Opening plan lacks equity target
As state looks to drop virus restrictions, vulnerable communities could suffer
California began a 10-week countdown to a full reopening last week, with Gov. Gavin Newsom’s bold proposal to lift nearly all coronavirus restrictions by June 15. But the ambitious plan contains no specific protections for vulnerable populations, sparking fears the state is about to repeat mistakes that devastated the Latino community last year.
The omission was surprising, considering that Newsom’s announcement was triggered by the delivery of 4 million vaccine doses to disadvantaged neighborhoods, a key goal that the state had set to address inequalities in the state’s inoculation efforts. In recent weeks, Newsom and other state officials have referred to equity as the “north star” of the pandemic response.
Yet the June reopening plan does not include requirements about how vaccines should be distributed, or to whom. Instead, it hinges on hospitalization rates remaining low and enough vaccines being available for all people over 16 — conditions that concern critics who believe the state must do more to ensure vaccines actually get into the arms of the most vulnerable.
Vaccinations continue to lag among Latinos, who have contracted COVID-19 at higher rates than any other major ethnic group.
“Right now, we have a timestamp on this,” said Christian Arana, vice president of policy at the Latino Community Foundation, which recently put $2 million toward grassroots community organizations to combat vaccination disparities. “We have only until June 15th to talk to as many people as possible to make sure they know about the vaccine and can get the vaccine — before they’re put at risk again.”
The California Department of Public Health did not answer specific questions from this news or
ganization about why it did not include equity or vaccination benchmarks in the reopening plan. In a lengthy statement, the department summarized prior or ongoing work related to equity, noting its commitment to reserve doses for vulnerable communities, $30 million the state has invested in on-the-ground community outreach and a Spanish language media campaign launched at the end of March, among other things.
“California made equity a top priority in the distribution and administration of vaccines, and that continues to be the case as we work to ensure every Californian who wants a vaccine gets one,” the department said, adding that the rate of vaccinations in the Latino community has increased 3% since mid-february.
Still, vaccination rates continue to lag among California’s hardest-hit populations, particularly Latinos. About 22% of the state’s Latino population has received at least one dose, compared to about 32% of White residents, CDPH data show. Latino residents account for 56% of COVID-19 cases and nearly 40% of the population, while White residents make up just 20% of cases and 36% of the population.
Last month, the state reserved 40% of doses for the lowest quartile of the “Healthy Places Index,” a metric that ranks census tracts based on factors like income and health care access. Since then, vaccinations in those disadvantaged areas have risen from 18% of the total to 23% last week. Still, residents living in the lowest quartile have received 20% of total doses, while 30% of doses have gone to the top quartile.
The state’s use of the Healthy Places metric has also been criticized for overlooking vulnerable communities that don’t meet its ranking. Just 10 of the more than 400 ZIP codes targeted statewide are in the Bay Area, and many hardhit Latino neighborhoods in the region were left out.
For community clinics in much of the Bay Area, supply remains a primary barrier to delivering vaccines. At the Mexican Heritage Plaza in East San Jose, where Gardner Health Services runs a walk-up vaccine site three days a week, residents sometimes start lining up at 2 a.m., seven hours before the clinic opens at 9 a.m., Gardner CEO Reymundo Espinoza said. Last week, the clinic turned away about 300 people seeking their first dose within an hour of opening.
“We’re still not vaccinating the area to the extent that we need to, and we’re concerned about it,” Espinoza said. “We could do more if we just had the vaccine.”
Providers also worry that California’s eligibility expansion to those 16 and up starting Thursday could shrink supply and appointment availability even further. Late Wednesday, CDPH confirmed that the state is expecting 90% fewer Johnson & Johnson doses next week, significantly curtailing firsttime doses.
Without a plan to vaccinate vulnerable groups, public health experts said the state risks seeing a surge in coronavirus cases like the one that followed its initial reopening in June 2020 and had a disproportionate impact on Latinos.
The Bay Area News Group detailed those impacts in a special report last month.
From late May to early July, when Newsom shut down the economy again, the case rate among Bay Area Latinos jumped to 19.9 per 10,000, up from 5.8. Among non-latinos, the rate increased to just 3.2 cases per 10,000, up from 0.6.
“Here we are, a year later, about to do the exact same thing,” said Dr. Jorge Caballero, a Stanford physician who also started a testing database called Coders Against COVID. “We know that there’s insufficient access to vaccinations precisely for the communities that are most likely to get the virus, have severe disease, and die.”
“It really feels like we haven’t learned anything at all,” he added.
Vaccinating people with more exposure to the virus — like essential workers — is key to reaching herd immunity and returning to normal life, said Dr. Kirsten Bibbins-domingo, a UC San Francisco epidemiologist. Deep pockets of unvaccinated people will cause outbreaks that ultimately will affect everyone.
“It’s not like, ‘It’d be nice to see that the vaccinations mirror the demographics of California,'” Bibbins-domingo said. “We really have to redouble our efforts to make sure that the communities that have had the most transmission are actually protected. That means using all our strategies at our disposal, and not just declaring victory.”