California's COVID Vaccine Plan: Speed Over Equity?
By Barbara Feder Ostrov | CalMatters
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In the affluent desert community of Rancho Mirage, Eisenhower Hospital recently invited donors to get their COVID vaccinations alongside health care workers in what executives called a private "test" clinic. In Walnut Creek, public health officials cut off a concierge doctor's vaccine supply amid concerns she allowed people to jump the line at the immunization clinic she organized. Hollywood power brokers are flying in private jets to Florida, where vaccine eligibility is looser.
It's not hard to see why health equity advocates are increasingly concerned about emerging disparities in California's vaccine rollout -- the same kind of inequities laid bare in so many other aspects of the coronavirus pandemic.
Their worries have only intensified as California officials expanded vaccine eligibility to the roughly 6.2 million people who are 65 and older. In doing so, the state scrapped complicated eligibility proposals that had prioritized essential workers and lower-income communities already most devastated by the pandemic.
Although some essential workers -- teachers, first responders and food and farm workers - remain next in line for the shots, the state after that will primarily expand eligibility by age, likely people 50 and up. The goal: to speed up a chaotic vaccine rollout that consistently has California lagging behind many other states in distribution rates even as it has given 3 million immunizations as of today.
THE VACCINE TRADE-OFF
Some health advocates now fear California is sacrificing equity for speed. They wonder how the state is going to live up to Gov. Gavin Newsom's oft-repeated pledge to distribute vaccines with an "equity lens."
"We feel like our communities are being once again overlooked," said Rhonda Smith, executive director of the California Black Health Network. "It's nothing new, but it's disappointing. This is our reality and why we do the work we do."
Alice Wong, a San Francisco disabled activist, said she was "completely thrown" by the new emphasis on age. Under previous criteria, Wong, who is 46, would have been eligible shortly after health care workers and nursing home residents.
"With high-risk people like me deprioritized, I will be part of a huge cohort and may have to wait longer or face more difficulty getting an appointment," said Wong, who has a progressive neuromuscular disability that requires the use of a wheelchair and ventilator. "It's very painful, especially with new variants of the virus emerging and knowing the pandemic won't end anytime soon."
DISPARITIES IN PANDEMIC FROM THE START
The pandemic has disproportionately affected Latino, African-American and low-income Californians. Latinos are 20% more likely to die from COVID-19 than Californians as a whole, and the case rate is nearly 40% higher in low-income communities, according to the California Department of Public Health.
State officials have tried to address equity concerns throughout the pandemic, tying counties' ability to reopen to their efforts to bring down case rates and increase testing in disadvantaged communities.
But because of the new, more infectious coronavirus variants emerging, some health experts believe speed is more important than equity. The faster California achieves herd immunity, the safer everyone will be from these variants, they say. And, they argue, vaccines should go to people by age because older people are more likely to die from COVID-19.
Yet the vaccination disparities emerging in California and nationwide are hard to ignore, even though their scope is hard to determine: California and some other states have not publicly released demographic information on those immunized.
Los Angeles County public health officials this week released data showing lower vaccination rates among health care workers who live in South Los Angeles, a primarily Black and Latino district. The county is opening six vaccination sites there, the Los Angeles Times reported.
A Kaiser Family Foundation analysis found that in 16 states reporting race and ethnicity in their vaccination data, Blacks and Latinos were vaccinated at rates lower than their share of population, while whites were vaccinated at rates higher than their share of population. The early data mostly involves health care workers and older people, but researchers say it provides "early warning flags" about problems with vaccine equity.
Underlying these disparities is a complex set of issues. Smith, of the California Black Health Network, cites a historic lack of trust in an American medical establishment perceived as racist. She said some Black residents fear the vaccine because of myths circulating on social media and because it was developed quickly.
Anthony Wright, executive director of the advocacy group Health Access, points to the barriers some marginalized groups face in getting access to vaccination sites: "technology, transportation and time." People seeking vaccinations often need access to the Internet along with a computer or smartphone, a way to get to a clinic, and the time to spend hours on the phone or online seeking an appointment. Many sign-up sites only offer English. Some lower-income groups lack access to the informal "whisper networks" that share tips on last-minute vaccine availability.
"The issues of equity are as much, or even more, about the logistical 'last-mile' issues that individuals face as they are about prioritization," Wright said.
The state's vaccine working group experts initially proposed allocating vaccine doses first to health clinics in communities scoring low on the state's Healthy Places Index, which evaluates income, insurance coverage, education, pollution, density and other factors affecting residents' health. The state has also launched a vaccine public education campaign in several different languages and is working with a California network of nonprofits groups who helped U.S. Census workers reach diverse communities.
After Newsom announced that people 65 and older were eligible, however, the group suggested that only 20% of vaccine doses go to those disadvantaged communities, with the remaining earmarked for older adults regardless of income or race.
A FRESH LOOK AT VACCINE DISTRIBUTION
Some help may come from the Biden administration, which has created a national COVID-19 health equity task force to advise on allocating vaccines and other pandemic resources. And within California, some public health experts suggest opening small vaccine clinics at elementary schools or fire stations, which exist in almost every community, including poorer neighborhoods.
Some efforts will be local: One South Los Angeles doctor -- irritated by the young, mostly white people who seek leftover doses at his COVID vaccination clinic -- hopes to secure grant money to bring mobile vaccination clinics directly to the homeless and other hard-to-reach groups.
In the meantime, as health advocates adapt to the new eligibility scheme, they're mobilizing to press health officials for more flexibility, particularly for the disabled.
Disabled rights advocates already have launched a grassroots call-in campaign to Newsom and state officials, and other health advocates say they're developing their own lobbying efforts.
"Everybody's got vulnerable people they're trying to represent," Smith told CalMatters. "Everybody deserves access and equity, but how do you prioritize? It's a really tough decision to make."
This story was originally published by CalMatters.