With early Philadelphia vaccination dates showing racial differences, executives from Penn Medicine, Mercy Catholic Medical Center, and the community have opened three clinics in a church, high school, and recreation center in mostly black neighborhoods.
The sheer number of patients vaccinated at these clinics – at least 3,800 – belittled concerns about vaccine reluctance in people of color, said Nida Al-Ramahi, an administrative assistant for Penn Medicine who co-authored a commentary on NEJM Catalyst's clinics.
Some vaccine recipients told the team, "If you hadn't been here, I would not have gotten the vaccine."
"The demand is there," she said. "We think it's more of an access issue than that people just aren't interested in getting the vaccine."
The clinics owe their success in part to a "no / low-tech" approach that used automated text messages and phone calls to schedule appointments rather than a website (a 102-year-old was able to sign up, Al-Ramahi said) ; The location of these clinics is close to where you live. and partnerships with grassroots organizations and religious leaders.
Some vaccine recipients have told the team, "Had you not been here, I would not have gotten the vaccine," said Al-Ramahi. Many have also said in patient satisfaction surveys, "I feel dignified."
"This can mean different things to people, but repeating this phrase shared with us by people we vaccinated is important," she said. Part of this, she added, could be because "we are prioritizing and realizing that access to vaccines is necessary and unequal".
Hesitation is decreasing, but structural barriers remain
The Philly-focused effort is one of many vaccine justice initiatives across the country aimed at increasing vaccination rates in people of color – who were vaccinated at lower rates despite being disproportionately affected by the coronavirus.
Recent polls suggest that hesitation about vaccines has decreased across the US. Black Americans – an early health professional publicity target due to historical medical experimentation and racial inequality that persists today – are showing the greatest surge in vaccination enthusiasm. Republicans and white evangelicals are the groups most likely to say they will not be vaccinated, according to recent KFF polls.
"We're talking about black communities hesitating, but I think they have a healthy amount of skepticism about a system that historically has mistreated them."
"We talk about black communities hesitating, but I think they have a healthy amount of skepticism about a system that has historically mistreated them to date," said Melody Goodman, associate dean for research and associate professor of biostatistics at the NYU School of Global Public Health, which studies health differences.
Yet, according to a recent analysis by KFF, Black and Hispanic Americans in all states continue to receive lower levels of vaccination compared to their exposure to COVID-19 cases and deaths, as well as their proportion of the population. As of April 19, the percentage of whites in 43 states who had received at least one dose of vaccine was 1.6 times higher than the corresponding percentage of blacks and Hispanic Americans.
A longstanding series of underlying structural inequalities has likely resulted in increased barriers to vaccine access for people of color and underserved groups.
While survey data suggest high levels of vaccination readiness across races and ethnic groups, and shows that willingness has increased over time, longstanding structural inequalities have likely raised barriers to vaccine access for people of color and underserved. said Samantha Artiga, the director of the KFF's Racial Justice and Health Policy Program.
A recent Morning Consult survey of 30,000 US adults found, among other things, that white adults who wanted to be vaccinated were more likely to report their shots than their similarly willing black and Hispanic counterparts, even when they control income – which suggests that “vaccine access is at least as problematic as the hesitation of vaccine. "
Early vaccination efforts focused on combating hesitation, "somewhat detrimental" in removing structural barriers that until recently had not been so apparent, said Georges Benjamin, executive director of the American Public Health Association.
With that in mind, "There are still concerns and we need to work to ensure (people) are vaccine-safe," he added.
Barriers to access to the vaccine
Barriers to vaccine access include restricted access to technological resources for navigating online planning systems. less flexibility in work and care plans in order to search for appointments or to be able to take appointments; limited transportation, which limits the area of viable vaccination sites; and possible language barriers, said Artiga.
People of color are uninsured at higher rates, she added, which means they may be more likely to have concerns about the cost of the vaccine if they don't know it's available for free. This can be especially confusing as some vaccine providers request insurance information in order to bill insurance providers for administrative costs. However, you are not allowed to charge a patient out of pocket or refuse the vaccination due to the coverage status.
Barriers to vaccine access include restricted access to technological resources for navigating online planning systems. less flexibility in work and care plans.
Households with a family member with an immigrant background may wonder if they are eligible to receive the vaccine (they are), fear of possible implications for their immigration status, or face challenges in providing proof of identification or residence requested by vaccination centers Artiga added.
It will be difficult to determine the real barriers to entry for marginalized people until COVID-19 vaccines are freely available and supplies are no longer a constraint, Goodman said. Although every state has now extended vaccination eligibility to all adults under President Biden's April 19 goal, she said it was too early to know.
"Right now, availability is the main barrier – and it affects all populations, although some have better access when things are tight," Goodman said. "But I think that's changing."
Efforts at the federal, state, and local levels
The Biden administration has launched a COVID-19 Health Justice Task Force, established state-run community vaccination centers in areas disproportionately affected by the virus, dispatched hundreds of mobile clinics, and sent cans to local pharmacies and community health centers that are disproportionately high the population is in need of protection. "
According to a recent KFF analysis, colored people made up the majority of recipients of coronavirus vaccines in community health centers between January and April, and health centers appear to reach colored people at higher levels than broader vaccination efforts – "which indicates their long-standing role in these communities," said Artiga.
People from more affluent, predominantly white neighborhoods snapped up vaccination appointments in low-income minority communities affected by the pandemic.
The government also announced last month it would spend nearly $ 10 billion on efforts to strengthen access and vaccination confidence in underserved communities, largely funded by the US $ 1.9 trillion rescue plan.
In the meantime, pharmacy chains have teamed up with hail shipping companies (Walgreens)
with more than
;; CVS health
) to facilitate fair transport access for vaccinations.
Some states have also tried to tackle racial inequality in vaccination through strategies like allocating extra doses of vaccine to hard-hit areas, setting up hotlines for scheduling appointments, and locating clinics in underserved communities, a KFF review shows.
"What we see in terms of successful efforts is that local organizations based in the community really guide the vaccination effort because they can tailor it to meet the needs and preferences of the populations they serve, ”added Artiga added.
Not all efforts to ensure equitable vaccination have proven successful: reports from the first few months of the country's mass vaccination campaign suggested, for example, that people from more affluent, predominantly white neighborhoods have taken vaccination appointments in low-income and minority communities due to the pandemic.
The Philadelphia team wanted to address this possibility by asking prospective attendees to acknowledge that the clinic should “eliminate the tremendous racial inequality in COVID outcomes and vaccine distribution by affecting ours from West & Southwest Philly * Black and Brown * Communities Vaccinate COVID "and provide a list of postcodes targeted.
About 36% of people stopped trying to sign up after it was announced, the researchers said.
Build trust in communities
After discovering that not many minority residents were vaccinated at an on-campus mass vaccination site, Ohio State University's Wexner Medical Center officials quickly set up a second location at a hospital in an underserved area, said Beth NeCamp, the center's executive director of community and community engagement and co-leader of the Ohio State Vaccine Differences Working Group.
While the campus remained open to everyone in Ohio, appointments at a new location were reserved for people with underserved zip codes.
While the campus remained open to everyone in Ohio, appointments at the new location were reserved for people with underserved zip codes. "So you didn't fight the whole city to get it," added NeCamp. "We tried to get the vaccine to the people who had the most difficult time getting access to the vaccine," she said.
To help tackle the time, digital literacy, and language barriers often associated with online planning, the NeCamp Group also launched a program encouraging community organizations to enroll their customers or members for vaccination lots, with your team adds the information of the employees "in the backend". “So-called patient navigators help meet needs such as transportation and interpreting.
"We really believe that this type of additional navigation service, as well as the simplified login service, really helps us get more of the hard-to-reach," said NeCamp.
Maryland's Vaccine Equity Task Force, led by the Maryland National Guard Brig. Gen. Janeen Birckhead, works with local health departments and handles requests from community and faith based organizations to move clinics and mobile vaccination units to places of greatest need.
The task force identifies vulnerable communities based on variables such as age, income, unemployment, educational level and minority composition. Birckhead added that his efforts benefit blacks and Hispanics, as well as other underserved populations, including poultry workers and rural residents.
"I hope that during times like this we will build trust in the churches and that no one will be left behind," she said.
Also read: Dr. James Hildreth: Here's how to increase people's confidence in vaccines