Community Health Centers Work to Address COVID-19 Vaccine Inequity

by Sally James

The State of Washington released a report on Feb. 10 showing that white people are getting a higher proportion of the limited amount of COVID-19 vaccines than other races and ethnicities in the state.

For Trang Tu, a community activist who cares for her elderly mother — who has dementia and needs 24-hour care — getting a vaccine presented numerous hurdles. Tu eventually got a last-minute tip from a mass vaccination site in Snohomish county, a long drive from her home south of Rainier Beach, and her mother is now vaccinated. "It's not just limited supply of vaccines itself," Tu said. "Access is not equal. It favors people who have time, an internet connection, transportation, and a certain language."

Tu's mother was able to overcome systemic barriers because, Tu says, "I have some privilege: I have a computer, I have a car, I can do advocacy." Many other BIPOC people aren't as fortunate.

Even though Black and Brown communities have been hit harder by the pandemic — with higher rates of bad outcomes from COVID-19 including hospitalizations and deaths — they are not receiving vaccines in an equitable proportion to their population in this state.

How much of this problem is from people not able to access the limited amount of vaccine? How much is from reluctance that stems from a history of racism in medical research and therefore a mistrust? Both factors may play a role, but without further study, it is impossible to know for sure.

Such racial inequity is unfortunately a historic pattern in the United States. Both lower incomes and racism have been part of lower life expectancy and less access to health services for minorities. But in the past few weeks, racial inequity in vaccines has been a frequent talking point at the national, state, and local level.

The data released on Feb. 10 by the Washington Department of Health (DOH) showed that people receiving a first vaccine dose who identified as Hispanic were only 4.7% of the total receiving a first vaccine, but that Hispanic people account for 13.2% of the state's population. Black people had received 2.2% of first vaccine doses, but represent 3.9% of Washingtonians.

For those over 65, the gap in vaccination rates in the state is also wide, according to the most recent data posted on the DOH's COVID-19 Data Dashboard. Of people over the age of 65 who've received completed vaccinations, 76% of them are white, though they make up 85% of those over age 65. But only 2% of people over 65 who've been completely vaccinated are Hispanic, even though they account 4% of those over 65. Similarly, only 1% of those over 65 who've been completely vaccinated are Black, even though about 2% of the state's population over 65 is Black.

There are limitations and complications with these numbers. Race or ethnicity labels are not available for about 11% of people who've received shots. And some of the categories, such as Non-Hispanic Other Race, are collected in some vaccination data, but there is not a corresponding category in population reports.

Data from King County is also incomplete, and though the county tracks vaccination rates by race and ethnicity, it cautions that data is self-reported and may under-report certain demographics. Public Health Seattle — King County notes on its website that it's working to find other data sources to improve tracking of vaccination rates according to race and ethnicity.

"The missing data doesn't change the overall story," said Aaron Katz, Ph.D., a researcher who retired last year from decades of studying public health at the University of Washington School of Public Health. Katz spoke to the Emerald from his home in Anacortes, Washington, where he is also a member of the Skagit County Health Board.

Sherry Williams, who is vice president for community engagement and external relations at HealthPoint, pointed out a few ways that the numbers may not reflect the community reality. People sometimes check the box for "white" in hopes that they will get better service, she explained to the Emerald. Other people who are multi-racial may not feel comfortable with the choices they are offered and check a box that isn't truly descriptive of their identity. Williams identifies as Black.

HealthPoint is a nonprofit that runs many clinics serving low-income populations in South Seattle, as well as Renton and Bothell. Williams also pointed to ways that HealthPoint patients, and other low-income people, get left behind in the process of trying to get a vaccine. If a person does not have a computer or smartphone, they can't sign up online for the state's Phase Finder application. After completing an online survey about age, health status, and other relevant information, Phase Finder sends out an email notifying people about when they qualify to receive the vaccine, but it offers no assistance on where someone can go to receive the vaccine.

Economic factors limit the ability to receive a COVID-19 vaccine. If a person works full-time and has no car, they need to deal with bus service on weekends, which is much reduced from pre-pandemic times. Williams has heard from patients who are willing to get a vaccine, but their bus service is spotty on weekends, and buses have reduced capacity. If a bus is "full" by the new pandemic definition, it will drive by a waiting person at a bus stop. Because of this, Metro announced some changes aimed at making it easier for people to use transit to get to vaccine destinations.

In addition, if a person doesn't speak English, their route to learning about vaccine opportunities is more difficult. While some community clinics include translation services, language struggles can still slow things down or keep some people from learning about a pop-up vaccine center, for example.

At HealthPoint, Williams and other staff have been meeting regularly to strategize ways to bring vaccines to the highest-need patients who may be without a computer, smartphone, or a car. One of their methods is to call People of Color by phone who qualify in the current 1B-1 phase (over 65 years old or over 50 in multigenerational households) and offer them the vaccine before offering it to other patients. At HealthPoint, they had given about 1,039 vaccinations to patients by Feb. 9, and of those, only 28% went to white patients, she explained.

"We don't have the ability to make things 100% equitable," Williams said. "But we can make the vaccine accessible to our patients that are high need and disproportionately disadvantaged," she said.

HealthPoint, as well as Sea Mar Community Health Centers and the International Community Health Services, are all community health centers, or CHCs, that serve predominantly BIPOC and immigrant populations. The Biden administration has selected CHCs to receive more vaccine doses more directly in order to try to ease inequity. To date, COVID-19 vaccine distribution has been complex and confusing. Allocation from the federal government has been growing but sporadic and sometimes delayed by weather and other factors. Allocations are to states, some retail pharmacies, tribes, and now, CHCs directly.

Politicians such as Mayor Jenny Durkan and Governor Jay Inslee have spoken out in favor of improving these numbers. Durkan announced some specific ways the city will target specific neighborhoods last week, telling a radio audience on KUOW that the city is having firefighters give vaccines at pop-up sites specifically targeted to neighborhoods with high rates of COVID-19 infections.

There is also a coalition of the city of Seattle, King County, and state resources directed at trying to move the needle on vaccine inequity, described in a Seattle Times article. On Feb. 9, the Seattle City Council hosted an online community panel on vaccine equity that featured Trang Tu, Esther Lucero, MPP, and Abigail Echo-Hawk, M.A., of Seattle Indian Health Board, Teresita Batayola of International Community Health Services (ICHS), Jesus Sanchez of Sea Mar Community Health Clinics, Dr. Ben Danielson, and Jiji Jally of the Marshallese Women's Association. The forum addressed barriers that immigrant and refugee communities, especially elders, have been experiencing with vaccine access.

Batayola has been making many media appearances to advocate for more vaccines for the Asian and the Pacific Islander population served by ICHS. Some of those patients are immigrants or refugees. In a television interview with CNN, Batayola compared the competition for vaccines to the fictional "Hunger Games," where the only the fittest can get through. "You must be digitally fit," she explained, to get the vaccine, knowing your way around computers and websites.

Tu, whose mother had difficulty getting the vaccine, is part of a coalition of community activists and organizations that pressured the DOH to include caregivers and multigenerational families in the latest 1B-1 phase of the state's vaccine rollout plan. "But I'm under 50," Tu said, noting that she technically doesn't qualify for the vaccine. Many BIPOC families are in the same situation. "If I get sick, my mother won't have care."

Some patients who are coming to HealthPoint for regular health issues are also offered vaccines if they fit in the state's phase to receive it at this time. According to the DOH's website, in general, people over 65 as well as people over 50 who live in multigenerational households are eligible. Health care workers, including nursing-home staff and first responders, continue to also remain eligible.

Katz said these inequities are a reminder that our complicated health system remains hamstrung by our racial history of injustice. He hopes that maybe the bright light shining now will make changes come faster.

"COVID has largely highlighted for us the racial and ethnic unfairness of just about every aspect of our lives, every aspect of our society," Katz said. While he would not bet his retirement on structural changes, he said he was hoping to see local and federal leaders "take the opportunity the light is providing to really try to make some headway on the structures that reinforce all these inequities."

📸 Featured Image: Preparing a COVID-19 vaccination at a pop-up community site. Photo courtesy of International Community Health Services (ICHS).