Who should be next in vaccine line?
“My strong feeling is that the communities with higher rates should get it next.”
NAACP New Haven Chapter President Dori Dumas
Who needs the COVID-19 vaccine the most? That is the question facing Connecticut’s vaccine advisory group as they decide which people come next in line.
New shipments of the Pfizer and Moderna vaccine are arriving every week, and after health care workers, some say Black and Latino communities need prioritization.
“My strong feeling is that the communities with higher rates should get it next,” said NAACP New Haven Chapter President Dori Dumas. She said most people living there don’t have the choice of staying home or possibly even social distancing.
When mapping hot spots of coronavirus cases, cities see the highest positive case rates when compared to other towns, as cities are more densely populated, have more low-income housing, and employ many essential workers and frontline jobs.
“We strongly feel when they (the advisory committee) look at that data they’ll see it’s people in certain communities being devastated and that’s just unacceptable,” Dumas said.
Connecticut’s Phase 1a of vaccination roll out, which is currently underway, includes frontline health care workers, residents of long-term care facilities and medical first responders.
As of Wednesday, hospitals and long-term care facilities in Connecticut reported they have administered the COVID-19 vaccine to 16,487 people.
“Building equity in plans to distribute the vaccines including culturally sensitive, multi-lingual outreach tailored for local communities will be essential for closing gaps in health outcomes,” National Medical Association President Dr. Leon McDougle said in a statement Monday.
Gov. Lamont’s COVID-19 Vaccine Advisory Group
has been meeting regularly to determine the next phases in distribution.
During the vaccine advisory group’s allocation subcommittee meeting Monday, they affirmed the Advisory Committee on Immunization Practices recommendation that frontline essential workers and people over the age of 75 be included in Phase 1b and added people living with co-morbidities and people living in congregate settings.
Phase 1b is scheduled to begin in January and last through May 2021. The state expects the vaccine won’t be widely available to the general public and people under 16 until late summer or the fall of 2021 at the earliest.
“When they’re having the conversations and making these decision we need them to look at who has been impacted and who is at the higher rate of who is dying and who is in these emergencies rooms,” Dumas said.
Coronavirus deaths are almost three times as high for Black and Latino communities compared to white counterparts and hospitalizations are as high as four times.
“These numbers are high and if we want to get a handle on it, to me it would be fair and equitable to go where there are the highest numbers,” she said. “If we’re not trying to make it equitable, we’re not going to get a handle on it and we’ll see a lot of people dying when they don’t have to.”
Dumas said by targeting Black and Latino communities with vaccination, the state will start to see cases decrease.
Without focusing on equitable distribution, the disparities of coronavirus outcomes are going to worsen as the pandemic continues, said Samuel Diaz III, Southwest Community Health Center senior director of communications.
“The direct correlation is it’s just going to enhance the (disparity) gap and make it bigger,” Diaz said. “The long term answer is it’s going to fuel some of the mistrust the Black and brown communities have in the medical community. If we’re not serving that community, how can you expect them to be enthused to receive that care?”
“If we don’t focus on our inner cities and Black and brown communities in the distribution of this vaccine, and don’t disperse them accordingly, we’ll see that longterm effect,” he said.
As with adults, the majority of children who die from COVID-19 are also children of color.
Native, Black and Hispanic children account for about 78 percent of deaths from the virus: 45 percent were Hispanic, 29 percent were Black and 4 percent were non-Hispanic American Indian or Alaska Native, according to a report by the Centers for Disease Control.
Three-quarters of the children who died had an underlying condition that made them more vulnerable to complications from the coronavirus. The most common underlying conditions were asthma, obesity and cardiac issues, similar to those comorbidities disproportionately found in Black and Hispanic adults.
Dr. Carlos Oliveira, a Yale Medicine pediatric infectious disease physician and assistant professor at the Yale University medical school, said more thought needs to be given to prioritizing communities of color as vaccinations occur as a way to protect children.
“One downward effect of coronavirus is if they (children) have to quarantine for weeks, they're missing school and it exacerbates the disparities,” he said.
About 10 percent of coronavirus cases are in children. Since April, at least 184 children have died from the disease in the U.S. and thousands more have been hospitalized, according to the Centers for Disease Control.
Oliveira said his first COVID-19 patient had to go on a ventilator and when he told his patient’s mother in the hospital, she cried because her husband had just been put on a ventilator hours before and now she was showing symptoms.
He said the family was Hispanic and the coronavirus affected them for months, not simply because they were sick but they subsequently missed work even as they had to care for three children.
“The ramifications of protecting these communities goes beyond the effects of the virus,” he said.
Equitable distribution of vaccines will be one of the cornerstones of curbing the impact of the pandemic, Diaz said, and equity will revolve around education and access, since for the Black and brown communities historically those have been the barriers contributing to health disparities.
Access means people are able to get the vaccine, that they can afford it, have insurance to cover it or can get care at a community clinic. Diaz said disproportionately Black and brown communities are either uninsured or underinsured or high quality physicians are outside inner cities.
“The second piece of access and health equity is education,” he said. “For Black and Latino communities there’s been mistrust of the health community because of systemic racism. . . We’ve been a second thought or an afterthought.”
But educating people about the vaccine, being transparent with information can empower people to make an educated decision, Diaz said.
“In terms of health disparities, educate educate educate, and we have to educate in the language of the community,” he said. “We have to understand the community and serve them where they’re at.”
Dumas said it’s important that the leaders in Black and brown communities educate people about the safety of the vaccine and let the people that look like them know it’s safe to get vaccinated and protected.
The National Medical Association, the largest medical organization representing Black doctors and patients, said the percentage of Black people enrolled in the Pfizer and Moderna vaccine trials was enough to have confidence in its safety for that population, and that efficacy was consistent across race, age, gender and ethnicity.