Statewide action needed to ensure vaccine equity

[Op-ed by Mark Abraham and Yusuf Ransome]

President Biden’s COVID-19 vaccination plan aims to provide 100 million shots during his first 100 days in office. To achieve this plan of reaching what researchers call herd immunity —when a large part of the population has become immune to a virus or disease— requires people in the most vulnerable communities to have unprecedented access to immunizations.

Among U.S. states, Connecticut is fourth in percent of the population that has received their first dose of the COVID-19 vaccine, and the number of doses administered each week continues to rise. Despite such success, data systems show troubling trends that require state action to stem now.

We have extreme disparities in access by geography. And while Black and brown residents have been at the highest risk of being exposed to and dying from COVID-19, we are learning that these same groups are less likely than white Americans to be able to get the vaccine, based on access as well as concerns that stem from systemic historical inequities.

In a focus group that DataHaven helped to organize in December, Black residents revealed widespread concerns about the safety and efficacy of vaccines. As in other focus groups conducted nationally, the concerns of Black residents here were rooted in their prior experiences of racial discrimination and barriers to accessing healthcare, which have deposited seeds of mistrust in science and conditioned people to avoid the healthcare system.

It has been clear from the beginning of the pandemic that without public policy intervention to address these interrelated issues of trust and access, the wellness gap in Connecticut would continue to widen.

The statewide DataHaven Community Wellbeing Survey in August 2020 found that 81 percent of adults in high-income towns such as Woodbridge said they would take the COVID-19 vaccine when it became available. But in Hartford, New Haven, Bridgeport, Waterbury, New London, and similar core cities, only 64 percent of white, 48 percent of Latino, and 32 percent of Black adults said they would. Black adults also reported lower levels of trust in local institutions to look out for their best interests. Among the subset of young adults (age 18 to 34) who reported less trust in healthcare providers, just 25 percent said they would get the vaccine. National tracking surveys suggest that public intention to receive the vaccine has slightly increased since August, but the increase is mostly among older adults, who are already the default priority for vaccination.

After a year of loss and hardship, with Black and brown people hit the hardest, policymakers must make informed decisions to avoid deepening public mistrust in the system. We need the following actions to ensure that relief reaches the most adversely affected Connecticut residents:

• Establish systems that cultivate unprecedented access to vaccinations but that will remain functional after COVID-19 ends. According to the Department of Public Health, as of early February, over 70 percent of older adults in many of the state’s wealthiest towns had received a first dose of the COVID-19 vaccine, compared to less than 25 percent of older adults in New Britain, Bridgeport, and Waterbury. The state needs more vaccination sites in Black and brown neighborhoods, whose residents are 2 to 2.5 times more likely to die from COVID-19 than white residents. A policy to open more vaccination sites 24/7 could allow people who work or care for children during the day to get vaccinated. State intervention should center vaccine access around the social drivers of health. Specifically, free public transportation can help those who don’t have a car get to vaccination sites (and more permanently, to other essential services) that are not located within walking distance.
• Establish linkages between health care and other community institutions that have historical participatory credibility. For instance, legislators must move beyond seeing churches solely as a physical site to utilize, and towards cultivating relationships in which on-the-ground demands and wisdom are listened to and respected. The legislature should direct funding to support social programs that uplift and empower residents. The state can build trust by increasing its support for small businesses, many of which have strong credibility in communities of color but are struggling to stay afloat and provide high-quality protective equipment. Investments must demonstrate a long-term commitment to community well-being, not only to preventing disease and getting past COVID-19.
• Establish more culturally congruent ways of informing people of vaccine availability. Letting people know when they are eligible for a vaccine and how to get it has been a bottleneck. It was reported that the state’s web-based vaccine scheduling system requires users to have an email address—and that the website was only available in English. Although there are alternatives for signing up and other efforts underway to try to reach residents in every town, we will need to do much more to reduce the current reality and perception that affluent residents have an overwhelming advantage.
• Ensure accurate, consistent neighborhood-level data collection and transparency. The first people to receive the vaccine have been disproportionately white. Detailed data about who is getting vaccinated—by age, gender, race/ethnicity, town, and neighborhood—must be collected and made available for the public to use to assist in ensuring that vaccination is rolled out equitably. High rates of vaccine uptake at a town-wide level can mask enormous disparities in access by neighborhood.

As Connecticut continues to lead the nation with vaccine implementation, we urge our leadership to act upon these calls through legislative and executive action. Connecticut has an opportunity not only to lead in vaccination numbers, but also in equitable approaches that ensure we are a place where all groups, regardless of race or socioeconomic status, can recover and flourish.

Mark Abraham is Executive Director of DataHaven, a non-profit organization with a 25-year history of public service to Connecticut communities. Yusuf Ransome is an Assistant Professor in the Department of Social and Behavioral Sciences at Yale School of Public Health.