Launch of vaccines that raise questions about race and access in the States

Some states say they are focusing on outreach, hoping to ensure that people of color are not left behind, as the vaccine is distributed more widely.

North Carolina has hired an advertising company to spread the word to Latino and black communities. New York has convened a working group of clergy, health officials, and civil rights advocates to help the process, for example, by making sure the materials needed for effective deployment (such as cleaning supplies and syringes) reach low-income areas.

Other states go a step further, saying the groups most affected by the virus should access the vaccine first.

Colorado has written in its vaccination plan an acknowledgment of systemic racism, although officials have not yet said exactly what steps the state could take in response. The California plan lists ethnic and racial minority groups among the “critical population” who could receive the vaccine ahead of other groups.

States should focus the first rounds of the vaccine on those most at risk, said Georges Benjamin, executive director of the American Public Health Association. This would include minority groups, he said, although he advised against everyone accessing the vaccine based simply on race.

Instead, he said, those at higher risk — such as people with pre-existing conditions or living in multigenerational households — should get the vaccine sooner; in practice, this would benefit racial minorities, who are over-represented in these groups.

“You have to be sensitive to race – you have to make sure you don’t leave out people who may be most at risk,” Dr. Benjamin said.

The first challenge, officials from several states said, will be to simply get information about the vaccine from minority groups, including those who do not speak English. Blacks, Latinos, and Native Americans receive flu shots at lower rates than whites or Asians, according to a report from the Centers for Disease Control and Prevention, in part because they are more likely to be uninsured.

Coronavirus vaccines will be free, regardless of whether someone has insurance. But a history of discrimination has left some minorities wary of being the first to achieve it. In a famous case, the U.S. Public Health Service conducted a study of the effects of untreated syphilis on black men in Alabama beginning in the 1930s. Even after discovering a cure for the disease, men were not treated.

A study by the Kaiser Family Foundation in August and September found that about half of black Americans said they probably or definitely would not want to receive the vaccine, even if scientists determined it was safe. Most white and Hispanic respondents said they would take it.

“We have a major problem in communities of color where people are reluctant to get the vaccine because of historical legacy issues in terms of experimentation,” said Yves Duroseau, president of emergency medicine at Lenox Hill-Hospital. Northwell Health of Manhattan.

Dr. Duroseau is now part of the campaign to overcome this skepticism. Last week, he and another New York health worker, both black, received the first doses of the vaccine in the state during press events. Major hospitals in the state are developing vaccination plans, which will include partnerships with community organizations to ensure dissemination to communities of color, Governor Andrew Cuomo said. The plans are pending state approval.

Cuomo said Monday that the state would also turn shipping containers into “community vaccination kits” with all the equipment needed to make shots. They could be deployed to community centers, churches or public housing projects, he said.

Meanwhile, North Carolina is working with leaders of Latino and black communities, including influential social media and church pastors, to make the vaccine safe and available.

“It’s about building trust,” said Goldie Byrd, director of the Maya Angelou Center for Health Equity at Wake Forest University, which co-chaired the North Carolina Vaccine Advisory Committee. “In some cases, we encourage those influential to see themselves getting the vaccine … to make sure people feel the vaccine is safe.”

On Sunday, the CDC released guidelines for phases 1b and 1c of vaccine deployment, which would give priority to the elderly; those with pre-existing high-risk medical conditions; and essential non-care workers, including employees and teachers of grocery stores.

While the CDC guidelines are not binding, officials from several states said such prioritization would benefit racial minorities without explicitly considering race. Racial minorities are overrepresented among essential workers and people with pre-existing conditions, meaning that minorities would disproportionately benefit from vaccinating these groups sooner.

In California, some officials are pushing for more ambitious goals to get the vaccine to Latino and black communities.

Richard Pan, a Sacramento state doctor and senator, said communities that have been hardest hit by the virus should get vaccinated sooner. “You could go to a neighborhood and prioritize the distribution of the vaccine to specific zip codes or census tracts where we know there are high percentages of people who are essential workers,” Dr. Pan, Democrat. “In the end, this helps us all. If rates go down there, they are less likely to spread from their communities to other communities. “

Nadine Burke Harris, California’s general surgeon, said the distribution of vaccines would not involve preferential treatment by race, “where it is, you’re this racial group, you’re first in line.” But he said the state is studying how it can use “equality metrics” to help determine who will have access to the vaccine and when. California has already linked reopening in larger counties to the number of Covid-19 cases and the positivity rates of the most disadvantaged census tracts.

Noting that black, Latino, and Native Californians have died at higher rates than whites, Dr. Burke Harris said, “We’re absolutely considering the risk of death … when we’re thinking about vaccine allocation.”

Write to Ian Lovett at [email protected] and Jimmy Vielkind at [email protected]