pew Research Center and National Equity Atlas. That can make it difficult to sign up for a vaccine appointment and get there on time.
- “In most areas of the country, we’ve essentially said car keys are a prerequisite for vaccination,” Brian Haile, CEO of the nonprofit medical clinic Neighborhood Health based in Nashville, Tennessee, told FreightWaves.
On top of all that, a Kaiser Family Foundation analysis found that Black and Hispanic adults are more likely than white adults to feel like they don’t have enough information about when and where to get vaccinated.
Kaiser also found that Black and Hispanic people are more likely to want to “wait and see” how the vaccine affects others before taking it themselves. But doctors like Haile and Peek said it’s a mistake to interpret that trepidation as the reason people of color aren’t getting vaccinated. They argue the real issue right now is about access.
- “When you have a market with high rates of vaccine demand, the issues around vaccine hesitancy are washed out,” Peek said during a bioethics webinar. “What we’re seeing around vaccine disparities really is a reflection of disparities in implementation.”
Solutions: Here are some of the steps doctors, researchers and business leaders are taking to create a vaccine supply chain that better serves people of color.
Focus on essential workers: Raifman said changing vaccine eligibility requirements to focus on essential workers could help combat racial disparities. An April 2020 report from the Economic Policy Institute found that Black people were overrepresented in essential jobs. The COVID-19 U.S. State Policy Database, created by Raifman, shows that 26 states are prioritizing older adults over essential workers.
Follow the data: AdhereHealth is a data analytics company that uses health information and socioeconomic data to help insurance companies identify the people most likely to misuse their medication, which can cause costly complications.
Now, the company is developing a product for states that uses the same kind of data to identify people who might have trouble getting a COVID-19 vaccine. AdhereHealth would then have clinicians call those people and enroll them in a vaccination program. The company also hopes to partner with rideshare companies or local transportation groups to help patients get to appointments.
- “I see ourselves as helping navigate the supply chain on behalf of the patient,” AdhereHealth CEO Jason Rose told FreightWaves. “When you think about all the things we’re talking about, whether it’s vaccinations, getting to see your doctor or getting access to your meds, it’s all supply chain.”
Bring the vaccine to patients: Haile said that to make vaccine distribution more equitable, the supply chain has to find ways to bring vaccines to people who have a hard time getting to vaccination sites.
- “A lot of what we’re going to have to do is take the vaccine to deliver it to homebound patients,” he said. “We’re going to have to take the vaccine to homeless shelters. In what ways does the supply chain anticipate that need of going off-site with a mobile strike force to do that kind of work?”
Knock on doors. Pick up the phone: Some doctors are taking a proactive approach when it comes to vaccinating people of color.
In Chicago, Oak Street Health, a network of medical centers that focuses on low income seniors, partnered with the city’s department of public health and more than 50 community-based organizations to vaccinate people in the hardest-hit ZIP codes. Everyone who lives in those areas — largely Black and Hispanic residents — is eligible to receive a vaccine.
Executive Medical Director Ali Khan said that his organizations trained community organizations to use a scheduling system, and then asked them to spread the word about vaccination efforts through their existing networks.
- “They’re doing a lot of work with us around proactive telephone outreach, texting, door knocking in the community,” Khan told FreightWaves. “We’ve found a lot of people we’ve vaccinated are recruiting their own neighbors to come get vaccinated. We’ve tried to make those channels as easy as possible.”
Oak Street Health was able to vaccinate more than 2,000 Latino people in the Belmont-Cragin neighborhood of Chicago in a single weekend.
In Philadelphia, Eugenia South, a professor of emergency medicine at the University of Pennsylvania, was part of a team that vaccinated 500 Black people in one day.
- “Equity isn’t hard, but it does take intentional work to overcome the inequitable inertia of the status quo,” South wrote on Twitter.
In a Twitter thread, she explained that the clinic was a success because her institution, Penn Medicine, partnered with a community hospital and more than 20 Black pastors. The team used a low-tech sign-up system that allowed people to schedule vaccines by text and called older people who weren’t comfortable with texting.
While these examples are encouraging, Persad warns there probably isn’t a one-size-fits-all solution to solve racial disparities in vaccine distribution.
- “You have different racial groups that are on the short end of disparities,” Persad said. “The things that are barriers for African-Americans in Illinois may not be the same as barriers for Latino Americans in Texas … or say Filipino Americans in California.”
Progress? Despite commitments from city and state governments to create supply chains that ensure vaccines get to people of color, it’s just not happening. The Kaiser Family Foundation is tracking racial disparities in vaccination rates, and little has changed since the start of the vaccine rollout.
Khan said part of the problem is that vaccine administrators are still too passive. They’re putting lots of effort into creating a perfect website or scheduling system, but any single strategy is bound to leave some people out. He said administrators need to take a proactive stance and use a wider net to find people of color searching for a vaccine.
- “The problem is that people are putting a lot of burden on single-channel efforts. We put up a website, and we think, how do we make the website more equitable?” he said. “It has to be multichannel. There are a lot of people out there who are ready and eager to get vaccinated, but they don’t know how to make their hand seen.”
Wishful thinking: One wish to improve COVID-19 vaccine rollout
Wishful thinking is a section of the newsletter where I give experts one wish to improve the health care supply chain. Send your wishes to firstname.lastname@example.org.
“One thing that would be enormously helpful at this point would be a national nurse advice line. If you’ve got questions about COVID call this number, so people can get answers to questions in real time.”
— Brian Haile, CEO of Nashville, Tennessee, community health clinic Neighborhood Health
Background: Haile said part of the reason many people of color are hesitant to take the vaccine is that they’re more likely to have chronic medical conditions or lots of medications. In those cases, recipients may want to check with their doctor before getting a vaccine. That adds another step complicating the process.
- “If you have to get them in to see a doctor, and then turn around and get them to a vaccination appointment … you’ve really increased the labor effort required to do vaccination and you’ve further delayed those vaccinations,” he said.
The wish: He said a vaccine hotline might help reduce vaccine hesitancy, especially for people who have lots of medical conditions. It would be easier than getting a doctor’s appointment, and would allow those people to get vaccines faster.
Reading list: The best stories about the health care supply chain
- “Second-Shot Crunch Leaves Many Without Complete Immunizations” — Bloomberg
- “To Vaccinate Veterans, Health Care Workers Must Cross Mountains, Plains and Tundra” — Kaiser Health News
- “A U.S. Vaccine Surge Is Coming, With Millions of Doses Promised” — Bloomberg
- “Trucking, Freight Industry Seek Faster Route to Covid-19 Vaccinations” — The Wall Street Journal
- “History Repeats Itself: COVID-19 Vaccine Inequities Echo HIV Crisis” — NPR