NM lags in vaccinating vulnerable
State trying to improve immunization equity
New Mexico leads the nation in overall COVID-19 vaccine distribution, but according to the Centers for Disease Control and Prevention, the state fell short in vaccinating some of its most vulnerable residents during the initial rollout.
In a report published late last month, the CDC ranked New Mexico 37th-lowest among 48 states in vaccine coverage for residents living in counties with “high vulnerability,” which is based on residents’ socioeconomic status and factors such as household composition, education and the number of people 65 and older.
The CDC reported that the majority of states, including New Mexico, needed to step up efforts to achieve equity in vaccination coverage for those who have been most affected by COVID-19.
“Improving COVID-19 vaccination coverage in communities with high proportions of racial/ethnic minority groups and persons who are economically and socially margin
alized is critical because these populations have been disproportionately affected by COVID-19–related morbidity and mortality,” the CDC said.
In New Mexico, Cibola and Luna counties top the list of counties with the highest overall Social Vulnerability Index scores, with McKinley, San Juan and Doña Ana counties rounding out the top five spots, according to a March 24 report by the New Mexico Community Data Collaborative at the Center for Health Innovation.
As a subset, Bernalillo, Cibola,
Curry, Luna and McKinley counties each have one or more areas with overall high SVI scores.
Nationally, Arizona, Alaska and Montana topped the CDC list when it came to achieving higher vaccination coverage in high-vulnerability counties. That compares with New Mexico, where vaccines disproportionately went to moderately vulnerable residents instead of those at higher risk.
The CDC report said states that achieved equitable coverage took steps early to reach out to underserved communities, and some offered free transportation to vaccination sites. “Ensuring equitable COVID-19 vaccine access is a priority for the U.S. COVID-19 vaccination program,” the CDC wrote. “Nationwide, vaccination coverage was lower in high vulnerability counties.”
The report reflects vaccinations given from Dec. 14 to March 1 in all states except Hawaii and Delaware.
DOH spokesman David Morgan told the Journal on Friday, “New Mexico has been making steadfast progress in vaccinating our most vulnerable communities.”
State Health Secretary Dr. Tracie Collins said her team “is very committed to equity.”
“So our lens for addressing how we get the word out about the vaccine is through an equity lens,” Collins said during an online discussion with the American Medical Association in late January.
Social vulnerability
First developed in 2011 to guide hazardous event response, the CDC index considers 15 indicators to assess socially vulnerable populations.
The indicators include poverty, unemployment, income, lack of a high school diploma, the number of those 65 and older, those ages 17 and younger, single parent households, crowded housing, and lack of access to transportation.
In its report on COVID-19 vaccinations, the CDC noted that some disparities may be rooted in vaccine hesitancy or in the priorities states gave various groups for vaccinations.
For instance, New Mexico put people 75 and older into a high priority group when the vaccine rollout began. But unlike most other states, the state was slow to lower that minimum age to 65 years old. New Mexico didn’t open vaccinations for those 60 to 74 as an age group until two weeks ago.
Beginning Monday, all adults in New Mexico will be eligible for vaccinations.
The state also created an online centralized registration system to schedule vaccinations, requiring eligible registrants to wait for the state to give them a vaccination appointment through a randomized system.
As of Thursday, New Mexico had the nation’s 14th-highest COVID-19 death rate, with 188 fatalities per 100,000 population. Among nearby states, Arizona had 233 deaths per 100,000, Texas had 167, Oklahoma had 125, Colorado had 107 and Utah had 66.
But New Mexico has led the nation in the percentage of population that has received at least one dose. Fifty percent of New Mexicans had been at least partly vaccinated as of Saturday, with more than 30 percent fully vaccinated.
Vaccine equity plan
Department of Health officials announced a “vaccine equity plan” in late February. The plan includes considering the CDC’s social vulnerability index and rates of positive cases in its vaccine allocation system.
The state’s vaccine equity plan also calls for the DOH to develop alternate ways for people to register for a vaccine, and permit walk-in or locally scheduled clinics, and mobile vaccination teams.
The DOH also said the state would monitor vaccine coverage with reference to the social vulnerability index and COVID-19 outbreaks.
Collins told a state Senate committee in mid-February that she was aware of the low vaccination rate of minority populations in New Mexico and said, “one of the issues ... the initial rollout did not address equity appropriately.” She didn’t elaborate. DOH spokesman Matt Bieber said in an Instagram update in February, “What changed over time was that in some places, some providers were more aggressive about distributing vaccine, filling up their schedules, getting folks in the door, getting shots in arms, and where providers were a little bit more aggressive, we then sent more vaccine.”
Morgan told the Journal that DOH has made strides in getting vaccines to minority populations and the underserved.
For example, he said, the state held an event to reach out to New Mexico’s African American population and an additional 1,044 African Americans registered online to receive a vaccine.
“Similarly, after our town hall meeting (in Spanish) to specifically address questions from Hispanics, an additional 23,652 Hispanics registered for the vac
cine,” he said.
Another example: The border community of Columbus, which has the second-highest SVI among 265 New Mexico communities (for which there is SVI data), has a relatively high vaccination rate of 74%; as of March 30, 760 of 1,031 residents 16 and older have had at least one shot, Morgan said.
Doña Ana County
Doña Ana County, which is about 68 percent Hispanic and the second-most populous county in the state, had the fourth-lowest percentage of residents vaccinated of any of the state’s 33 counties one month ago.
The county has been hit hard by the virus. It has had the second-highest number of COVID-19 cases, 24,089, and deaths, 421.
The issue of equitable distribution arose when the Las Cruces City Council in mid-March approved a resolution calling on the state to send more vaccine to the city and Doña Ana County.
“The region remains in the highest risk level in the state’s framework (for reopening), yet Doña Ana County has received proportionally fewer vaccines than all but a few counties in New Mexico,” the resolution said.
Bieber of the DOH was quoted as saying, “In Doña Ana, some of the providers (of vaccines) were a little less aggressive than in other places in the beginning. It’s not to place blame at all. It’s just to name a fact. As a result, in these early days, DOH did send more vaccine to other places.
Collins and her DOH equity task force have since pushed additional vaccines to the county, so as of Friday, Doña Ana County had moved up to 16th place, with 39 percent of its residents at least partly vaccinated, surpassing even Bernalillo County, which had nearly 38 percent receiving at least one dose, according to the state vaccine dashboard. The percentages don’t reflect vaccines distributed by federal agencies.
Meanwhile, Bernalillo County includes ZIP codes that consistently rank in the top 10 for new positive COVID-19 cases each day.
For instance, in the 87121 ZIP code in Southwest Albuquerque, where 20 percent of residents live below the poverty line, more than 10,000 cases have been reported — the highest of any ZIP code in the state.
Collins said at a recent update on vaccine distribution that the DOH planned to “drill down” to reach out to residents in certain ZIP codes as part of its equity program.
Federal assist
To address equity, the Biden administration launched a health center vaccine program in February to directly allocate COVID-19 vaccine to federally supported health centers. That’s a departure from the norm, in which shipments are sent to the states to allocate to providers.
The program seeks to accelerate delivery of vaccines to medically underserved communities and disproportionately affected populations.
Of the 16 federally qualified health centers in New Mexico invited to participate, only four are enrolled, but more may join this month, said Scott Kodish, a spokesman for the federal Health Resources & Services Administration.
The participating clinics are Clínica de Familia Inc. in Las Cruces, Southwest C.A.R.E. Center in Santa Fe, Las Clínicas Del Norte Inc. in El Rito, and the Ben Archer Health Center Inc. in Hatch.
At the Ben Archer clinic, which is receiving both state and federally directed vaccines, about 130 people, including farmworkers, received at least one dose in late March.
“As soon as the state allowed essential workers, they were here,” one clinic staff member said. “They wanted to be vaccinated.”