Jackson’s new COVID vaccine policy is likely to favor the more affluent. Here’s why
Jackson Health is requiring those from 55 to 64 with certain medical conditions to get a doctor’s note for a COVID vaccine appointment, posing challenges for minority and low-income people.
Miami-Dade County’s public hospital scheduled its first COVID vaccine appointments for people 55 and over with certain medical conditions on Tuesday, but there is one major caveat: a physician needs to sign off before you get the shot.
That is likely to be especially difficult for South Florida’s low-income communities and will serve as a barrier for those with less access to healthcare, but who would potentially benefit even more from the vaccine, according to experts interviewed by the Miami Herald.
By enacting a policy this week requiring doctor’s notes to vaccinate those 55 to 65 who have one of 13 ‘at-risk’ medical conditions, the public hospital has solidified a tilted playing field where more affluent — and disproportionately white — people will have an advantage in accessing a public health resource, said
Zinzi Bailey, a University of Miami research professor who studies healthcare inequities.
The policy will disadvantage underserved communities without robust access to healthcare despite plentiful research showing that people in those same neighborhoods are more likely to have some of the medical conditions — such as obesity — that would put them at higher risk for severe COVID, and potentially death, Bailey added.
“A lot of the people who are most in need of the vaccine at the age of 55 and may have weathered things like discrimination over time and may actually have similar outcomes to those 65 and older are going to be missed if they do not have a regular doctor,” she said.
Asked about people who do not have access to a primary care physician, , Jackson CEO Carlos Migoya said Friday that anyone with one of the 13 conditions should be under a doctor’s care.
“If there is someone out there that has one of these 13 very high-risk conditions and doesn’t have a physician, then I would highly recommend that they go see a physician,” Migoya said.
Bailey said she routinely encounters people in Miami
for whom getting a doctor’s note is not a realistic option, especially with certain conditions, including one that would qualify them for the vaccine.
“Often times, we do health fairs and such and we find numerous people who have underlying hypertension or diabetes who are not currently seeing one regular doctor,” Bailey said.
The 13 conditions that require a doctor’s note by Jackson include breast cancer, congestive heart failure, leukemia, lung cancer and morbid obesity with a body mass index greater than 40. Diabetes is not listed as a qualifying condition, despite the U.S. Centers for Disease Control and Prevention listing both Type 1 and Type 2 diabetes as conditions that could put patients at risk of developing more severe COVID.
Hospital officials said on Tuesday that Jackson is “trying to strike a balance by creating a policy that’s not a burden on patients — like getting a full medical record — or relying solely on the honor system, which might make it harder for those with genuine medical conditions and a doctor’s advice.”
“We proposed this system to state officials and were told it was an acceptable approach,” the hospital said in a statement.
Adults of all ages with conditions that would put them at risk for severe COVID currently qualify to receive the vaccine under
an order from Gov. Ron DeSantis, but they have had a hard time finding appointments. Jackson is the first major vaccine provider in South Florida to open appointments up to the public 55 and over with certain medical conditions.
ACCESS TO HEALTHCARE ISN’T EQUAL IN MIAMI
More affluent patients are more likely to have an easier time accessing their doctor, said Bailey, the healthcare inequities researcher at UM.
In turn, the people most likely to have a hard time accessing medical care sometimes get care at federally qualified health centers, Bailey added, and those clinics are typically overwhelmed and therefore less likely to produce a doctor’s note on short notice.
Even for those who occasionally see a physician, a quick timeline — between scoring an appointment and showing up for the vaccine — could be especially challenging, said Dr. Hansel Tookes, a physician and University of Miami professor who works at Jackson.
He knows from personal experience. On Monday night, Tookes heard from a patient who has lymphoma and was alerted that the vaccine was available for him at Jackson. He successfully signed up, but needed the doctor’s note within 24 hours.
“I’m the type of physician
where he texted me last night and I was able to get it to him this morning, but it’s not going to be the same across the board,” Tookes said. “Not everybody has that kind of access to their doctors.”
OBESITY AND INEQUITY ‘TRAVEL TOGETHER’
One of the 13 conditions that qualifies Florida residents for a vaccine at Jackson is obesity, specifically with a body mass index over 40, or severe obesity.
Obesity is a known risk factor for severe COVID-19, and Jackson has consistently monitored the number of overweight and obese people hospitalized in its facilities with COVID at a given time.
But obesity is a medical condition that can be verified using simple height and weight measurements, making it somewhat puzzling for experts that the hospital is requiring a doctor’s note proving a patient has it.
“The same way we went to the nursing homes with the vaccines, I think that this is one of the few conditions on the list that could be objectively verified quite rapidly,” said Tookes, who has set up medical clinics in underserved parts of the city such as Overtown.
Eric Toner, a senior scholar at the Johns Hopkins University Center for
Health Security, said a lack of equity in COVID vaccine distribution has been a recurring theme, “and
obesity and inequity correlate with one another — they travel together.”
Toner said the approach to verifying medical conditions that would qualify someone for a COVID vaccine should be as lax as possible to avoid disadvantaging people without routine medical access. While someone’s body mass index would be relatively easy to calculate, even at home, Toner said it would be just as meaningful to eyeball it in person and allow those who appear to be severely obese to be vaccinated.
“Not everybody who should have medical care gets medical care,” Toner said. “You can ask them to calculate their BMI, but you could also look at them.”
JACKSON ALERTS ITS PATIENTS
As a public hospital, Jackson’s mission is to serve anyone who lives in MiamiDade County, regardless of their income.
To that end, the hospital has started proactively notifying its sprawling patient pool, many of whom might be on the fringes of routine healthcare access.
Tookes, the UM professor who works at Jackson, emphasized that effort, adding that it “should not be underestimated.”
But he also added that Miami has significant swaths of people going without access to healthcare, as is the case in most parts of the country. He said the policy of requiring a doctor’s note was “less than ideal.”
“That could definitely pose challenges for patients in getting doctor’s notes — major challenges,” he said.
Bailey, the healthcare inequity researcher at UM, said the doctor’s note policy works to serve a medical purpose: making the process run smoother for the hospital system, “as opposed to a public health purpose.”
She added that it’s important for local officials to learn from the lessons of the pandemic — including very recent ones about vaccine hesitancy being easily overcome with convenience.
Just this weekend, people in Miami Gardens lined up for a county-led mobile vaccination effort that required no appointments — and no doctor’s notes — and drew massive lines of people.
“There are ways to reach people and structurally allow people to access vaccine. And we’ve learned that we need to be intentional about equity,” Bailey said. “All of those things are important. So we must learn from our recent, recent past in our approach. It’s not that far away. We must learn from that.”