San Antonio Express-News (Sunday)
Virus data to help Hispanics, Blacks still problem for Texas
Advocates, watchdogs see state’s struggles as a matter of priorities
At the onset of the pandemic and again with the vaccine rollout, Texas officials have struggled to gather data critical to protecting Black and Hispanic Texans who are among those at higher risk of serious complications from COVID-19.
Almost two months into the vaccine distribution, the Department of State Health Services promised Thursday to begin requiring all providers to report race and ethnicity data for all vaccine recipients.
That pledge came after advocates and health experts raised concerns that the information was missing for nearly half the 1.8 million Texans who have received at least one dose of the vaccine.
The lack of information was similar to the state’s difficulties tracking infections and deaths among communities of color at the start of the pandemic, when officials spent months without complete data before committing to fully evaluate the disproportionate effect of the virus on minority groups.
In Texas, Latinos have accounted for nearly half of all COVID deaths despite making up about 40 percent of the population. Nationally, Black and Hispanic people are about four
times as likely as white people to be hospitalized with COVID-19 and about three times as likely to die from the virus, according to the Centers for Disease Control and Prevention.
Over the past year, the state’s data problems have surfaced in nearly every facet of the COVID-19 response, from calculating the rate of positive tests to tracking infections in public schools. The pandemic has required data collection efforts on a massive scale for local and state health officials often working in understaffed offices with outdated technology.
But advocates and public watchdogs say the state’s continued struggles collecting basic demographic data are also a matter of priorities.
“Any time you have a calamity like we have today, you have to ask yourself: Are you coming at it from a race equity lens?” said Kazique Prince, the interim executive director of the Central Texas Collective for Racial Equity. The lack of data “speaks to the unwillingness or inability to really tackle this challenge,” he said.
“The quicker that data is collected, the quicker it’s analyzed, the quicker we’ll be able to create the change we’re looking for,” Prince said.
Chris Van Deusen, a spokesman for the health services department, said the state has “clearly and consistently” told providers to gather and report demographic data on those vaccinated, “but it’s still lacking.” That will change as the state requires providers to include the information before they can submit reports.
“We believe it’s important to have reliable data on race and ethnicity as a measure of how vaccination is going and to help determine whether there are certain groups that may need additional outreach about the importance of being vaccinated,” he said.
Advocates have been voicing concerns since Texas kicked off its vaccine distribution effort last month, allocating most doses to hospitals, grocery store pharmacies and other institutions that are more heavily concentrated outside of areas with high-minority populations — even though officials knew Blacks and Latinos were being infected at higher rates.
“Racism is a public health issue,” Prince said. “If it wasn’t an issue, we wouldn’t see these disparities.”
Now that the state has shifted to a “hub” strategy giving thousands of doses to a handful of providers, local institutions have been able to better place the vaccine hubs in underserved communities, though it is unclear whether they are reaching the most vulnerable residents.
Calls to reboot a state agency
Over the past seven weeks, the state has collected race and ethnicity data from vaccine providers that offer it. But with 45 percent of the data missing — accounting for more than 800,000 people — it is impossible to determine whether the communities hit hardest by the pandemic are receiving the aid they need.
The state has never before undertaken such an effort to immediately collect and distribute testing or vaccine data, much less the race and ethnicity of those affected, said Anne Dunkelberg, the associate director of the nonprofit Every Texan.
She said state officials have taken a hands-off approach to the public health crisis, often delegating responsibilities to multiple agencies that delegate to local authorities — thus putting big-picture issues such as data collection on the back burner.
“We just haven’t seen a lot from the top down in Texas, in terms of a public discussion in how our systems are taking (race) into account and trying to make up for it,” Dunkelberg said.
It’s a national issue, too. Though the federal government requires states to track race and ethnicity, only 20 states are including that information on their vaccine dashboards — and most of those states are also missing much of the data, the Seattle Times reported.
Amid the outcry over bad COVID data, some lawmakers and experts have called for the reinstitution of Texas’ defunct Office of Minority Health Statistics and Engagement, which closed in 2018 after the Legislature quietly defunded it.
“We would be able to see where the health disparities are, and then, specifically related to COVID, we’d be able to see why certain populations are more affected than others,” said Sean Walker, a policy fellow at the Hogg Foundation for Mental Health at the University of Texas at Austin.
Six states, including Washington and Massachusetts, have similar offices tracking health equity data.
The data is crucial not only to understand gaps in vaccine access, but also to help officials confront vaccine hesitancy within communities of color. National surveys have indicated that Black and Hispanic people are less likely than whites to pursue inoculation — a symptom of the deep-rooted mistrust in government and health officials that stems from a long history of systemic racism and medical abuse, said Monica SchochSpana, a medical anthropologist and senior scholar at the Johns Hopkins Center for Health Security.
“If we want to align the demand for and the benefits of COVID-19 vaccines for communities of color, we as a country have to provide lasting opportunities for our communities of color to exercise collective agencies over their own health and well-being,” she said.
Counties struggle to keep up
Part of the trouble in Texas is the state’s reliance on individual providers — some of which had never reported public health information to the state — to submit data in a timely fashion. That was an Achilles’ heel for state officials as Texas ramped up COVID-19 testing last summer, later finding hundreds of thousands of backlogged test results that had not been reported in real time because of submission issues.
Before the pandemic, the mosttracked disease in Texas was chlamydia, which accounts for roughly 150,000 cases per year.
“This is just beyond comprehension, what we’re expecting,” said Marilyn Felkner, a clinical assistant professor at UT-Austin who worked for the Department of State Health Services from 2010 to 2016. “It is good to have data, absolutely. We would love to have that data. But is it realistic given the staffing and the IT infrastructure? No.”
And the data entry struggles vary by county. While state data indicates that race information is unknown for about 30 percent of vaccinated individuals in Harris County — which also has its own dashboard detailing inoculations by demographic group — areas such as El Paso County are missing up to 90 percent of that data.
The missing data rates are at or below average in other metropolitan areas. In Bexar and Travis counties, 45 percent and 48 percent, respectively, of the information is unknown. In Dallas and Tarrant counties, it is about 35 percent.
Last year, the testing data was completely collected and entered into a new state database by other entities, said Van Deusen, the health department spokesman. But now, because the state is tracking vaccines using an existing system, “we can and will make it a required field,” he said.
In Bastrop County, roughly 49 percent of race data is missing. Dr. Desmar Walkes, the county health
authority, didn’t know why but said the county has still been able to target the communities most affected by the virus by zeroing in on ZIP codes with the highest infection rates.
“Now that we’re doing the vaccine rollout, we’re looking at where we can take our resources and protect not only the at-risk folks in the Black and brown communities but also protect our seniors and our first responders,” Walkes said.
It’s not clear how long it will take before the state is able to get a large enough set of reliable data to draw any conclusions on vaccine access by race. But Van Deusen said that information would not necessarily affect the current vaccination strategy because the majority of the state’s weekly allocation is going to the hubs.
In the weeks since the state moved into phase 1B of vaccine distribution, which opened up eligibility for Texans 65 and older and most people with pre-existing conditions, the state has also made a “significant effort” to distribute the vaccine to underserved communities, he added. This week, dozens of community health centers and rural health clinics will receive allocations.
Through the hub strategy, local officials have been able to more successfully designate vaccination sites in minority communities, said state Rep. Vikki Goodwin, DAustin, who sent a letter to state health officials this month describing concerns that vaccination sites were “much less concentrated in areas that have a higher percentage of minority residents.”
In San Antonio, two of the city’s four vaccination hubs have been placed on the South and West sides to better serve the largely Hispanic population concentrated in those areas.
Going forward, Goodwin expects that the state may embrace mobile vaccination sites — a strategy it began piloting in five rural counties Thursday — to access harder-to-reach communities.
“A lot of people are out there wanting us to use every tool in the toolbox, whether it’s a really large clinic at a community center or a mobile van going around through the neighborhoods,” she said.