Opinion: White Americans are being vaccinated at higher rates than Black Americans. Such inequity cannot stand."Uché Blackstock is an emergency physician and founder and chief executive of Advancing Health Equity. Oni Blackstock is a primary care and HIV physician and founder and executive director of Health Justice.
Yet White Americans are being vaccinated at rates of up to three times higher than Black Americans, as early data from the 23 states that are reporting racial and ethnic data on vaccinations show. In fact, across the country there arereports of majority-Black areas struggling to deal with nonresident White people traveling to their communities to be vaccinated.
Such inequity cannot stand. The Biden-Harris administration must urgently act to ensure that Black Americans are not left out of the vaccine rollout process. Here are four things the administration can do to stop this from happening.
First, Black people must be explicitly prioritized for the covid-19 vaccine. Despite the disproportionate impact of the pandemic on Black Americans, the Centers for Disease Control and Prevention has not explicitly used race and ethnicity as a criterion to delineate vaccine priority groups. The strategy from the CDC’s Advisory Committee on Immunization Practices of using “essential workers” and “people with underlying medical conditions” to include Black Americans is insufficient. In fact, overwhelming data shows that Black Americans have fared worse than others, even within priority groups, such as health-care workers and nursing home residents.
Second, we need to bring the vaccine to the people and meet them where they are. Most notably, the initial phase of vaccine distribution has been predominantly limited to large health-care systems and chain pharmacies, which are significantly less prevalent in Black communities. While locating vaccination sites in Black communities is absolutely necessary, it is insufficient given the lack of Internet access or digital literacy and the pervasiveness of medical mistrust, as a consequence of historic and present-day racism.
Black communities need easily accessible and trusted points of access to the vaccine, such as community centers, faith-based organizations, schools and mobile vaccination units run by credible and trustworthy community-based organizations. Additionally, vaccine appointments at sites in Black communities should and must be prioritized for people living in that community.
Third, we are running months behind on an expansive public health campaign that would provide education and address concerns about the vaccine. This campaign would provide much-needed information in a clear, digestible and culturally responsive manner. Trusted messengers, including community organizers, barbers and religious leaders, would provide vaccine education and help make vaccine appointments. Community health workers, trained lay professionals familiar with these communities, could also facilitate door-to-door outreach to residents.
Finally, the Health and Human Services Department and the CDC must mandate that states collect complete racial and ethnic demographic data, including Zip codes of those who are vaccinated, to help target public health efforts toward Black communities. As Marcella Nunez-Smith, the head of the Biden administration’s Covid-19 Health Equity Task Force and a former co-chair of the presidential transition team’s covid-19 advisory board, said: “We cannot address what we cannot see. We are making a choice every time we allow poor-quality data to hinder our ability to intervene on racial and ethnic inequities.”
These data would then be published on a public-facing dashboard, updated in real time, and used to inform federal, state and local vaccine distribution and outreach efforts. It would also help to ensure that those in the hardest-hit communities are receiving the vaccine and not being pushed out by people from less-impacted areas.
Some in the public health field have suggested that a focus on equity could slow down the vaccine rollout. While there is urgency to vaccinate quickly, it cannot and must not be done at a cost to equity. We agree strongly with Lawrence Gostin, a professor of global health law at Georgetown University, who argues that, given the detrimental impact of systemic racism on the health of Black Americans, “a racial preference for a Covid-19 vaccine is not only ethically permissible, but I think it’s an ethical imperative.” In the long run, prioritizing racial equity during the vaccine rollout will result in more lives saved overall, including in the communities that have suffered the most.
If we’ve learned anything from this pandemic, it’s that systemic racism has detrimentally influenced the material living conditions, opportunities and experiences of Black Americans, leading to a devastating human toll. A color-blind approach to vaccine distribution will no doubt prove catastrophic. If we do not act urgently, the pandemic’s existing racial health inequities will only worsen. We cannot afford to waste any more time."