Missing the boat on vaccinating the black community

A strategy for boosting uptake, saving lives

MASSACHUSETTS LEADERS have pledged to address systemic racism. A COVID-19 vaccination strategy that prioritizes heavily impacted black communities is the opportunity to slow the spread of the disease while bringing real meaning to those words.

Black and brown Americans have shouldered the burden of the pandemic, with blacks particularly impacted. In undervalued and underpaid jobs, many have worked on the frontline of the COVID-19 economy. Measures to protect them have been insufficient, even as their disproportionate exposure, infection, and death from the virus continues.

Hope for the future lies in receiving the vaccine. However, a critical mass of large vaccination clinics in communities of color is noticeably absent in state plans to scale the vaccination effort. A strategy that accounts for the nuanced needs and expectations of black residents has not been announced. It would seem that blacks are again being left behind with the structural barriers that have led to the dual pandemics of health inequity and racial injustice perpetuated.

Data released by the Kaiser Family Foundation shows that in the current round of vaccines, largely to frontline healthcare workers, blacks are receiving COVID-19 vaccinations at much lower rates – in Massachusetts 2.6 percent of whites have been vaccinated compared with 1.8 percent of blacks as of January 28. The first group of eligible recipients should have been easy to vaccinate. However, issues of equitable access, such as leaving environmental services workers off emails about vaccine registration, caused a derailment. When compounded with the legacy of vaccine mistrust, vaccination among blacks lags.

At the root of medical mistrust is centuries of experimentation on black people without their consent. Apologies, new ethical standards, and vaccine education will do little to combat hesitancy without improved access. Polling results show that knowing someone who has received the COVID-19 vaccine greatly influences a person’s willingness to get vaccinated. Thus, establishing a means for everyone to get vaccinated easily will develop the momentum necessary to gain ground in the black community.

The strategy must account for the structural and technological barriers faced by blacks to make a fair distribution of vaccine doses possible. In fulfilling their commitment to an antiracist approach to health policy and interventions, state officials are engaging trusted community voices and established pillars, typically religious leaders. But they need to also activate the network of recreational centers, minority physicians and nurses and their professional associations, health advocates, and community health centers. The state should include independent pharmacies in the vaccine rollout. They are often the only point of care for  residents of lower socio-economic communities. These pharmacists know their customers and their medical histories.  And those customers trust them.

The Reggie Lewis Track and Athletic Center in Roxbury has opened as one of the vaccination sites in communities of color. This represents a significant step towards achieving equity; however, questions remain. Will community representatives have significant input in site operation and will vaccine doses be administered by professionals in whom black people have confidence? Data shows that black patients desire care from black healthcare workers whom they trust the most.

Further, Roxbury is home to only a segment of the black community. Multiple sites are needed in every area hardest hit. Mobile clinics should also be considered. Because of the racial wealth gap, black households in Massachusetts are less likely to own a car. A system of vaccination that requires families to rely on public transportation to obtain their shot is burdensome. Many also work multiple jobs with little paid time off, making lengthy travel for vaccination a tall ask. We should also think about the health hazards in stepping on a bus given the high positivity rate and variable quality of masks used.

Surely this undertaking will require an upfront financial investment. However, should we affix a price to potential lives saved, reduced mental anguish, ability to safely earn wages, as well as slowing the pandemic in these heavily impacted communities?

Meet the Author

Sharma E. Joseph

Assistant professor of anesthesiology/Anesthesiologist and critical care physician/Student, Tufts University Medical School/Tufts Medical Center/Harvard T.H. Chan School of Public Health
At stake is not only the health of those who have risked their lives to earn a living while keeping critical services functional, but the opportunity to regain the trust of black Americans who have seen their contributions to American prosperity frequently dismissed.

Dr. Sharma E. Joseph is assistant professor of anesthesiology at Tufts University School of Medicine, Aaesthesiologist and critical care physician at Tufts Medical Center, and a student at the Harvard T.H. Chan School of Public Health. She also currently serves as director of health policy and advocacy at the New England Medical Association.