Break all vaccine rules to end racial gap in cities
Among the steady stream of people exiting Stamford Hospital Friday night with fresh COVID vaccines in their arms, most of them white, a 71-year-old immigrant from Trinidad named Odette counted herself as fortunate.
She especially wanted the vaccine because of her asthma and another condition. “I did go online but nothing happened,” she told me. So she called her doctor, who pulled some strings and within a day — probably due to cancellations in the dusting of snow — she had an appointment.
Odette, who lives near the hospital, disagrees with the notion that other Black people don’t want the inoculation. “Most of the people I know, know that they need to get it,” she said.
Still, there’s a disconnect. Somehow, a disconnect.
We don’t know how big the gap is between white vaccine-seekers and people of color sitting for the injection. Data that appears to show that Black people were less than half as likely to have been vaccinated as white people between Dec. 14 and Feb. 3 is most likely being incorrectly interpreted by political leaders — including Gov. Ned Lamont and Sen. Richard Blumenthal — and by the media.
The probable gap shrinks if we look carefully at those numbers released by the the state Department of Public Health, which correctly warned of the data problem.
And yet, there’s a gap, another racial inequity in the health care system. The bad news is, it’s part of a centuries-old pattern. The good news: It’s an easy fix because we’re talking about a free pair of shots, not the big cahuna of equal access to all health care.
The state over the last two weeks has moved in with more outreach — Lamont hired a well regarded, outside consultant Friday — and, as of Monday, launched a plan to hold providers accountable with benchmarks for vaccinating people of color in cities.
Racial equity was one reason why Lamont on Monday switched strategies and went with age as the determining factor of who goes next, rather than letting front-line workers and people with medical conditions have the next round. The simpler system will serve more people faster, he reasoned. Who wants to fight over medical conditions and job status?
And the benchmarks will aim to make sure vaccinated people of all races not only receive equal opportunities, but equal numbers of shots in proportion to their numbers.
Critics say Lamont got it dead wrong. Many of the people with conditions making COVID-19 deadly, such as hypertension and obesity, and many of the front-line workers driving buses and checking out groceries, are Black and brown. Some of them will now wait longer.
How to make it right
Whichever side is correct, the state is tackling vaccine racial equity with aggressive outreach, allocation of doses and those benchmark goals.
But it isn’t enough. Lamont & Co. must now take a radical step to get it right: Forget the benchmarks, forget the order of vaccinations in the cities, forget the complex VAMS online registration system panned by advocates such as Amos Smith, CEO of the Community Action Agency of New Haven, an anti-poverty group.
Here’s how to do it: In the five or six poorest cities with the highest percentage of people of color, any resident should be allowed to get a vaccine on-demand through a separate, dedicated track, a separate flow of doses to providers with no other clients, no other mission at those locations.
Any age. Any job. Any immigration status. Any medical condition. Any race. Instant registration. Simple and straightforward. You live in one of those cities, you go to the front of the line with a phone call. Period. Not an online registration in a federal system designed by bureaucrats. Not a weeks-long waiting period.
We combine that with the outreach from churches, community centers, clinics and agencies like Smith’s — and we don’t solve the problem, we end it.
Is this fair? Not really. There are equally needy and worthy vaccine hopefuls outside of those cities. Is it equitable? Certainly not. It would give special treatment, not equal treatment, to a targeted group.
And with vaccines having such a short shelf life, the urban-on-demand inoculations would require a courier system to shuttle doses quickly to where people were waiting with rolled-up sleeves.
Still, it would, for this one exercise, send a message that the most vulnerable population is the priority.
‘What health equity means’
In looking at this racial gap, I watched and listened as Blumenthal heard from health providers and community activists at an online forum Friday, then followed him and Lt. Gov. Susan Bysiewicz to a vaccine clinic at a magnet school in downtown Waterbury.
Smith was easily the most powerful voice of the day.
“I thought that this would have been an opportunity for us to really demonstrate health equity,” he said to Blumenthal.
One of his points: Requiring people in socially vulnerable neighborhoods to sign up using either the clunky online VAMS system or a time-consuming phone system, doesn’t work. Another point: That same system allowed people from rich Fairfield County towns to grab the clinic reservations in Fair Haven and elsewhere.
Another point: The well documented hesitancy by Black people to take the vaccine — “I was as hesitant as anyone else,” he said, but he did reserve a shot — was taken as a reason for the health care system to pull back on its aggressive outreach. That one might not be fair and accurate, but it’s part of Smith’s cohesive view.
“We have to think about what health equity means and how it actually shows up. And right now, we’ve missed an excellent opportunity for us to begin to demonstrate that Black and brown people can be served along with everyone else using that process,” he said at the forum. “But it has to be more than one track to do it. The track that we instituted in this state was a track that benefited people who were familiar with technology, who had access to technology.”
He suggested to me later that the urban clinics should have been allowed to give vaccines to all of their regular clients, not just older people. “If we’re going to change the policies related to health equity, we have to look at it in real time,” Smith said.
Walk-in clinics are coming
Bethany Kieley, operations chief at the Cornell Scott-Hill Health Center in New Haven, told Blumenthal, “In some ways we are victims of our own testing success.”
That is, the clinic’s COVID testing attracted people from outside the city. “We saw that as a good thing,” Kieley said, “for them to have maybe a different perception of what it means to visit a federally qualified health center. But those people are now coming back to us looking for vaccines.”
And so the clinic is trying to serve its base. One idea: No VAMS system for them, it’s all done through their own call center. “We’re also figuring out how we can do, actually, walk-in vaccination,” Kieley said.
Walk-in vaccination, without appointments, proved a disaster in places like Florida, where people waited for hours only to be turned away, and where many people who were not in target groups received vaccinations. Still, it can work in Connecticut, especially for targeted groups of local residents, as the number of doses rises.
At the state Department of Public Health, spokeswoman Maura Fitzgerald said the town of Vernon did a walk-up vaccination clinic and the health departments in Bridgeport and New Haven have tried versions of it.
“We’re doing a lot but there’s always room for improvement,” Fitzgerald said of state and local efforts at outreach. “The essential fact that Blacks and Latinos are being vaccinated at a lower rate than whites is true.”
Calculating the gap
We know the gap exists from the stories about Black and brown nursing home workers who took the vaccine at much lower rates than their white colleagues. We know it from totals of people vaccinated in Bridgeport, Hartford, Waterbury and New Haven, compared with richer, much whiter towns. We know it just by watching who’s coming in and out of clinics, unscientific as that is.
But how big is the gap? State data showed that among 224,000 doses given to people of recorded races in Connecticut as of Feb. 3, 83 percent went to white patients and only 5 percent to Black patients and 7.7 percent to Latinos.
That seems convincing, but first of all, we don’t know the racial makeup of the whole eligible population including health care workers. And second, half again as many vaccines, about 110,000, were given to people with no race recorded, or in some cases, “multiple races” — making the data mathematically useless.
It was the same for the 119,881 people 75 and over who were vaccinated: The data, where race was recorded, showed that 30 percent of whites and only 13 percent of Black people in those age groups were vaccinated. (Thanks to The CT Mirror for pointing out that the state was using 2010 census data instead of 2019 estimates, an error that showed a smaller gap.)
But race was not shown for fully one-third of the 75-plus population. In order to believe the 2-to-1 vaccination rate, we need to assume that 92 percent of those 42,000 old people of unknown race were white. That might be a stretch.
Now get this: If 75 percent of those elderly people of no known race were white, instead of 92 percent, then, in that scenario, 43 percent of white people, 38 percent of Black people and 45 percent of Latinos were vaccinated. The big shift works mathematically because the numbers of Black and Latino people 75 and older are so small.
Fancy calculations aside, we know there’s a gap. Considering we failed to get it right the first time, the best remedy now is to blow it away with different rules, not to tinker. If Black and Latino people in cities end up with an unequal benefit, well then, at best they’ll gain a few months’ advantage with one vaccine, which will be easily available to anyone by this summer.
If you think that’s unfair, Amos Smith would be happy to help you with some history lessons.