The COVID vaccine system is unfair to those who need the shots most. This was predictable.
Policies have been set in place to make access to COVID-19 vaccine access fair and effective, but they are largely failing. The COVID-19 vaccine distribution is a mess, with many of those who need it most left behind. There are too many special case scenarios, competing risk factors and lifestyle risks to determine exactly who should have priority.
Knowing this mess was likely inevitable, months ago, as a health equity researcher at Weill Cornell Medical College, I proposed a plan to make COVID-19 vaccine access truly fair. I recommended that states roll out vaccines to communities most at risk of COVID-19 transmission and most at risk of dying from the virus. This would put low-income communities and communities of color at the top of the list.
Here is what I meant: We need to physically go into these communities, set up multiple vaccine distribution centers, and make it easy for people to show up and get a vaccine.
Vaccines for those with time, tech skills
Fast forward to today: Not only are vaccine rollouts not serving the most vulnerable populations, they are continuing to put low-income and underserved communities at a higher risk of getting and dying from COVID-19. The very things required to get a vaccine — being savvy with technology to sign up for a spot, having the ability to travel long distances to get a vaccine, having time to keep looking for an available slot — are the precise luxuries and resources that the poor and underserved in America do not have. We hollowly praise many of our essential workers such as grocery store clerks, delivery drivers and public transit employees as “heroes,” without giving them adequate access to vaccines.
Who is getting vaccinated? The individuals who have the time, resources and tech skills to get those coveted vaccine slots. This means they are also more likely to be the ones with the luxury to work from home and engage in protective behaviors until vaccines become more accessible for everyone.
What makes this problem even worse is that blue states, which pride themselves on advocating for justice and fighting the COVID-19 pandemic more strongly than red states, have created the worst inequities. A recent New York Times article highlighted how blue states are doing a worse job than red states at mass vaccination because the very rules designed to promote equal access have made it a huge challenge to get vaccines in arms. And because the penalties for breaking the rules of eligibility are so severe, there are reports of vaccines actually expiring before they reach a person’s arm due to the mismatch in eligibility and availability of individuals.
This is a common and tragic mistake often made within our health care system when attempting to make it equitable. Leaders with good intentions tend to push for what on the surface appears like it serves those most in need, but these efforts often make us feel morally upright while failing to consider what structural and procedural strategies actually eliminate inequities.
Doctor:With COVID, we kick the homeless while they’re down. Vaccinate this vulnerable group.
Structural barriers are often the biggest contributors to unequal access to health care services, such as what we are seeing with the current vaccine rollout. Most underserved populations suffer under the American health care system because it requires things like access to a mobile device or internet, time for multiple follow ups to find an open slot, and the ability to travel long distances to get a vaccine. When you are elderly or lower income, you often do not have the capabilities to take time off work or leave your home for long periods of time to travel to a vaccine site. You may also lack the access or skills needed to use a hard-to-navigate website to get a vaccination slot.
Certainly, there are many structural issues contributing to the failing vaccine rollout. Multiple administrative issues — from lacking workers to distribute vaccines to inconsistencies and uncertainties about when and how many vaccines will arrive — have all slowed the vaccine’s rollout progress. These are clearly structural issues that must be worked out in order to move forward and get vaccines in American’s arms.
Bring vaccines where they’re needed
However, developing cumbersome and complicated formulas for vaccine eligibility and creating distribution centers without placing them in underserved communities only serves to exacerbate injustice embedded within our healthcare system. It is critical to address the systemic barriers head on rather than creating formulas meant to promote equal access but actually make it harder for vulnerable populations to gain access.
Don’t hold out:Take whatever COVID vaccine you can get. All of them stop death and hospitalization.
Let’s make it easy for the often homebound elderly, low income citizens, high-risk workers, and underserved communities to get a shot in their arms.
Let’s place distribution centers in poorer communities.
Let’s make scheduling a slot easy to do over the phone as well as through other means.
Let’s consider distributing patient navigators to help coordinate vaccine slots.
Setting all of this in place now will allow us to get as many shots in as many arms as possible as quickly as possible, with a focus on serving those most in need. True equality will only exist when the vaccine distribution becomes accessible to everyone, not just those who can navigate the rough terrain and unwieldy websites of our health care system.
Megan J. Shen, Ph.D., is an Assistant Professor of Psychology in Medicine at Weill Cornell Medical College in the Division of Geriatrics and Palliative Medicine, the Director of the Communications Core at the Cornell Center for Research on End-of-Life Care, and an alum of the Op-Ed Project. Follow her on Twitter: @MeganJShenPhD