Racial inequities in COVID-19 vaccination show up again

PHILADELPHIA — The Black Doctors Consortium was among the first in the city to offer newly approved COVID shots for young children in June, setting up clinics at its health center in a mostly Black neighborhood in North Philadelphia.

Despite the neighborhood’s demographics, most of the 100 families that showed up were white. When it comes to children’s vaccinations in Philadelphia, that’s not uncommon.

More than a year and a half since COVID vaccines became available, ensuring equitable access to all Philadelphians, regardless of race or income, remains a challenge. The demographics for vaccinations among children under 5 have not yet been collected, but among 5- to 11-year-olds, who have been eligible since last fall, about 37% of Philadelphia’s white children are fully vaccinated, compared with 25% of Hispanic children and 22% of Black children. Vaccination rates among Asian children are much higher than the rest in that age group: 57%.

White and Asian Philadelphians are more likely to have received booster doses, too, with 38% of white city dwellers and 48% of Asian residents having received additional shots. Just more than a quarter of Black and Hispanic Philadelphians have received a booster.

Staff at the consortium emphasized that getting any child vaccinated was a win, but echo other experts who say that as the focus on COVID has waned, old inequities are reasserting themselves.

“We’ve done our best effort to try to help fill in that gap,” said Jabaris Swain, a doctor and one of the consortium’s medical directors. “I think the city and surrounding areas have much more ability to influence this than we do and I’m not sure I’m seeing that messaging coming across.”

Health care experts and providers in the city say there is less leadership from government officials on vaccination, particularly in the effort to get doses to children.

Officials from the Philadelphia Department of Public Health, though, see earlier, more visible approaches aimed at the general public as less effective now. The best way to reach families, they say, is through individual conversations with care providers.

“People who remain unvaccinated are unlikely to be convinced by ads or the simple existence of a vaccine clinic nearby,” said Matt Rankin, a spokesperson for the health department. “They need the opportunity for one-on-one conversation with a health care provider they are familiar with.”

Vaccination remains the most effective tool for preventing serious illness and death from COVID. Though children are far less likely to develop serious symptoms from COVID, they are able to spread it, posing a risk to vulnerable and elderly relatives. And the number of people younger than 18 killed by COVID in the United States, about 1,250 since the pandemic began, are comparable to deaths from measles and worse than those killed by flu or chicken pox.

“It is concerning that marginalized populations, particularly Blacks and Hispanics, aren’t coming out to be vaccinated,” Swain said.

But other obstacles hindering children’s vaccinations are similar to those that have plagued the vaccination effort throughout the pandemic. While doses for adults are relatively easy to find, doses for children younger than 5 are less readily available. Pharmacies are not allowed under current federal regulations to vaccinate children under 3, and large pharmacy chains require or recommend appointments for 3and 4-year-olds. Misinformation and fear of the vaccine remain a major factor.

“The conspiracy theories that are put out there in social media is the main stream of it,” said Cheryl Garfield, a community health worker with Penn Medicine, who said she still hears outlandish stories about the vaccine’s dangers from parents.

Rankin acknowledged that white and Asian residents have been quicker to get their children vaccinated, but noted that for children ages 5 to 11, doses are as easily available as for adults, so access doesn’t explain the disparity.

“We feel it’s like that mistrust of the health care community continues to play an essential role in early uptake of novel vaccinations,” Rankin said. “This has been found in survey after survey regarding uptake of adult vaccinations, and likely is influencing Black and Hispanic communities’ trust in the pediatric vaccines.”

Throughout the vaccination effort, the health department has tried to improve access and trust through measures such as offering the first doses to people with high-risk conditions, door-to-door outreach and personal messages, vaccination events ranging from mass clinics to popups, and messaging campaigns that included television ads from Black and Hispanic health care workers.

This work has seen results. More than threefourths of Philadelphians 12 and older are fully vaccinated (meaning they’ve had the first two shots of the series, but not necessarily boosters), and vaccination rates among Hispanics have caught up to rates among white residents. Vaccination rates among Black residents still lag compared with those for white residents, but the gap has narrowed to about seven percentage points. That’s progress compared with a year ago, when white residents were vaccinated at a rate 15 percentage points greater than Hispanic residents and 18 percentage points greater than Black Philadelphians.

The adult vaccination effort “has almost been a full 180,” said Ala Stanford, the pediatric surgeon who founded the Black Doctors COVID-19 Consortium, and now leads the regional Department of Health and Human Services office.

Now, the health department is no longer hosting its own clinics, “though we may pivot at any time if need exceeds local capacity,” Rankin said. Instead, it is focusing on pairing community organizations with vaccine providers in the city.

“It is no longer effective to fully staff the amount of clinics we once did during the more critical times of the pandemic,” he said. “Most vaccinations at this point take place at pharmacies and at health provider locations like hospitals.”

The city still runs social media campaigns promoting vaccination, he said. But others say there’s a lack of leadership — especially regarding vaccines for children.

“There are not enough people still involved in pushing for residents to bring their children to get vaccinated,” said Quetcy Lozada, vice president of community engagement and organizing for Esperanza, a Hispanic community organization in the Hunting Park neighborhood.

The end of mandates, and reduced rates of infection and death have made the virus feel less urgent, she noted, though the virus has waned before only to surge again.

“As the city started to open up, and folks were able to come back to their places of work and their places of worship, and the mask mandates started to become less and less required, the sense of urgency I think also became a little bit relaxed,” she said.