As coronavirus vaccinations gain momentum, equity challenges increase, too

covidkillerfactors-300x130Roughly a tenth of adult Americans (~37 million people) have gotten coronavirus vaccinations, as the Biden Administration pushes to increase vaccine supplies and shot sites, while also boosting disease testing capacity and availability of personal protective equipment (PPE) for health workers.

The battle against Covid-19 may seem still to be a slog, with vaccine demand exceeding supply and frustration high as to why the nation has not made greater progress in quashing the pandemic and returning to normality.

As expected, Republicans in Congress have declined to join the new president and his administration in the Democratic plan to fast track and go big with a pandemic response — especially with a $1.9 trillion relief plan that will follow hard on the heels of a $900 million package that was stalled for months by the GOP but finally approved in December.

Biden and his allies are forging on. They have increased vaccine supplies by working with makers and releasing holds, including reallocating excesses from planned programs at long-term care facilities. (It seems supplies were calculated based on numbers of beds in the facilities, not on the number of their actual residents). The vaccination campaigns slowly but steadily are catching up to the aged, sick, and injured in nursing homes and other similar centers, especially as the giant drug store chains CVS and Walgreens step up their inoculation campaigns.

Hesitancy and inequity in vaccination efforts

Hesitancy and inequity persist as significant challenges to the vaccination rollout.

But private-public efforts have kicked up for big time information campaigns (thanks, Budweiser!) to let the public know that the speed with which the coronavirus vaccines were developed has not undercut the rigor with which they have been tested. Tens of thousands of volunteers got the shots in clinical trials with serious side-effects or complications rare. As millions around the world take the vaccine, this reality has only increased, with the reactions so few that public confidence is growing in this key weapon to battle the pandemic.

Outreach and supplies may need to be much higher, however, to deal with increasing evidence that, even as the pool of people eligible to get vaccinated has expanded, the shot recipients far and away have been white, affluent, and computer-savvy enough to fight through — or to get others to help them do so — complex and balky online sign-up programs.

The disparities that this has created have been marked in the District of Columbia, where the coronavirus has savaged poor communities of color, but the vaccination programs have benefited wealthier white areas. As the New York Times reported:

“[I]n Washington, 40% of the nearly 7,000 appointments initially made available to people 65 and older were taken by residents of its wealthiest and whitest ward, which is in the city’s upper northwest section and has had only 5% of its Covid deaths.”

The newspaper later explained further, talking with Kenyan McDuffie, a member of the D.C. City Council whose district is two-thirds black and Latino:

“A few days after its 65-and-older population became eligible for the vaccine on Jan. 11, Mr. McDuffie … flagged the issue of wealthier residents getting disproportionate access to the vaccine in a call with city officials. Overall, 74% of deaths and 48% of cases in Washington have been among black residents, who make up 46% of the population; 11% of deaths and 25% of cases have been among white residents, who make up nearly the other half of the district. By the end of that week, the city announced a new policy — offering the first day of new appointments to people in ZIP codes with the highest rates of infection and death from the virus. Under the new system, more appointments would be added a day later and people from other neighborhoods could sign up then. The city also quadrupled the number of workers helping people make appointments through its call center, to 200.”

The efforts to make vaccination programs more equitable across the D.C., Maryland, and Virginia area has ramped up, with door-to-door contacts, as well as assistance with shot sign-ups and transportation, and juggling of schedules to better accommodate people working different shifts in essential jobs, the Washington Post reported.

Health policy experts say it has been tough to assess and improve equity in vaccination efforts because many localities are not collecting data based on key demographics like race. The available information paints a harsh picture of the disparities, though, as the New York Times reported, looking nationally:

“Early vaccination data is incomplete, but it points to the divide. In the first weeks of the rollout, 12% of people inoculated in Philadelphia have been black, in a city whose population is 44% black. In Miami-Dade County, just about 7% of the vaccine recipients have been black, even though black residents comprise nearly 17% of the population and are dying from Covid-19 at a rate that is more than 60% higher than that of white people. In data released last weekend for New York City, white people had received nearly half of the doses, while black and Latino residents were starkly underrepresented based on their share of the population.”

Administration officials have stressed that billions of dollars in the pandemic relief package they are pressing for will help fund not only for a big escalation of vaccination efforts, with new and significant federal support, it also will increase equity, not only with more availability to the underserved but also with outreach to and information for them.

Age-based divides in the pandemic response

Age may be another dividing demographic in the fight against the infection. This administration has worked uphill against its predecessor’s last-minute, uproar-causing decision to expand significantly the vaccine eligible — not just health workers, first responders, and long-term care residents and caregivers but also a sizable and vulnerable group of Americans older than 65. Public health experts were coalescing around a strategy of prioritizing older people for vaccination — balanced with the need to get early inoculations for essential workers, including teachers, as well as hard hit populations like black, Latino, and native people.

Now, as the older groups get vaccinated, officials are toiling still to try to work in the other priority recipients, watching with wariness the infection data.

The numbers say that older people still die at disproportionate rates, if infected (see chart above from new study on underlying conditions as highest mortality risk factors). But people in their 20s, 30s, and 40s now are getting infected with and spreading the coronavirus more than other groups, especially because individuals in this demographic — especially if they are less affluent, black, Latino, or native people — also are essential workers. With the economy still sputtering, joblessness high and not falling as officials hoped, and fears huge about evictions of renters, people who must go out of their homes to work have little choice but to do so.

Biden officials have tried to help struggling families by pushing, too, to get schools re-opened and young people back in them. (This helps get parents, especially moms back to work, if they need to.) The federal Centers for Disease Control and Prevention, with new leadership and reinvigorated in the pandemic fight, has argued that research from around the globe finds lesser risk from re-opened schools as coronavirus spreading sites.

Federal officials are moving to provide increased financial support as well as cajoling to governors, mayors, school boards, and education leaders to get young people returned to class — provided that their teachers, many with underlying health conditions and older, and their powerful unions can be persuaded.

The importance of individual actions

With the federal government now becoming big and active in the battle against the coronavirus, public health officials are stressing still that individual actions will be decisive in the course of the disease in the months ahead, which still may be grim.

Infections and hospitalizations (notably stays in intensive care units) for the coronavirus are falling, sharply, while deaths — a lagging indicator — stay at scary levels. This has led to the easing by states and local governments of public health restrictions, including allowing more restaurant options and the reopening of hair cutting, nail, and other services.

Will these moves cause another spike in cases? Will the Super Bowl go in the books as a super spreader event? Will people take the long president’s weekend to shop and gather and eat — and transmit the virus?

Concern remains high about viral variants and the possibility that the coronavirus might mutate away from the protections that vaccines can provide, even as more types of shots rise on the availability horizon.

This is not the time to ease up and think the pandemic, magically, will end.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

The nation has been run down even more, not only by the coronavirus but also months of a flood of anti-scientific falsehoods and federal-level chaos and inaction by a now-gone administration. Folks are trying to reset the country on a better course based on research, evidence, and medical-scientific expertise.

This needs our support with common sense, familiar steps that are not so hard to follow. We can maintain our high hygiene (especially hand washing), cover our faces, keep our distance, avoid closed and poorly ventilated indoor spaces, and mostly stick at home — or stay with people in our immediate households. When given the chance, with careful consideration for individual circumstance, we can take the coronavirus vaccines and encourage others to do so, too. We can get ourselves, our loved ones, and our country to a better place — but we have much hard work to do.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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