Equity in Access: COVID-19 Vaccine Uptake in Minority and Racialized Groups

THE RACE ACROSS THE POND INITIATIVE ‘Women of Color in the Healthcare System’ Series

Equity in Access: COVID-19 Vaccine Uptake in Minority and Racialized Groups

By Laëtitia K.M. Diatezua, Saara Bouhouche, Sherihane Bensemmane, Yasmine El Addouli Across the world, minority populations are bearing the greatest burdens of COVID-19 cases. The elements below, discussed in the context of the US, are globally relevant to countries worldwide in containing and suppressing COVID-19. It is recommended that non-US audiences observe how the below discussed factors are relevant to their population and COVID-19 case & vaccine distribution.

As more countries work to suppress their case-loads and death tolls amid ongoing or recent surges, they now look to the developed COVID-19 Vaccines – Pfizer-BioNTech, Moderna, Oxford/AstraZeneca, Johnson&Johnson/Janssen, Gamaleya (Sputnik V), Novavax, Sinopharm, SinoVac, Bharat Biotech – to give them an advantage over the virus and its circulating variants. While administering the vaccine, the U.S is one of the few countries collecting race, ethnicity, and gender data with vaccination (55.3%-57.9% of administered doses so far). According to the data, only 8.3% of Black and 9.5% of Hispanic/Latino, persons are fully vaccinated—despite these communities carrying some of the highest burden of COVID-19 in that country.

During this pandemic, as case numbers and deaths climbed to all-time highs, we saw COVID-19 cases and deaths disproportionately affect Black and Brown persons. In one US city, Chicago, Black people made up 60% of COVID cases despite being only 30% of the city’s population. Furthermore, the United States Centers for Disease Control and Prevention published data showing that the risk of COVID-19 infection for Hispanic/Latinos, Black Americans, and Native Americans are 2.0, 1.1, and 1.6 times higher respectively when compared to White Non-Hispanic persons; their risk of death from COVID-19 is 2.3, 1.9, and 2.4 times higher in comparison. As of 17 April 2021, weekly cases per 100,00 people in the United States still show that the highest numbers were those pertaining to Black non-Hispanic persons, and Hispanic or Latinos.

Women of Color Advancing Peace, Security, and Conflict Transformation Race Across the Pond: Women of Color in the Healthcare System Series

So, why are the vaccine access rates so low in these populations who, arguably, are among the greatest in need of it? The answers lie in the vaccine distribution processes themselves and whether they overlook the safety, infrastructure, and financial factors that bar Black and Brown communities from seeking vaccines once they are available.

In reviewing or updating the vaccination process, states and countries should consider the following elements affecting Black and Brown communities: Safety: Is COVID-19 the greatest threat to the safety and well-being of my person and loved ones? – Vaccination can reduce the spread of COVID-19 and improve the safety of Black and Brown persons; but, for many members in Black and Brown communities, there are greater threats to their safety than contracting COVID-19. Fear of deportation is a significant concern among undocumented persons. For immigrants, the 2019 revised public charge rules limit their accessing of public services and create fears that accessing public services, such as vaccinations, can prevent their path to residency. (As an immigrant myself, I can honestly say there was no greater time of extreme caution nor greater fear than in waiting for your residency to come through.) Anecdotally, some Black and Brown persons, especially women, must consider the risk of violence in accessing the vaccines. If travel to and from a vaccine site requires returning home later in the night than normally done and/or using an unfamiliar route home, this puts persons at risk of violence from police officers, and gang violence (already international authorities recognize organized crime will, if not already have done, infiltrate or disrupt vaccine supply chains on a global scale) as well as xenophobically-driven violence.

Infrastructure: Is registering for the vaccine and accessing the vaccination site truly accessible? – In most states within the US, vaccine registration is online and requires bringing proof of registration to your vaccine appointment – which is predominately done in pharmacies. Since only 51% of Hispanics and 60% of Black persons in the United States own personal computers and roughly 30% of black people in the United States have access to quality broadband, the online registration method likely misses at least one-third of Black and Brown persons. Furthermore, for Black and Brown communities that reside in “pharmacy deserts” - like those in Los Angeles, CA and Chicago, IL – vaccine access is severely compromised even they successfully register.

Financial: Can I financially afford the vaccine and the risk that its side effects could take me away from work for multiple days? – The Pfizer and Moderna vaccine are reportedly showing side-effects that take one or more days to recover from as part of conferring immunity. Therefore, persons registering for vaccine need to accept the possibility of having to take leave from work. In 2018, National Partnership for Women & Families reported that 62.2% of Black working adults and 72.5% of Hispanic working 2

Women of Color Advancing Peace, Security, and Conflict Transformation Race Across the Pond: Women of Color in the Healthcare System Series

adults are either ineligible or cannot afford to take leave. Furthermore, the US Census showed that Black and Hispanic persons are overrepresented in poverty and lower income classes. These factors make the vaccine a significant financial risk to families and individuals who cannot afford to take time off work or whose employers will terminate their employment if they do so.

Safety: Can I confidently trust the vaccine and the professional inoculating me or will they obfuscate in answering my questions about this vaccine? – Mistrust is high towards the vaccine and the personnel who are vaccinating persons and/or providing care post-vaccine. Lack of information that answers questions about COVID-19 vaccines is compounded by the fact that Black and Brown communities have historically been lied to and exploited many times for the sake of medical advancement.

The Tuskegee Syphilis Experiment and Ringworm Radiation Experiment, along with sterilization eugenics and Indigenous People experimentation, are among several examples in which Black and Brown persons were lied to by multiple care providers when they expressed concerns about the “treatment” they were receiving. Furthermore, the implicit racial bias of medical professionals towards Black and Brown persons historically has led to negative health outcomes within these communities, continuing into the treatment of COVID-19. Under these circumstances, a lack of community-relevant questions being addressed will delay vaccine uptake by Black and Brown people.

Vaccines play an integral role in increasing the quality and longevity of life. This fact has never been clearer than during this pandemic. These barriers to vaccine access and uptake are not unique to the United States, North America, nor the Global North.

Globally, addressing these barriers to equitable vaccine access must be prioritized in a collaborative effort in a country-specific context under the guidance of the communities being targeted. The efforts must be as diverse as the people themselves. With guidance from Black and Brown communities, vaccination and case rates can improve to the betterment of everyone. We can do it

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