New Haven Register (New Haven, CT)
CT’s urban health centers lead push for vaccine equity
Agencies seek to bend rules for inoculations
The state’s federally qualified community health centers, serving hundreds of thousands of low-income residents, are asking the state for permission to ignore age limits immediately as they administer
COVID-19 vaccines, using a new, direct federal supply of doses.
Five executives from the 17 community health center organizations in Connecticut formally asked the state Department of Public Health earlier this month to let them bend the rules.
Their logic: Their patients are among the hardest to reach and least likely to make, and keep, inoculation appointments through the standard online and telephone systems. Why not jab them with vaccinations whenever they walk in the door, regardless of their age?
That makes sense because those patients will need vaccinations sooner or later — and the sooner the better if they live in dense urban housing and work on the front lines, as many of them do.
It makes sense for another reason: As of this month, the Biden Administration has added a direct supply line of vaccines to the federally qualified health centers, known as FQHC’s, much like the direct lines to pharmacies. With this week’s shipments, those community health centers in Connecticut will have received about 60,000 first doses through the new program.
And it makes sense for yet another reason: The health centers serve the exact populations that are slow in receiving vaccinations, state data suggests. Their patients are about 75 percent Black and Latinx and they live, largely, in the same 50 Zip codes that Gov. Ned Lamont has targeted for 25 percent of vaccinations in order to achieve some semblance of racial equity.
Dr. Deidre Gifford, the acting public health commissioner, had not given the health center directors an answer as of late Monday. She issued a statement in response to my query: “Our FQHCs have been and continue to be excellent partners in our vaccine program. We truly appreciate our collaboration with FQHCs and all of their work to meet our equity targets.”
You know that means no, and she went on to say the providers should focus on the age groups, oldest first. She should reconsider.
On Monday, Gov. Ned Lamont pushed up the date when any Connecticut resident can make an appointment from May 3 to April 5. So, in a way, it won’t matter after that day but it does matter until then and it matters symbolically.
“Because of our unique position providing communities of care especially in the Black and brown communities,” said Ken Lalime, CEO of the Community Health Center Association of Connecticut, “we believe that this would meet the goals of the state.”
That’s what they do in Chicago: in targeted neighborhoods, no restrictions. It’s not “fair” in a narrow way of looking at it, bending the rules, but so what? What does “fair” even mean in a world where access to medical care is connected to wealth and employment? Bending the rules for target populations works for public health and that’s all that matters.
In a Feb. 23 column, I wrote that if we want to end the race gap on vaccinations, the state should end all eligibility rules in cities. Just head into the neighborhoods with doses, forget about making appointments and sticking with age 55, or age 45, or teachers or whatever. End. All. Rules.
And the best way to do that is through the health centers. By no coincidence, as of last week only the community health centers have hit that 25 percent number. The pharmacies lagged, at 14 percent of their vaccinations going to residents of the 50 target Zip codes even though Walgreens and CVS say they are focusing in the cities.
The hospitals and local health departments also lagged, though not as badly as the pharmacies, state reports show.
“They should have been dong that from the start,” said Amos Smith, CEO of the Community Action Agency of New Haven, an anti-poverty group, who has been outspoken that the system in place is designed to let wealthier, overwhelmingly white people seeking COVID-19 vaccinations take most of the appointments in the urban health centers.
It’s not that DPH is sitting on its hands when it comes to equity. The agency set the 25 percent target and it’s working with the providers.
Still, with the dedicated stream of vaccines heading to the FQHC’s, those clinics should be able to serve their populations in a targeted way. “We really need to figure out a strategy to ensure equity in the distribution of the vaccines,” said Mark Masselli, founder and CEO of Community Health Center Inc., which is based in Middletown and is the only one of the center’s that’s statewide.
The racial gap between white people and people of color receiving vaccinations appears to be narrowing but the numbers are not clear because the race of some people receiving inoculations isn’t recorded.
The community health center movement started in the 1960s as a reaction to then-rising unequal access to care. A federally qualified health center has some key financial advantages through Medicaid, and must be run by a board made up of people in the communities served, among other obligations.
They are the largest source of primary care for the more than 800,000 Connecticut adults and children enrolled in HUSKY Medicaid.
We’ve seen examples of aggressive outreach by the community health centers. On Saturday, Fair Haven Community Health Center joined with community activists in an effort to knock on some 5,642 doors to make appointments for neighborhood residents. They needed to stick to the over-55 rule, unfortunately.
On Sunday in Stamford, Community Health Center Inc. joined with local groups there, to vaccinate more than 300 immigrants .
It’s all great, but not enough. Even if it’s just for a few weeks until April 5, the community health centers need to do what they do, unfettered, with all the vaccine supply they need.
If, at the end of the day, they have vaccines left over — then couriers can carry those doses not needed in the cities to the nearby town halls, where wealthier people able to isolate in larger houses can line up at 6 p.m., six feet apart, waiting for a shot at a shot. That seems fair to me.