Terminology - Vaccine equity in the US

Copyright © Françoise Herrmann

Sometimes, even the best efforts to ensure equity are vexed with stubborn obstacles. This is the case of the COVID-19 vaccine campaign in the US, where efforts have consistently been deployed to ethically rollout vaccinations, for medical personnel, the elderly and most vulnerable populations first. A gracious, bully-proof policy, aimed at countering perverse twists on survival-of-the-fittest, while setting the tone for the rest of the world. However, despite such best ethical efforts, together with a stockpile (under fire) of vaccines large enough to provide vaccinations for all of the US population plus more, and 100% free administration of vaccines at multiple venues with almost no-questions asked, the US vaccine campaign is definitely flunking racial/ethnic equity.  

ABC News Vaccine Watch - California vaccine demographics

Specifically, despite 1> the new Biden administration successful launch of an unprecedented, top-priority, vaccine roll-out across the nation: at all the National Football League (NFL) stadiums and closed-campus parking lots, in churches, and other places of worship, at the large retail pharmacy chains, such as Walgreens, CVS, Rite Aid and Safeway, at clinics, healthcare centers, and other medical facilities, in cooperation with FEMA, the Federal Emergency Agency of the US Department of Homeland Security. 2>  US Federal government purchase of a total of 600 million doses, 300 million respectively from Pfizer and Moderna, intended for 100% free administration (Staff HHS, Feb. 2021), and 3> A pace of vaccinations, scaled up to 3 to 4 million inoculations per day, the undeniable success of this campaign is also marred. 

In other words, even if the campaign appears to be rolling out successfully with the necessary infrastructure of "stuff, staff and space" such pre-requisites also appear far from sufficient to guarantee equal access. Insufficient, according to the Kaiser Family Foundation (KFF) research, tracking race/ethnicity of the US vaccination campaign (Staff KFF, April 2021).

For example, based on CDC data, the KFF found that: 

 “As of April 6, 2021, CDC reported that race/ethnicity was known for just over half (55%) of people who had received at least one dose of the vaccine. Among this group, nearly two thirds were White (65%), 11% were Hispanic, 8% were Black, 5% were Asian, 1% were American Indian or Alaska Native, and <1% were Native Hawaiian or Other Pacific Islander, while 9% reported multiple or other race [Italics mine].” Ndugga et. al, April. 2021 

 KFF further tracked and analyzed race/ethincity data published in 43 US States, precisely to inform action for a more equitable US campaign. In this regards, acknowledging the incompleteness of the data sets, the KFF also  found:  

“ […]  a consistent pattern across states of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases and deaths and compared to their shares of the total population. […]

Overall, across these 41 states, the vaccination rate among White people is 1.8 times higher than the rate for Hispanic people (28% vs. 16%), and 1.6 times as high as the rate for Black people (28% vs. 17%).” Ndugga et. al, April. 2021

Thus, many additional dependent variables appear related to vaccine equity in the US, all of which are being investigated and further acted upon, to remedy the situation (Ndugga etc. al. March 2021). The following are some of the additional variables identified, known to prevent the vaccination equity that most people expect and deeply desire (Lewis, 2021).

1. Car ownership enabling people to drive to the nearest vaccination center, which may be located way beyond walking distance. (Lewis, 2021)
2. Living far from public transportation for access to a vaccination center.(Lewis, 2021)
3. Poor internet access, creating a challenge to secure a vaccination appointment.(Lewis, 2021)
4. Inadequate literacy skills to make an appointment on the Internet, and/or confusing and maze-like instructions for securing a COVID-19 vaccination appointment.(Lewis, 2021)
5. Language barriers for non-English/limited English-speaking people, coupled with burdensome proof-of-eligibility requirements.(Lewis, 2021)
6. Differences in age-expectancy between black and white populations, brought on by systemic racism. In other words, the shorter life span of the black population, makes the black population more vulnerable at a younger age than the white population. Hence the call for lowering the age-cut-off for black populations, prior to lifting the age-related pecking order for vaccinations.(Lewis, 2021)
7. Conversely, a higher life-expectancy for Hispanic populations compared to non-latino white populations, despite the lower socio-economic status of Hispanics. Demographics which might consequently result in raising the age cut-off for Hispanics. However, the latino population suffered far more COVID-19 casualties than the non-latino white population, which canceled any age-raising suggestions.(Lewis, 2021)
8. Differences in the age-expectancy of the Native American population, also calling for lowering the age cut-off for Native Americans. A population that dies way before the white population, and that has suffered more casualties and difficulties, during the pandemic. (Lewis, 2021)
9. Mistrust and skepticism preventing vaccination uptake, arising in a long tradition of malpractice promulgated against communities of color, and structural racism. (Chavez and Peña, 2021)
10. Fear of vaccinations, callously fueled by misinformation on potential negative long term health effects, side-effects, ineffectiveness, danger considering existing health conditions, mistrust of the Trump administration, and the costs of vaccinations (Chavez and Peña, 2021)

References

ABC News Vaccine Watch https://abc7news.com/vaccine/

Chavez, G. R. and J. M. Peña (Jan, 25, 2021) Skepticism and mistrust challenge COVID vaccine uptake for Latinos. https://www.brookings.edu/blog/how-we-rise/2021/01/25/skepticism-and-mistrust-challenge-covid-vaccine-uptake-for-latinos/  

Lewis, T. (March 2021) The biggest barriers to COVID-a9 vaccination for Black and Latinx people.    https://www.scientificamerican.com/article/the-biggest-barriers-to-covid-vaccination-for-black-and-latinx-people1/

Ndugga et. al. (March 10, 2021) How are States Addressing Racial Equity in COVID-19 Vaccine Efforts?  Kaiser Family Foundation.   https://www.kff.org/racial-equity-and-health-policy/issue-brief/how-are-states-addressing-racial-equity-in-covid-19-vaccine-efforts/

Ndugga, N. et. al. (April 7, 2021) Latest Data on COVID-19 Vaccinations Race/Ethnicity.  Kaiser Family Foundation.    https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

Staff (Feb. 11, 2021) Biden Administration purchases additional doses of COVID-19 vaccines from Pfizer and Moderna - US Department Health and Human Services. (HHS).   https://www.hhs.gov/about/news/2021/02/11/biden-administration-purchases-additional-doses-covid-19-vaccines-from-pfizer-and-moderna.html

Staff (April 9, 2021) COVID-19: Vaccinations by race/ethnicity.  Kaiser Family Foundation Dashboards.     https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/#raceethnicity