A Black Neighborhood in Alabama Has Yet to Get a Single Vaccine

(Bloomberg) -- More than two months into America’s vaccine rollout, a community clinic that serves the poorest of the poor on Birmingham’s majority-Black north side has yet to receive its first dose. The Alabama Regional Medical Services clinic has watched the vaccine flow elsewhere, including a pharmacy in nearby Mountain Brook, the state’s wealthiest town.

The proportion of Alabama’s White population getting the vaccine is almost twice that of Black people, according to state data. And it’s not because of the oft-repeated claim that African-Americans don’t want it, said Sheila Tyson, a commissioner in Jefferson County, which includes Birmingham. “It’s an excuse,” Tyson said. “How do they know we are turning down the vaccine if it is not offered to us?”

Across the state and the nation, Black people have died disproportionately from Covid-19. Alabama’s disparity underscores who is suffering the most from it and who is benefiting most from the historically fast development of vaccines. The state trails the nation in the percentage of its population that’s been vaccinated and the proportion of its doses used, according to a Bloomberg analysis. Its data collection has been so poor that it makes it virtually impossible to say how well it has vaccinated its Black residents compared with other states.

“How could the vaccine not have gone first to the people who were getting hurt the worst by the virus?” Tyson said.

Alabama began reporting data on the race and ethnicity of vaccine recipients about two weeks ago — although the numbers remain limited. As of Wednesday, 9.2% of the White population had been vaccinated, compared with 5.2% of Black residents, according to the Bloomberg Vaccine Tracker. White residents make up 68% of the population and almost 80% of those vaccinated. Black people, at 26.6% of the population, were just 17.6% of those who had gotten a shot.

Many of the nearly 900 clinics and pharmacies in Alabama that were approved to vaccinate are still waiting. That includes half of the community clinics in the lowest-income areas.

State and local officials blame vaccine scarcity, and say that they have followed federal recommendations. But critics say they were too eager to get doses into every county, and bypassed community infrastructure that could have reached the minority population in places such as Birmingham, including the ARMS clinic.

The state’s largely colorblind process for vetting clinics and pharmacies to give vaccinations ended up giving an edge to those who got in line first or who had more resources. An overreliance on internet vaccine appointments made matters worse: Across the U.S., web-based sign-ups have favored wealthier people.

In Alabama, “a disproportionate share of the African-American populations are dealing with chronic or underlying conditions that make the virus worse,” said Jim Carnes, director of Alabama Arise, which advocates for the poor. “The longer we wait in delivering the vaccine to them, the more likely they’ll be to suffer poor outcomes. We are very worried that this is playing out along the old lines.”

State and local health officials said the disparity will shrink as more essential workers join the eligibility list: That cohort is disproportionally African-American and Hispanic. Assistant State Health Officer Karen Landers said several efforts have been successful in reaching the Black population, including four University of Alabama-Birmingham drive-thru clinics in Jefferson County. The strategy has been based on data and a resolve to distribute the vaccine broadly, Landers said. 

“We continue to be open to any changes that need to happen,” she said. “We are particularly concerned about our state, given the overall demographics. We are not a healthy state.”

Things are looking up for ARMS in North Birmingham — thanks not to the state but Jefferson County, which will provide 400 doses to patients in the second week of March.

In fairness, Alabama isn’t alone in reporting lower vaccination rates for Blacks people.

Studies have found only about half of states are using the Social Vulnerability Index — a planning tool for natural disasters — to craft vaccine strategies. Others, including Alabama, are using an algorithm called Tiberius to plan; while it allows localities to request the SVI data. Alabama has used it mainly to find health-care workers, Landers said.

In an analysis released in December, Duke University researchers found only a handful of states — California, Indiana, New Mexico, Massachusetts, Alaska, Louisiana, New Hampshire, Oregon and New Jersey among them — had robust plans that accounted for the advantages Whites enjoy in the health-care system. Those include better access to information, doctors, transportation, technology and more time.

At a minimum, an equity plan should include community leaders and institutions, bring vaccines to familiar locations, provide transportation and ways to get appointments that don’t require websites, said Hemi Tewarson, a visiting senior fellow at the Duke-Margolis Center for Health Policy.

Tyson, the county commissioner, has been pushing that approach in Birmingham. It’s also how the ARMS clinic handled Covid testing, according to marketing director Chris Mosley. “Access means taking it out to the people,” he said. “We tested at churches, schools, public housing. We had already developed the infrastructure to deliver the vaccine.”

Some jurisdictions give minority populations priority codes for appointment websites. Massachusetts, North Carolina and Mississippi reserve vaccines specifically for minorities. So does Chicago, where a recent event vaccinated all comers of any age in a neighborhood of undocumented workers.

Duke’s Tewarson said other states prioritize speed over equity. Last week, Florida Governor Ron DeSantis defended putting pop-up clinics in a wealthy retirement village with predominantly White residents. “Go where the seniors are, try to knock it out,” he said.

In Alabama, planning for equitable access was never strong. The state also assumed it would get more doses and that the federal government itself would favor states with large African-American populations. That’s what should have happened “if the point is to save lives,” said David Hicks, deputy health officer at the Jefferson County Department of Health.

In September, the state invited vaccinators to register, officially request the vaccine and prove — via a photo of equipment serial numbers — that they had the tools to keep doses cold. Those who had cleared the vetting earliest got doses, Hicks said. Then the pipelines closed behind them. Vaccines went to providers “who got their act together” first, Hicks said.

Ritch’s Pharmacy in Mountain Brook was one of them. It received its first 1,000 doses in late December for the Birmingham area’s myriad health-care workers, followed by 2,000 more as eligibility requirements expanded. The pharmacy invested in new coolers and staff, said pharmacist and co-owner Ralph Sorrell.

MainStreet Family Care also got vaccine. A chain of 17 urgent-care clinics across Alabama, most in majority White areas, MainStreet was acquired by Dallas private equity firm Trinity Hunt Partners in September and got its first shipment before Christmas.

Marketing director Betsy Stewart said the company got vaccines because of its reach in rural areas, its five freezers and because it was already in the vaccine data system. It can handle from 500 to 1,000 shots a day.

Some low-income clinics got vaccine too, once eligibility loosened again in February. They include Christ Health Center in eastern Jefferson County, which serves a clientele that includes public-housing residents, about half of whom are people of color, according to chief executive Robert Record. 

Christ Health hedged its bets, buying an ice-chest-sized ultra-freezer to accommodate Pfizer doses so the clinic wouldn’t be competing for one vaccine. “It was a hard decision for us,” Record said. “It cost us $10,000.”

While the clinic got its paperwork in early, it waited weeks for vaccine. Record said he doubted no one’s good faith, but that “equity takes effort. It was always going to take quite a bit of intentionality to get vaccines to people our health system left behind.”

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