Vaccine rollout draws praise — and equity concerns
For weeks, Connecticut’s COVID-19 vaccine rollout has been lauded for its speed, with praise for Gov. Ned Lamont and his administration coming from as high as the White House’s senior coronavirus adviser.
And while Connecticut continues to lead in the overall percent of people who have been vaccinated, health officials and advocates say the state’s rollout to date has largely failed its residents of color.
Last week, the state Department of Public Health released data that showed that white residents are significantly more likely to have been vaccinated than Black residents. That’s despite the reality that
Black and Latino residents are at notably greater risk of contracting and dying of COVID-19.
And when it comes to the question of whether the vaccine rollout has been equitable, “the answer’s in the data,” said Dr. Reginald Eadie, the president of Trinity Health of New England and the co-chair of the governor’s COVID-19 vaccine advisory group.
“Right now, what we’re doing is great for the television and for health care systems to bang on their chest saying, ‘We’ve done a lot,’ ” Eadie said. “But the data doesn’t show that you’ve done much at all for the populations that really need it.”
Vaccination disparities have
been seen in states across the country, and public debate has revolved around both hesitancy and access. But Connecticut health officials say the most significant driver of disparity is not public perception, but public access.
High stakes
In early February, the state Department of Public Health released data showing that Black residents are significantly less likely to have already been vaccinated than are white residents.
Among those 75 and older — an age group that has been eligible for the coronavirus vaccine since January — about 31% of white residents had already received the vaccine, compared with only 19% of Black residents. In the same age group, about 35% of Hispanic residents had received the vaccine. Overall, about 60% of the total distributed doses had gone to white residents — and only 2% each had gone to Black residents and Hispanic residents.
The data had some limitations and gaps, but health officials said the overall message was clear: The vaccine rollout has served white residents better than it has served Black residents.
“So far in Connecticut, we have a lot to be proud of. Connecticut ranks as one of the best states for getting the vaccine into the arms of people as quickly as possible,” said U.S. Sen. Chris Murphy at a roundtable he hosted Tuesday. “But when you break it down by race, the numbers aren’t as good.”
The past year of the pandemic has made evident the stakes of vaccination. Without a vaccine, people will fall ill with COVID19. Some of those people will end up in the hospital. Some of them will die. So far, Connecticut has seen more than 7,500 coronavirus-linked deaths.
And while that’s true for any unvaccinated community, the danger is even more acute for communities of color, which are already at higher risk of contracting and dying from COVID-19.
The Courant reported over the summer that Black and Hispanic residents are three times as likely to have tested positive for COVID19, and between 1 ½ and 2 ½ times more likely to have died from the illness. There are many reasons for this, including pre-existing health disparities and an increased likelihood that Black and Latino residents work in frontline jobs and live in densely populated areas.
Unvaccinated communities are not only at risk themselves. Eadie noted that, unless the entire population reaches herd immunity, the coronavirus will continue to circulate — and to mutate. If that were to happen, the virus would continue to threaten everyone.
“You can’t leave one single community behind unless we’re all going to be living — because of mutations — in this current pandemic for much longer than we’re doing or anticipating doing so far,” Eadie said.
‘It’s not hesitancy. It’s access.’
Since the promise of a coronavirus vaccine first appeared on the horizon, medical experts and community leaders have warned of likely skepticism among people of color, particularly Black people.
American medical institutions are rife with examples of racist treatment, including everything from physicians not believing Black patients’ symptoms to researchers using Black people as medical experiments without their consent or knowledge.
Connecticut health officials say that hesitancy was, and is, a real issue in some communities. A December poll from the Kaiser Family Foundation COVID-19 Vaccine Monitor found that Black adults were somewhat less likely than the overall population to say they’d take the vaccine, with about a third saying they wouldn’t. Locally, the Yale New Haven Health system said that only about 40% of its Black employees have been vaccinated, compared with about 70% overall, although the vaccine has been available to them for weeks now.
But right now, the problem of hesitancy is less significant than the issue of access, according to health officials who spoke at Tuesday’s roundtable on equity.
“It’s not hesitancy. It’s access,” said Tiffany Donelson, the president of the Connecticut Health Foundation.
With vaccination rates among Black residents still low, the state has not vaccinated all of the eligible Black residents who would like to be vaccinated. The barriers that those residents are facing must be brought down in order to increase vaccination rates.
Health officials have also noted that hesitancy tends to fade as general vaccination rates increase — when hesitant residents see that their friends and neighbors have been vaccinated, they’re more likely to take the leap themselves, too.
“What’s most troubling is this assertion that ... the low vaccination rates in communities of color is based solely on hesitancy. That is completely not true,” said Nichelle Mullins, the president of Hartford’s Charter Oak Health Center and the co-chair of the state vaccine advisory group’s Allocations Subcommittee.
Placing the blame on hesitancy obscures the larger systemic barriers, Mullins said.
“We have to open the lines ... so that anyone who wants to be vaccinated can be vaccinated. That’s essential, and it’s necessary,” Mullins said. “And then we can determine whether or not hesitancy is a true factor that is contributing to the low vaccination rates.”
At a Tuesday press briefing, Lamont was asked if he views hesitancy as the primary factor in the vaccination disparities.
“I think that’s a big part of it. I mean, we’ve tried to prioritize underserved populations from the very beginning and ... there was some pushback and there was some questions about, ‘Maybe I’d like to wait,’ ” Lamont said. “But look, I’m not letting our team off the hook. We can continue to always try and do better.”
‘That leaves a lot of people out’
Connecticut ranks in the top handful of states for the quickest vaccine rollout, and last week was tied for fourth place in per capita vaccinations. Alongside North Dakota and West Virginia, Connecticut has so far vaccinated 16% of its overall population, which is a handful of points behind frontrunners Alaska, New Mexico and South Dakota.
Connecticut has achieved that remarkable task in part through mass vaccination sites, which can churn out shots by the thousands.
The state’s largest vaccination site, near East Hartford’s Rentschler Field, could administer 1,000 doses per day when it first opened, and has ramped up even more since then. Hartford HealthCare opened a mass vaccination site in the Connecticut Convention Center’s parking garage, and has plans to open five more mass sites in the coming weeks.
Mass sites can rapidly boost the state’s overall vaccination numbers. But officials, including Hartford Mayor Luke Bronin, say mass sites also miss some of the most vulnerable residents. It’s a tradeoff, he said, between efficiency and effectiveness.
“It’s real efficient to have a big vaccination center where everyone can drive through, get the shot, sit in a car in 15 minutes. But ... that leaves a lot of people out,” Bronin said at Tuesday’s roundtable. “It’s less efficient — but far more effective — to bring the clinic to an apartment building, set up in the lobby and knock on the doors and say, ‘Hey, come on down. We’re here.’ ”
Not only are large drivethru sites inaccessible to people without cars, officials at Tuesday’s roundtable noted that the state’s vaccine registration systems require technology, which excludes people who don’t have computers or smart phones, and some of the registration systems are only available in English, which excludes people who don’t speak English.
On a more fundamental level, Connecticut’s system relies on residents to first know when they become eligible for the vaccine and then to sign themselves up for their appointments.
That system automatically favors the most aggressive, most in-the-know residents, according to Dr. Mark Silvestri, chief medical officer at New Haven’s Cornell Scott-Hill Health Center.
“At the beginning of each phase, the people who have the most access are those who know how to navigate the system the best,” Silvestri said.
Donelson, the president of the Connecticut Health Foundation, said the key to reducing disparities is making the process easy for the residents, even if that makes it harder for the vaccine providers.
“The main thing I would say is meet people where they are ... with the resources that they need to get access to the vaccine,” she said.
The state has made some efforts to lower those access barriers for residents of color, including holding mobile clinics and setting up sites at churches. Lamont on Tuesday received his first shot of the vaccine at First Cathedral Church in Bloomfield, while encouraging others to do the same.
Josh Geballe, the state’s chief operating officer, said on a Tuesday press briefing that the state is also making sure that community health centers and mobile clinics, both of which typically serve the communities of color in cities, have all of the vaccine doses that they need.
“We’re going to keep pushing hard, and if that sacrifices a little bit on speed, we’ve already decided that we are going to make those tradeoffs, and have made those tradeoffs, and still are able to execute very well,” Geballe said.
But the numbers, still, show disparities.
“We’ve got to do better,” Lamont told The Courant last week. “We have more work to do.”