To avoid vaccine gerrymandering, the US must focus on racial equity | Byline Keon L Gilbert and Rashwan Ray | Opinion

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Evidence has emerged across the United States about how well-intended plans to encourage vaccinations and provide neighborhood access to communities of color have been usurped by more affluent white people who do not live there. For many communities of color, this form of vaccine gerrymandering unearths a collective memory of how the resources in their communities are often co-opted for white and corporate gain. For example, Prince George’s county, Maryland, home to the most affluent predominately Black area in the country, had to cancel appointments to purge people from vaccine sign-ups who do not live or work in the county.

As the US faces its worst public health crisis in over a century, the question of race, socioeconomic status, and place sits squarely in the middle of the conversation. The US is less than 60 days into the rollout of an international vaccination program, where 43% of Black and 37% of Hispanic people are willing to “wait and see how [the] vaccine is working” compared to only 26% of whites. In a recent survey, 48% of Black adults and 36% of Hispanic adults report having less confidence the vaccine will take their needs into consideration. These feelings reflect current and historic experiences of racial animus from government agencies and healthcare systems. We assert that without a focus on racial equity vaccine allocation will further divide the country and perpetuate health inequalities.

There seems not to be a consistent national, state, or local strategy to create vaccine equity, improve vaccine risk communication, and promote healthcare utilization campaigns. There are massive inconsistencies in state-level capacities for appointments, vaccine supply, and priority setting for vaccination. Data from a 19 January Kaiser Family Foundation report documents troubling discrepancies:

  • Eligibility requirements vary by state, county and health systems.

  • Timelines by state for eligibility vary dramatically.

  • Twenty-eight states include people 65 and older in phases 1a and 1b with massive delays in registration.

  • Nineteen states include younger adults with high risk health conditions in phase 1a and 1b. However, only 10 of these states have opened up eligibility for this group, while 15 are actively registering high-risk young adults for the vaccine, often with long wait times and delays in appointment setting.

  • Teachers are placed at various priority levels depending on the state.

  • Many states have convoluted sign-ups and only online options.

These differences are a perfect storm for inequity, where communities of color will be left out of vaccine allocation and more affluent groups will be able to game the system. This storm could have been managed with proper preparedness by using clear public health messaging, community-driven outreach, and using mapping tools that identify areas of inequality. The St Louis department of health is taking this approach.

While vaccine distribution cannot be legally determined solely by race, other markers of inequality and structural racism can be used. For example, the CDC’s Social Vulnerability Index (SVI) has been suggested. SVI captures geographic-based vulnerability largely for emergency preparedness and natural disaster response. Another measure, the Area Deprivation Index, measures neighborhood level socioeconomic disadvantage using census tracts. These indices when combined with epidemiological data to show areas hardest hit by Covid morbidity and mortality to prioritize neighborhoods for vaccinations. Race and ethnicity does not become the primary factor but one of many.

Most places have largely adopted a colorblind vaccine allocation process. Not taking race into account binds the hands of decision-makers. This approach promotes invisible channels of vaccine access that reifies structural mechanisms of racism and community disinvestment.

So, how should policymakers overcome these barriers to avoid vaccine gerrymandering? Well, if race cannot be used, zip code and other measures of social vulnerability can become primary determinants that structure vaccine allocation. It is vital for zip code data and other key demographics to be collected upon registration to monitor and create accountability mechanisms. While places like Washington DC are taking this approach, states like Texas are blocking these important strategies to address racial and social class disparities by threatening to not give cities like Dallas vaccine doses. This is what vaccine redlining looks like and it will cost lives. Vaccine redlining further perpetuates the long-held belief within communities of color, that neither the government nor healthcare systems care about them, which further erodes trust in both.

If cities and states use available morbidity and mortality data, a large percentage of racial/ethnic minorities are eligible under the National Academies of Science’s Framework for Equitable Allocation of Covid-19 Vaccine Phase 1b. With each subsequent phase of the framework, additional layers of high susceptibility to Covid-19 become included, which also incorporates more individuals from racial, ethnic, and lower socioeconomic groups. Following patterns of chronic disease prevalence further allows people to become eligible for vaccination. Unfortunately, we are simply not following or implementing the science of prevention. Instead, we have followed the science of privilege.

The persistence of structural inequities that increases a person’s risk for Covid-19 has become the risk factors for vaccine hijacking. For example, many older people do not have high-quality broadband access or smartphones with internet connectivity. For appointment systems driven by online sign-ups, this will prevent them from making appointments in a timely manner. They should also not be subjected to large vaccination sites, which may challenge their physical capacity to wait in long lines, walk long distances, and be exposed to inclement weather. Similarly, we should not expect workers who have yet to receive paid leave to schedule appointments without having adequate time to receive the vaccine. Companies should follow the leads of others and provide paid time off for employees to receive the vaccine. If not, many workers will choose work over health.

Black and Latino workers have risked their lives to help keep the economy going. Many others with the privilege of social distancing, the ability to work from home, the ability to take off from work to make and show up for a vaccine appointment are unwilling to risk or delay vaccination to protect those workers and their families from additional risk to Covid-19. We must collect real-time data about who receives vaccines without policing vaccine lines and ethically prioritize those of greatest need.

Bottom line, applying a colorblind framework is not enough to ensure equitable vaccination of those who are most vulnerable. The World Health Organization offered the principle of reciprocity as a guide to ensure there is equal respect and equity in vaccine allocation and uptake. We offer that equity, reciprocity, justice, and an anti-racism model be applied in determining eligibility for vaccine allocation.

Hafta Ichi
Source: The Guardian
Keyword: To avoid vaccine gerrymandering, the US must focus on racial equity | Byline Keon L Gilbert and Rashwan Ray | Opinion

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