COVID-19 vaccine rollout needs a shot of equity

In the rush to get as many people as possible vaccinated against COVID-19, the United States has become obsessed with numbers. How many doses have been distributed? How many people can be inoculated in President Joe Biden’s first 100 days? Is 1 million doses a day too modest, and is 1.5 million too bold? What percentage of people need to be vaccinated to reach herd immunity?

Yes, we should work to get shots in as many arms as possible, but we must start by getting shots in the right arms.

As two people who have worked in public health for decades — including at the Centers for Disease Control and Prevention — and have been involved in vaccine distribution strategies at the federal, state and local level, we’re concerned that the most important question of all is one being left out our national conversation: Is America’s vaccination effort reaching all of those who need to be vaccinated now? From what we have seen, the answer is no.

The nation has lost sight of the fact that while this pandemic is affecting every community, it is not affecting every community the same. Black, Latino and Native Americans — many of whom are front-line essential workers — are being infected, hospitalized and dying at rates that far surpass their proportions of the population. Given this reality, we must do everything we can to ensure that more of them get to the front of the vaccination lines.

The inequities that COVID highlights

We understand that states must maintain the flexibility to implement a rollout plan that best serves their populations, with the federal government providing funding, high-level guidance and coordination. However, in many states, an overzealous focus on speed is leaving behind many of those who should be vaccinated most urgently. After all, a state might exhaust its doses by mainly reaching people who have the means, know-how, time and connections to navigate what can be challenging systems. Every vaccine a low-risk person receives endangers a higher-risk person.

The CDC’s COVID Data Tracker provides a useful snapshot of how states are managing vaccine distribution, but what we don’t see in the data leaves us vulnerable to more inequities. This is the case at a time when concern around vaccines is still high, especially in communities of color that have suffered disproportionately because of this nation’s legacy and ongoing experience of structural racism. The data gaps undermine our ability to serve high-risk communities.

CDC’s Mortality and Morbidity Weekly Report, published Monday, noted that America has race and ethnicity data for only about half of the vaccinated population. Researchers concluded that “more complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical” to address these disparities.

The Kaiser Family Foundation found that in the states reporting race and ethnicity, the evidence is troubling: Black and Latino Americans account for a smaller share of vaccinations compared with COVID-19 cases and deaths.

We need data on race, ethnicity, occupation and neighborhood from every state to accurately assess how this nation’s vaccine rollout is going — and to see whether the people at greatest risk are getting vaccinated first. Congress must provide funding for states and localities to support the collection and reporting of these data, and to fund and support grass-roots efforts to build vaccine trust, specifically in communities of color.

COVID-19 vaccine on Jan. 21, 2021, in Vero Beach, Florida.

Those carrying the messages and urging people to get vaccines must come from trusted voices within each community, whether faith leaders or community organizers, medical practitioners or others. The decisions on how to engage and whom to involve must be made by these same people. Importantly, we also need consistent and regular communications from public health experts, rather than politicians, guided by the best science available.

Success for our vaccination program will take more than just prioritizing the right groups to receive them. We must make the process easy. Many workers, especially those at increased risk, can’t take time from work to wait in lines, so vaccinations must be available after hours and on weekends. More than 20 million people in the USA lack broadband and high-speed internet access, so registration should be easily available by phone or by walk-in. While drive-thru vaccination sites are efficient, millions of people who should be in this first wave don’t have a car. These challenges should be addressed intentionally and urgently.

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If the United States were flush with vaccines and could immediately inoculate every person who wants one, the frenetic rush to vaccinate people in any order — no matter their risk, ZIP code, income level or skin color — might make more sense. However, given what we know about the health risks and the expected pathway to herd immunity, all states must recalibrate their plans to lead with equity. This is the right approach for public health — and one that serves all populations.

Prioritizing equity in the vaccine distribution

We are heartened to see that the new administration has vowed to put equity front and center, in the distribution of treatments and vaccines. Rochelle Walensky, the new CDC director, has pledged the full force of the agency to address the inequities we have seen throughout this pandemic. Together, these efforts will guide the public health and economic response in a way that we hope will ensure that all Americans have what they need to protect themselves, their families and their communities until this crisis finally ends.

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For the millions of people across the country who are waiting for a vaccine but are perhaps confused, frightened and frustrated, we share their concerns but remain hopeful that better days are ahead. Meantime, we all must be vigilant in doing our part — wearing masks, social distancing, washing our hands and, when it comes to vaccinations, waiting our turn — if we are to move beyond this difficult chapter in our history.

Let us make the vaccine rollout a model of American public health. One’s health and well-being should not be determined by one’s wealth, connections, access or ZIP code. This approach may have been our nation’s past, but we must not let it be our future.

Richard Besser, president and CEO of the Robert Wood Johnson Foundation, worked at the Centers for Disease Control and Prevention for more than a decade, including as acting director at the dawn of the H1N1 pandemic in 2009. Follow him on Twitter: @DrRichBesser. Julie Morita, executive vice president of RWJF, was a commissioner for the Chicago Department of Public Health and recently served on the Biden Transition COVID-19 Advisory Board in a personal capacity. Follow her onTwitter: @DrJulieMorita

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