The COVID-19 pandemic has laid bare the longstanding inequities present in almost every corner of American society. Inequities in education, the economy, and health care all disproportionately harm communities of color, particularly Black, Latinx, and indigenous communities. In this new phase of the COVID-19 response—one that has largely focused on vaccine distribution—challenges in ensuring equity persist, as the communities most vulnerable to COVID-19 are demonstrably the least likely to gain access to this critical intervention that could help save their lives. The Biden–Harris Administration, in partnership with local public health entities and dedicated volunteers, have already taken steps to improve the situation, but much more needs to be done to chart a path toward true equity in COVID-19 vaccine distribution.
Who’s Getting Shots?
According to the Centers for Disease Control and Prevention (CDC), as of March 11, white, non-Hispanic people make up a disproportionate majority of those who have received one or more doses of the COVID-19 vaccine, at 64.8 percent of recipients; Hispanic/Latinx make up 8.6 percent; Black, non-Hispanic people make up 6.7 percent; Asian people make up 4.8 percent; and American Indian or Alaska Native people make up just 1.7 percent. This imbalance is particularly problematic when it is Black, Hispanic, and indigenous people who are much more likely than their white counterparts to contract COVID-19 and become seriously ill from complications associated with the virus or die from it. Furthermore, while there is limited data on vaccination up-take among people with disabilities, there has been only a patchwork attempt across states when it comes to who is being prioritized based on disability status or chronic health condition, per guidance from the CDC. As a result of this inequitable vaccine distribution, people of color and people with disabilities are more likely to grapple with the health and socioeconomic impacts of COVID-19—impacts that could be felt for generations to come.
Compounding factors are impacting access to the COVID-19 vaccine across vulnerable populations. Media reports have ranged from lack of vaccine availability within certain geographic locations, to challenges people face navigating online portals to sign up for vaccine appointments, to infrastructure issues making travel difficult, among other things. Health officials in some states and localities are also reporting that even in majority low-income neighborhoods and communities largely inhabited by people of color, wealthy white people are taking up a hefty share of the limited vaccinations available in these locations. The public’s confidence in the vaccine has also risen as a reported challenge, particularly among people of color. Based on an article recently published by the New England Journal of Medicine, acceptance rates have increased, with 62 percent of Black respondents and 63 percent of white respondents surveyed stating they would get the vaccine. However, confidence in the vaccine varies greatly between Black and white respondents, at 33 percent and 43 percent, respectively. Due to the longstanding and well-documented history of racism within the health care system and medical mistreatment toward African-American patients, which has led to distrust of the medical establishment, some African Americans do have concerns about the vaccine being properly tested for safety and effectiveness. Even with these reservations, however, we are seeing a steady increase daily in COVID-19 vaccinations.
Some Progress, Yet Challenges Remain
The United States is averaging about 2 million vaccine shots per day. President Biden has announced that the country would have enough vaccine doses for every adult by the end of May. The country is certainly well ahead of the pace needed to meet Biden’s initial goal of having 100 million Americans vaccinated by his first 100 days in office. Doses are being shipped to states and localities weekly, and now that there are three available vaccine options on the market, the 100 day national goal may be met two months early.
States have employed a number of interventions to help make the COVID-19 vaccine available to everyone. Mobile vaccine hubs, drive-through vaccination sites, and pop-up clinics are offering shots in cities across the country. Local pharmacies have stepped in as well. To accommodate the needs of targeted populations and communities with higher demand, local gymnasiums, community centers, and churches are providing additional options for places to get vaccinated. Online portals are used to sign up for appointments, and some sites allow sign-ups via phone. Education campaigns at the national and local levels have been employed in order to engage hard-to-reach populations and instill confidence in vaccine efficacy and safety.
Despite this progress, major challenges in ensuring equitable distribution of the COVID-19 vaccine remain. Availability and accessibility are major hurdles for people of color and people with disabilities in particular. In preparation for this article, I collected the stories of three women of color, all of whom are also living with a disability or chronic health condition.
Alice Wong, a 46-year-old Asian American disabled activist based in San Francisco, has waited in fear as age-based priority groups have been vaccinated first in her city. Alice founded the Disability Visibility Project, and lives with a neuromuscular disability. She uses a noninvasive ventilator, called a BiPap. Her condition is not listed in the CDC’s guidance. And while the guidance was initially meant to inform public health entities of the types of conditions that can cause serious illness in patients who contract COVID-19, states have used it as an ironclad rubric for prioritizing “high-risk” groups. This approach has been to the detriment of those living with conditions that fall outside of what’s on the list. Other states—such as California—have downplayed disabilities as COVID-19 risk factors. On January 25, Alice tweeted about her experience using the #HighRiskCA, after California Governor Gavin Newsom eliminated the 1C phase of priority groups, which would have included disabled people who are chronically ill and immunocompromised people under the age of 65, as well as essential workers. Governor Newsom decided to instead continue the focus on the age-based approach. Solely focusing on age-based eligibility, however, does not serve younger people, like Alice, who are living with chronic conditions. When I asked Alice whether or not she had attempted to “skip the line” to get vaccinated by informing health authorities in her state of her condition, she responded by saying “Breaking the rules doesn’t feel like justice to me. I will wait my turn.” Beginning on March 15, a broader group of high-risk people living with chronic illness will be eligible for the COVID-19 vaccine in California. However, many with disabilities will remain ineligible for the time being.
Taryn Williams is a 39-year-old African American woman living with inflammatory bowel disease and arthritis. She lives in the Northeast quadrant of Washington, D.C. and described her experience trying to get vaccinated as “incredibly demoralizing and hard.” When the district opened vaccine eligibility to people between the ages of 16 and 64 with qualifying medical conditions, Taryn found herself getting stuck in the appointments portal, even with use of multiple devices. She spent over thirty-five minutes trying to get an appointment. Despite this, she considers herself lucky as she was able to finally get her first dose on March 5. She told me that the District is working to offer more appointments, and improve accessibility of the portal. Call-in appointments are also now available for those who may not have a computer, smartphone, or access to the internet. During Taryn’s vaccination appointment, she took note of some additional barriers that may impact a vulnerable person’s ability to navigate getting the COVID-19 vaccine. The first of which was that she did not receive information about the vaccine, or its side-effects—she only received a vaccination records card. Taryn was also asked for an ID and health insurance card, which the staff promptly photocopied. It left Taryn asking, “If you don’t have these things, what does this mean?” The question is certainly understandable, given the high rates of poverty and homelessness in the District, how these requirements could be a deterrent for undocumented immigrants, and the simple fact that there are a host of logical reasons why a person may not have an ID or health insurance card. Getting a photo ID is particularly challenging for people in poverty and the elderly, as well as Latinx and African-American people.
Then there’s the story of Ms. Dorothy Davis, a 90-year-old African American woman living with speech and physical disabilities. She is a retired psychiatric nurse. Her caretaker and granddaughter accompanied her to get vaccinated on February 27 in Prince George’s County, Maryland. They had to wait for hours. In line, they were among over forty elderly and disabled people braving the frigid temperatures outside of the facility without chairs. When Ms. Davis was finally able to get vaccinated, no apology was given for the wait or the lack of accommodations for the disabled people at the vaccination site. Prince George’s County is a predominantly Black, middle-class town. Ms. Davis’s granddaughter, Michelle Burris (my colleague, who received the permission of her grandmother to share her story), had this to say about the experience: “Overall, the experience was horrific, but I’m grateful my grandmother was vaccinated. It was sad to see elderly and disabled people treated this way.”
The Federal Response
The federal response to the pandemic has picked up greatly since President Biden took office in January. One of his first executive actions was to establish the COVID-19 Health Equity Task Force as part of a whole of government approach to identify and eliminate health and social disparities associated with the pandemic. He has worked with relevant agencies, health experts, and the pharmaceutical industry to fast-track the release and distribution of three highly effective COVID-19 vaccines. President Biden also announced a $1.9 trillion multi-faceted plan to help America recover from the pandemic. The historic American Rescue Plan Act of 2021, signed into law on March 11, dedicates a total of $16 billion for initiatives that accelerate and improve COVID-19 vaccine distribution as well as for education and outreach to better ensure vaccine confidence at the community level. And earlier this week, the Biden–Harris administration announced a $250 million health literacy program aimed at enhancing equitable community responses to COVID-19. The program will be administered by the Office of the Assistant Secretary for Health and the Office of Minority Health. On March 11, President Biden also announced that he would be directing states, tribes, and territories to make all adults by May 1 eligible to receive the COVID-19 vaccine.
The Work Ahead
To build on the work of the Biden–Harris administration and Congress in protecting the health of the American people, here are additional actions that can be taken to support equitable distribution of the COVID-19 vaccine:
- instill confidence in the vaccine by dispelling myths about vaccine efficacy, safety, and side effects through a health literacy campaign that also acknowledges the history of medical mistreatment and distrust among the Black community and other communities of color;
- prioritize distribution of vaccine doses to areas with scarce resources as soon as they become available;
- work with states and localities to implement more uniform standards and procedures for distribution across states, including equitable approaches;
- address the digital divide by offering navigators to help set up appointments for those in need and make online portals easier to use;
- abandon the requirement for IDs and health insurance cards, which are not a requirement for access and could be a deterrent for certain populations including the people of color, the elderly, transient/homeless people, low-income people, and undocumented immigrants;
- ensure diversity and inclusion within decision-making entities tasked with developing plans and procedures to support equitable distribution of the COVID-19 vaccine, including adequate representation of people of color, indigenous people, and people with disabilities; and
- ensure accessibility and proper accommodations at all vaccination sites, as consistent with the Americans With Disabilities Act.
Progress on vaccine distribution is rapidly evolving. Once all people have access to the COVID-19 vaccine—regardless of race, ethnicity, insurance coverage, disability, zip code, and immigration status—we can say we have truly met the goal of equitable distribution. Access to the vaccine should be a public good. Processes and procedures that are not uniform across states have posed a myriad of challenges for those already experiencing compounding oppressions and barriers to America’s health and social systems. And with some states such as Texas, Maryland, Mississippi, and Wyoming rushing to lift safety precautions and reopen prematurely, delay in ensuring equitable vaccine distribution could cripple the progress we have made thus far.
header photo: A dose of the new one-shot Johnson & Johnson COVID-19 vaccine is prepared at a vaccination event at Baldwin Hills Crenshaw Plaza in South Los Angeles in Los Angeles, California.