The birth of a disparity: What does the high vaccination rates among white America say about justice?

To watch the troubled rollout of the COVID-19 vaccination is to be present at the birth of a disparity.

Millions of people are being vaccinated every week. About 6% have been fully vaccinated including more than 900,000 people in Pennsylvania. “There is a light at the end of the tunnel as vaccine production and distribution increase,” Gov. Tom Wolf said remembering the one-year anniversary of the virus coming to PA.

Yet, despite public health officials’ efforts to prioritize those most at risk, there is a racial vaccination gap developing across the country. While people of color are dying at a higher rate, they are getting vaccinated at lower rates than white people. Wealthy white America is edging out poorer Black and brown America for the shot.

(Photo by CDC on Unsplash)

According to the Kaiser Family Foundation (KFF), white people’s vaccination rates are over 2.5 times higher than Latinxs and nearly twice as high as African Americans. In Pennsylvania, white people are four times more likely to be vaccinated than Latinxs.

A  KFF December poll showed that about 50% of Black Americans who plan to get the vaccine are taking a wait-see attitude to see how it is working first compared with 36% of white Americans. “However, these differences in ‘willingness’ to get the vaccine do not appear large enough to explain disparities that are emerging in vaccination rates, suggesting that other factors, such as access barriers, may be playing a significant role,” KFF explained.

Looking at the Latinx community specifically, KFF cited barriers such as lack of insurance, lack of a primary care physician, difficulty in finding an accessible health care facility, linguistic barriers and immigration status concerns all play in the lower vaccination rate.

And these problems have created opportunities.

Stories of vaccination tourism abound in the press as wealthier white people cross state lines or crowd into poor inner-city clinics to get their shot. A recent story in the Philadelphia Inquirer, reported that Rite Aid, a major vaccine distributor in the city, contributed to the city’s vaccine inequity because 87% of its dosages went to white recipients and 60% to people who live outside of Philadelphia.

One reason may be the chaotic vaccine rollout in the suburbs.

“The sign-up system in suburban Philadelphia, if it can even be called in good conscience a ‘system,’ is to consumers no different than a slot-machine session in a two-bit speakeasy,” said Philadelphia Inquirer columnist Marie Panaritis, whose reporting has shown that local suburbs were getting less dosages when compared to smaller counties in the state. [Editor’s note: Generocity will look at the vaccine rollout in the suburbs and the impact  especially in the communities of color there, in a forthcoming article.]

Public health experts have maintained vaccine hesitancy is a main driver of the racial gap but that narrative is being contested. “Vaccine hesitancy is a real concern, but I worry that focus on vaccine hesitancy is a way to deflect responsibility for equitable distribution on the front end,” Anne Sosin, program director for the Dartmouth Center for Global Health Equity told Politico.

Here is how the country’s healthcare system and elected officials fumbled the vaccine distribution and instead of equity created a rollout that gave preference to wealthier white Americans.

Trust

White America is not burdened with a lack of trust in their health care providers. Data is from a KFF survey showed that almost 8 out of 10 white patients trust their doctors and 7 out of 10 trust their local hospital to do what is right. Over half trust the healthcare system. All of these numbers are higher than for Latinx and African American patients.

In addition, only 41% of white patients think “our health care system treats people unfairly based on their race or ethnic background” compared to 70% of Black adults. On the other hand, 1 of 5 Black and Latinx adults admitted to being treated unfairly because of their race or ethnicity when getting health care for themselves or a family member in the past 12 months. Only 1 of every 20 white adults had a similar experience.

With trust, built on a history of positive interactions with the health care system, there is no need to take a “wait-and-see” approach.

Information networks

Access to information has allowed for a quicker response. According to KFF, about 6 in 10 Latinx adults say they do not have enough information about where to get the vaccine, compared to about half of White adults. The problem is the internet is a faster information source than a hand delivered flyer or a phone call from a trusted messenger with information about vaccination.  This is what is required to reach an at-risk population. Public health leaders must connect and collaborate with community and faith-based organizations who have the strong neighborhood ties.

 Digital divide

Sign up procedures were designed for those with working cellphones, strong bandwidth, fast internet, good English skills and digital literacy. Many of those most impacted by COVID-19 lack access to the internet, have difficulty using technology, and often need a digital navigator to help them once they are on a site. Dr. Jessica Boyd, the chief medical officer of Unity Health Care in Washington, D.C. told reporters that the “digital divide was evident. After the city opened vaccine appointments to those 65 and older, slots were gone in a day. And Boyd’s staffers couldn’t get eligible patients into the system that fast.”

Time and transportation

The cumbersome process of finding and registering to get vaccinated requires significant amount of time freedom that many low-wage workers lack. They don’t have a job that would allow them hours needed to navigate websites searching for an appointment. Even if time wasn’t a problem, transportation can be a serious obstacle. A private vehicle will beat SEPTA any day in terms of providing convenient accessibility to a vaccination site. Black households are less likely than other groups to have access to a vehicle. Accessing care is an issue. About a quarter (24%) of Black adults and 3 in 10 Latinx adults say it is difficult to find healthcare at a location that is easy for them to get to, compared to 18% of white adults.