Vaccine Equity for People of Color Should Be a Priority in California
Written By: Public Health Advocates for Anti-Racism in COVID-19 Response
This article was originally published in The San Francisco Chronicle on March 3, 2021.
Health care workers line up to get a COVID-19 vaccine at a Vaccination Super Station which opened at Tailgate Park, providing large-scale COVID-19 vaccinations to San Diego’s health care community on on Jan. 11 in San DiegoPhoto: K.C. Alfred / San Diego Union-Tribune / TNS
COVID-19 has disproportionately affected people of color in case rates, hospitalizations and deaths. Despite this, people of color are getting vaccinated at significantly lower rates. Structural racism and COVID-19 are, together, creating a syndemic for Blacks, Latinos and Native Americans. On top of that is a justifiable lack of trust among the communities most at risk stemming from racist practices and policies in our public health and health care delivery systems.
As a group of UC Berkeley School of Public Health students, faculty, and alumni committed to the goals of antiracism in COVID-19 Response, we advocate a more concerted focus on race and ethnicity in California’s COVID-19 vaccine efforts.
As we enter the second year of the COVID-19 pandemic, we are in the fortunate position of being able to allocate several safe and astoundingly effective vaccines. More vaccines are likely to be approved this spring. With supplies increasing, vaccination rates are also on the rise. The Golden State now has a “golden” opportunity to become a leader in reducing racial disparities in vaccination. The California Department of Public Health recently released its plan for vaccine equity, which relies on three pillars:
- Allocation of 20% of the vaccine supply for underserved communities in California;
- Use of a “Pay-For-Performance” system that rewards providers who meet state vaccine equity targets;
- Creation of a centralized data platform that provides daily information about the location of vaccines in the state and who is getting vaccinated.
In its shift to an age-based system of allocating vaccines, many people are not aware of the state’s continued emphasis on equity. By creating a centralized vaccine database, anyone in California will be able to determine whether the state is meeting its equity goals. This accountability demonstrates the state’s commitment to equity; there is no equity without data to back it up.
The early process for getting a vaccination appointment generated frustration and confusion. The state has addressed this by creating the My Turn website, where Californians can either make an appointment, if currently eligible, or register to be notified about future eligibility. The website also includes this number, 833-422-4255, so those without internet access can make appointments or register. We applaud the state for these initiatives and are eager to hear more details about the state’s equity efforts.
State and county health departments are using the California Healthy Places Index (HPI) to identify census tracts with the highest COVID-19 vulnerability. However, the state has yet to share details of how the 20% allocation of vaccines received will be distributed. We recommend that the state report vaccination outcomes by race and ethnicity within these HPI priority tracts in order to demonstrate what “health equity” means in practice. Similarly, the state has not shared how the pay-for-performance program, designed to incentivize providers who meet vaccine equity goals, is structured. Absent public transparency into how these incentive payments will work, we cannot evaluate their alignment with equity goals of reaching Black, Latino, Native and API populations.
In addition, no amount of supply-side planning can substitute for outreach. The goal of outreach should be to provide accurate, credible information about vaccines and vaccination so that people who are vulnerable to COVID-19 can make informed decisions about vaccination. Such information is more likely to reach those most vulnerable to COVID-19 if it comes from already trusted community leaders. While California has entrusted Blue Shield with its vaccine plan, traditional health care providers have not closed racial disparities and, alone, are unlikely to close this one.
California should integrate federally qualified health centers (FQHCs) into its plan. These centers exist to serve those who have the least reliable access to health care, and the Biden administration is providing vaccines directly to these centers. FQHCs are natural partners in addressing COVID-19 vaccine disparities. Along with faith-based organizations and community health workers, already noted as partners in the state’s plan, FQHCs should be integrated into the state’s outreach and vaccine delivery plans.
The trend lines for infection continue to reflect long-standing inequities in health and health care. Acknowledging that disease burden reflects unfairness in social structures is a first step toward systemic change. Vaccine distribution systems that successfully account for and mitigate structural health injustices could be a model for similar accounting and restoration in health care access and quality.
By providing vaccines to the hardest hit communities, paying providers for reaching those suffering from the syndemic, tracking state progress, and creating robust outreach, California could begin to rewrite the story around COVID-19 vaccine equity.
Written By: Public Health Advocates for Anti-Racism in COVID-19 Response
Group Members and Affiliations: Ben Delikat, MBA/MPH Program, UC Berkeley School of Public Health; Amy Garlin, M.D., associate clinical professor, UC Berkeley School of Public Health; Ann Keller, Ph.D., associate professor, UC Berkeley School of Public Health; Rev. Dr. Clyde W. Oden, Jr., OD, MPH, The Manna Group, LLC, and UC Berkeley alumnus; Sarah Anne Reynolds, Ph.D., researcher, UC Berkeley School of Public Health; Stephen Shortell, Ph.D., MPH, MBA, distinguished professor & dean emeritus, UC Berkeley School of Public Health; May Simpson, chair of the Berkeley City Community Health Commission; UC Berkeley alumna.