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In the United States, people of color, specifically Black, Latinx, and Indigenous populations, are disproportionately impacted by COVID-19 and account for an overwhelming number of cases, hospitalizations and deaths. Black people have higher rates of cases (1.4 times), hospitalizations (3.7 times), and deaths (2.8 times) relative to their white counterparts. The development and distribution of COVID-19 vaccines offers hope for combating these inequities. Unfortunately, vaccine rollouts have proven to be yet another area where we see inequities playing out. In the 23 states that collect demographics about vaccine recipients, white residents are getting vaccinated at higher rates (often double or greater) than Black residents. This can be attributed to systemic challenges that have led to medical mistrust, increased occupational exposure, limited culturally competent care, limited vaccination sites in Black neighborhoods, and limited supplemental support. In order to change the inequities that Black populations are facing during the pandemic, vaccination rollout must have a health equity lens.
Vaccination Efforts Must Acknowledge Medical Mistrust
Medical mistrust is a large contributing factor to the hesitancy that many Black people feel when they are deciding whether or not to receive the COVID-19 vaccination. The United States has a long history of withholding care (e.g., the Tuskegee Syphilis Study), experimenting on Black people (e.g., chemical and radioactive testing on prisoners), coercing medication use (e.g., incentivizing welfare recipients with more financial assistance if using long-acting contraception), and conducting procedures without patient consent (e.g., forced sterilizations on Black girls and women). Against this historical backdrop, skepticism about the vaccines is well-grounded.
As institutions and providers begin to increase outreach efforts, historical brutalities have to be acknowledged and understood. Allow Black people to talk about their questions and concerns. Provide education that is accurate, culturally relevant, and not fear-based so people can make informed choices for their lives. Materials and discussions should include information about side effects, efficacy, contraindications, development time, and how both COVID-19 and the vaccine can impact people living with pre-existing conditions.
Vaccination Stages Should Take into Account Occupational Exposure
Frontline industry workers have an increased risk for contracting COVID-19 because of exposures to multiple people and the inability to socially distance, and Black people make up 17% of all frontline industry workers in the United States. This includes workers from six areas (grocery, convenience, and drug stores; public transportation; trucking, warehouse, and postal service; building cleaning services; health care; and childcare and social services). It is, therefore, important to include frontline workers in the early phases of vaccinations. This may require vaccination sites to give precedence to type of employment (e.g., cafeteria workers in a hospital) over age. Frontline industries can show that they value the lives of their employees by allowing them to take time off for vaccination appointments.
Vaccination Should Be Grounded in Culturally Competent Care
Access to health care is not just about proximity to a health center or hospital; language is also a factor in accessibility. Community health workers are a vital part of ensuring equitable care. They often reflect the demographics of the communities that they serve and so can communicate in a way that is familiar to community members. Materials about vaccinations should be available in the languages that local residents speak. Too often, Caribbean and African immigrants miss out on valuable care because of language barriers. Outreach should be conducted in people’s primary languages. It is beneficial to have interpreters or a video interpretation service present at vaccination sites.
Utilize the relationships community partners have with Black people as a way to expand outreach efforts. If materials are only available in health centers and hospitals, there is a missed opportunity because many people will not see them. However, teaming with local barbershops and salons, cultural grocery stores, places of worship, and neighborhood associations increase the chances of timely outreach materials getting to people.
Vaccination Sites Should Be Located in Black Neighborhoods
The challenge with vaccination sites in Black neighborhoods is twofold: (1) there are not enough in Black neighborhoods and many are located in whiter neighborhoods and (2) cities are reporting that residents from neighboring communities are taking appointments. In order to increase vaccinations, more sites need to be set up in Black neighborhoods. Local vaccination sites decrease travel time, which can make it easier to make an appointment while balancing working and caregiving. Driving into a neighboring community to get an earlier appointment or avoid longer lines is a privilege. This means that people with limited resources to travel now have an unnecessary obstacle to accessing care in their own communities. Black people are six times more likely to use public transportation than white people; they also experience discrimination in ride sharing due to systemic and personal bias. It is important to prioritize local residents having access to appointments at sites in their neighborhood. As vaccine rollout continues, cities and towns should also include home visits in their equity plans. One in four Black people have a disability, and while many are able to travel, those who are homebound are at a great disadvantage.
Supplemental Support
Vaccinations are vital when it comes to decreasing the spread of COVID-19. However, vaccines are only part of the multi-faceted efforts needed to address health inequities that Black people face. The truth is that many people, regardless of race, will choose not to receive the vaccine. Solutions to decreasing the inequities must address other aspects of COVID-19, including increasing access to personal protective equipment, decreasing occupational hazards, and making care culturally competent.
The COVID-19 pandemic has taken an extensive and deadly toll on Black people in the United States. As health professionals continue to fight this pandemic, it is vital to include health equity in all of the work. Uniting health equity and vaccinations can improve health outcomes for Black populations and, in turn, benefit others.