Are COVID-19 resources going to who needs them most? Targeting tests, treatments, supplies, and vaccines to those most at risk of COVID-19, such as communities of color, would go a long way toward preventing the spread of the virus and reducing the health disparities exacerbated by the pandemic.
In the face of a dangerous pandemic, clinicians and public health officials are desperate for effective treatments and resources, particularly in underserved communities. So far, however, the federal government’s efforts to distribute resources follow a disturbing pattern of speed over need. Throughout the pandemic, the government has shipped out medications, money, and masks quickly–sometimes seemingly at random–rather than providing these resources to those at greatest risk of COVID-19. Now, with vaccines trials underway, the Department of Health and Human Services (HHS) must commit to reversing this pattern. We must ensure that the vaccine reaches those who need it most, first.
Drugs, bailouts, and masks
When Gilead’s antiviral drug remdesivir was first distributed in May, there appeared to be no rules guiding the process. In Massachusetts, for example, HHS gave remdesivir to the hospital with the greatest number of COVID-19 cases: Massachusetts General Hospital. But the agency bypassed other hospitals with caseloads that were almost as big in favor of hospitals with fewer COVID-19 cases. Notably, HHS did not provide remdesivir to Boston Medical Center, a hospital the Lown Hospitals Index ranked most inclusive for patients of color in the state, despite BMC having the second largest number of cases in the state.
Similarly, HHS distributed the first $50 billion of CARES Act bailouts to hospitals not based on their COVID-19 burden, but on their Medicare revenues. As a result, many hospitals serving communities of color hit hardest by COVID-19 didn’t get the relief funding they needed. HHS later moved to allocate more money to safety net hospitals and those in COVID-19 hot spots. Unfortunately, this money was delayed for months, putting hospitals at risk of closure or needing to furlough staff.
Such disorganization could potentially be justified in the beginning of the crisis. However, this pattern has persisted beyond the first few months of the pandemic. Some states, like North Carolina, had not received any remdesivir as of mid-August, despite being a COVID-19 hot spot in July. The administration’s distribution of 650 million masks this summer was also haphazard and inefficient.
Who gets a vaccine first?
Given this trend, we should be worried about how an eventual COVID-19 vaccine will be distributed. Is HHS is setting the groundwork necessary to get the vaccine to communities of color?
The Centers for Disease Control and Prevention (CDC) recently released criteria recommending that essential workers (including health care workers), those with high-risk medical conditions, and those age 65 and over get the vaccine first. Black and Latinx people are nearly three times as likely as white people to get COVID-19, and almost twice as likely to die from it. Living in high-occupancy households puts many people of color at greater risk of COVID-19, even if they aren’t essential workers themselves. Yet the CDC’s criteria does not specifically mention targeting communities of color. This omission is concerning. Without acknowledging the people we need to reach, we start a step behind in the process of vaccinating successfully.
An equitable rollout
Giving out a vaccine is not as simple as it sounds. The vaccine not only has to be available, it has to work. Also, communities have to trust that it is effective. If we want communities of color to get the vaccine first:
- they must be well-represented in clinical trials;
- public health officials need to reach out to these communities to address any concerns they may have about the vaccine; and
- health departments need adequate staff, PPE, and funding to administer the vaccine safely
We have a long way to go toward these goals. Members of Congress have impressed upon vaccine makers that diversity is “not optional,” but as of late August, only 24% of participants in Moderna’s Phase 3 trial were people of color, less than their proportion of the population (and far less than the 66% recommended to achieve rates of inclusion twice that of the population).
Some state and local health departments have taken the initiative to reach out to communities of color to understand and answer questions they may have about taking the vaccine. However, there does not appear to be a nationwide plan to make sure that people are ready to take the vaccine once it becomes available. Public health departments in areas hit hard by COVID-19 are already underfunded and understaffed; they need much more support to administer vaccines quickly and safely.
Let’s not give out the vaccine the same way we did other COVID-19 resources–sloppily and inequitably. HHS has an opportunity to lessen racial health disparities with a strategic and equitable vaccine rollout. This will only happen if they do the opposite of what they have been doing. We must be deliberate about allocating resources to those at the greatest risk.
Judith Garber
Latest posts by Judith Garber (see all)
Shannon Brownlee