San Francisco Chronicle - (Sunday)
Vaccine equity: State reaches goal for communities in need.
When Gov. Gavin Newsom visited Union City to mark the opening of vaccine eligibility to everyone 16 and older, he applauded the 24 million doses that have already gone into Californians’ arms. But a second metric, he said, was just as important. “The number I’m most proud of, though not yet satisfied with yet, is the 4.84 million vaccines that have gone into our most impacted communities in the state,” he said Thursday, referencing the fact that California has surpassed its goal to administer 4 million doses in the lowest income areas.
It is “an important metric of our success in terms of these equity goals,” Newsom said. “But as a state, we still have a lot of work left to do.”
Whether that work includes setting a new equity benchmark is unclear. When asked whether the state has set a specific target beyond having already achieved the 4 million shots, the California Department of Public Health did not directly answer. A plan to roll out additional equity strategies may be available soon, a department spokesperson said.
The agency highlighted its ongoing work with communitybased organizations to bring vaccines to those disproportionately harmed by the pandemic. Officials pointed to one sign of progress: Since the state began allocating 40% of vaccine supply to the lowestincome ZIP codes in early March, the gap between the proportion of shots going each week to the wealthiest and the poorest communities has been reduced to three percentage points from 18.
Public health experts and community advocates worry that a lack of clear targets will exacerbate existing disparities in who gets shots.
Despite the state’s concerted efforts to ensure equitable vaccinations, disparities remain.
About 21% of total vaccines administered have gone to people in the lowestincome areas in California, compared with 30% to people in the highestincome areas, state data shows. The areas at risk of falling behind with expanded eligibility are not defined formally by race and ethnicity but take into account income, education level, housing and health care access. Those factors collectively align closely with communities that are primarily Latino, Black, and Asian and Pacific Islander. “While opening up eligibility to everyone might appear equitable, oftentimes it works in the most inequitable ways,” said Dr. Kirsten BibbinsDomingo, chair of UCSF’s department of epidemiology and biostatistics.
She said open eligibility puts people who lack resources — such as computers to book appointments or cars to drive to vaccination sites — at a disadvantage to find a place in line.
“The patients I talk to say, ‘I can’t take time off work to find an appointment,’ ” BibbinsDomingo said.
According to state data, 23% of available doses have been administered to Latinos, who account for 39% of the state’s population. About 3% have been administered to Black people, who are 6% of the population. The proportion of white people and Asians receiving vaccinations also is below their share of population, according to the data, but the gap is narrower.
“While I appreciate the state’s focus on equity in the words, I don’t think the numbers are in keeping with the true disproportional burden,” said BibbinsDomingo.
The percentage of vaccinations each week in the lowest income quartile is growing, from 15% in late February to 25% in midApril. Meanwhile, the percentage of vaccinations each week in the highest income quartile is falling, from 33% to 28% during the same period, according to state data.
“We’re moving in the right direction,” Kimberley Goode of Blue Shield of California, which manages vaccine distribution for the state, said Wednesday during a meeting of the state Community Vaccine Advisory Committee. “We’re closing the gap, but clearly we’re not where we need to be.”
The state recently announced a $60 million boost — including $7.6 million to Bay Area counties — that health care providers can use to expand clinics, staff, and weekend and evening hours in a bid to get shots to more people in the poorest areas.
Blue Shield said it will soon start a pilot program in lowincome communities with low vaccination rates to try to improve results. Whatever happens at the state level, counties and cities, as well as the nonprofit and philanthropic sector, say they are pushing ahead on local efforts to ensure that vaccinations are provided equitably.
“Equity has been a top priority at every step of the vaccine distribution process,” the Alameda and Contra Costa County health departments said in a joint statement. “While mass vaccine sites are an important element to quick and efficient distribution, locations in neighborhoods and communities hardest hit by the pandemic also ensure that distribution is fair and equitable.”
Contra Costa County plans to open new walkup vaccination clinics in its hardesthit regions, including Richmond and Antioch. With a daily capacity of 500 to 700 doses, the clinics are the kind of model that public health experts say is critical to reaching residents who might not otherwise seek the shots.
Overall, communities of color represent less than onethird of the 63 million people who are now fully vaccinated in the United States, but they are twice as likely to die from COVID19 — and three times as likely to be hospitalized as white Americans, according to data collected by the Rockefeller Foundation.
Last week, the foundation began a $20 million initiative to increase vaccinations in communities of color in five pilot cities, including Oakland.
The philanthropic funding will help Roots Community Health Center activate a network of mobile medical clinics and accessible vaccine sites to reach Oakland’s lowwage individuals, people of color and women, officials said.
“Those with least access to reliable technology and transportation, and whose work and family obligations prevent them from accessing health services, are at serious risk of being overlooked when it comes to not only receiving lifesaving vaccines but also lifesaving information they need if they become ill with COVID,” said Dr. Noha Aboelata, the center’s CEO and founder.
Such outreach is crucial to promoting equity, and “because the wellbeing of the larger community could hang in the balance as this dangerous disease continues to mutate and spread,” Aboelata said.
A key element of equity efforts by cities and counties has been partnering with community organizations for outreach.
Experts worry the current pause on administering Johnson & Johnson’s vaccine could affect lowincome communities and mobile sites, even though the shot accounts for just 4% of California’s vaccine supply.
Because it requires only one shot — in contrast to the twodose regimens for the two other vaccines — Johnson & Johnson’s product has been more convenient for people who might not come back a second time, or who are in hardertoreach communities, such as homeless or homebound residents.
Public health experts say a majority of people want to get vaccinated but sometimes are seen as reluctant simply because they have trouble accessing the shots.
“It is our ontheground experience, they may be harder to reach and faced with barriers, but are lining up in droves,” said Bibbins-Domingo, who helped establish UCSF’s popup vaccination site outside Glide Memorial Church in San Francisco’s Tenderloin.
A HIT Strategies survey among people of color in Oakland, backed by the Rockefeller Foundation, found that 84% of respondents wanted to get vaccinated when eligible, but 62% did not know how.
“Our goal is to eliminate racial disparities by increasing access and information about the vaccine through hyperlocal community mobilization efforts,” said Otis Rolley, senior vice president for the foundation’s U.S. Equity and Economic Opportunity Initiative.
The initiative aims to get 70 million people of color vaccinated by July, which would account for about 37% of available vaccine doses.
“Without having equitable distribution, we will never get out of this pandemic,” said Krutika Kuppalli, vice chair of the Infectious Diseases Society of America global health committee. “It is our moral, ethical and human obligation to ensure that we do all that we can to work towards having an equitable distribution of vaccines.”
“We’re moving in the right direction. We’re closing the gap, but clearly we’re not where we need to be.” Kimberley Goode of Blue Shield of California