Biden’s Pledge of Equitable Vaccines Awaits Boost by More Shots

The Biden administration is struggling to address a persistent racial disparity in the U.S. coronavirus vaccination campaign that has seen White Americans receive a disproportionate share of shots, even in places that have large minority populations.

A patchwork approach in states to both administering vaccines and reporting data on who is inoculated has left the federal government with significant blind spots and only partial control over who gets a shot. Incomplete data from states show that relatively lower proportions of Black and Latino populations have received injections, compared to White people.

In Philadelphia and Washington, Black people make up more than 40% of the population but just over 20% of vaccinated people for whom racial data is available, according to the Bloomberg Vaccine Tracker. In Texas and California, Latinos make up 39% of the population but just 21% and 18% of those vaccinated, respectively. In Arizona, White people make up 55% of the population but have received 76% of vaccines.

Biden and his top advisers, led by Vice President Kamala Harris, have pressed for vaccinations to be equitable in a pandemic that has disproportionately ravaged communities of color. An equity task force, which sprung from a bill Harris once proposed, held its first meeting on Friday, where officials stressed the need for better data. But the administration has been hamstrung in its ability to address disparate distribution of shots across the country.

“It is critically important to have equity in vaccine distribution, because of everything we know about how disproportionate the impact of Covid-19 has been on communities of color,” said Lisa Cooper, a physician who directs the Johns Hopkins Center for Health Equity. “We may not all be in the same boat, but we’re in the same storm -- if other boats are capsizing, it’s not good for the rest of us.”

People of color -- including American Indians, Alaska Native persons, Black people and Latinos -- are roughly three to four times as likely to be hospitalized with Covid-19 than White people and roughly twice as likely to die of the disease, according to data from the Centers for Disease Control and Prevention.

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The reasons are broad and complicated, including higher rates of pre-existing conditions that worsen the virus’s impact, less access to health care, and a higher share of people who live in multi-generational households or work front-line jobs.

“The crisis of Covid-19 and inequity go hand-in-hand,” Marcella Nunez-Smith, a physician and professor at the Yale School of Medicine who leads the task force, said at Friday’s meeting. Equitable vaccinations are crucial “not simply because it’s the right thing to do, but there is frankly just no credible path at all forward to our new normal without it.”

The frustration over vaccine inequities within the administration is sufficient that Jeff Zients, Biden’s Covid-19 response coordinator, has suggested some states could be punished if it doesn’t improve.

“We’ll monitor channels, make sure channels are performing in two ways: efficiency and also fairness and equity,” Zients said this week in a press briefing. “Future allocations across channels could be changed based on performance.”

Two developments may soon give the federal government more power to reduce inequities. Under Biden, the federal government has begun distributing millions of doses of vaccines directly to pharmacies and community health centers, particularly those in under-served areas, instead of directly to states -- giving the administration more control over who gets shots. The shipments and locations are set to expand with supply.

In an interview Friday with Univision News, Biden urged Black and Latino people to take the vaccine and said he’s focused on more equitable distribution. Polling has shown that Americans of color are more reticent than White people to take shots.

“I can assure them it’s safe, number one, and I can assure them I’m doing everything to make it possible, to make it easier for them to get access to the vaccine,” he said.

And a surge in vaccine supply could be around the corner. Manufacturers have promised millions more doses a week, and Food and Drug Administration authorization is believed to be imminent for the nation’s third coronavirus vaccine -- a shot by Johnson & Johnson that’s only one dose and doesn’t require extraordinarily low-temperature storage, like competing vaccines made by Pfizer Inc. and Moderna Inc.

The new shot might more easily allow for vaccination from vans sent into neighborhoods or to remote places, though the plan for its distribution isn’t final. The administration has moved to head off questions about differences in efficacy between the vaccines, urging people to take any one they can find.

“Get vaccinated. The vaccine that’s available to you -- get that vaccine,” Anthony Fauci, Biden’s chief medical adviser, said Friday.

But Nunez-Smith has warned that a surge in doses could actually fuel inequity if mismanaged. “People of color aren’t getting vaccinated at equitable rates. And as eligibility opens up more, so does the need to address potential structural barriers to equitable access,” she said Friday.

The vast majority of vaccine doses under Biden, about 85%, still go to states, who take their own approach to distribution. Some have performed better in targeting doses to communities of color. New Mexico, for instance, is the only state with available data where Latinos’ share of vaccinations actually exceeds their share of the population.

But the issue is complicated by another top priority: putting shots in arms as fast as possible. Biden’s administration has opened mass vaccination centers such as the one at NRG Stadium in Houston that the president visited on Friday. The vaccination centers quickly put shots into lots of arms, but they tend to benefit more privileged people -- those who own vehicles and can afford to wait in long lines, and thus risk further inequity.

“Efficiency and equity are both central to what we’re doing, and I don’t see any trade-off,” Zients said at a Feb. 9 briefing.

Shortfalls in available data continue to stymie the administration’s effort to balance the two priorities, said Cameron Webb, a physician who serves as a Covid adviser to Biden.

“The equity piece is actually mission-critical to ending the pandemic,” he said in an interview. “If you want to stop people from dying, being hospitalized and spreading Covid, you have to go to the communities that have been hardest hit.”

The administration has paired its mass-vaccination drives with more targeted outreach to communities of color. On Thursday, Harris visited a pharmacy in a majority Black neighborhood of Washington to highlight the effort to deliver doses to disadvantaged people.

Even that approach isn’t without pitfalls, however, as some online appointments get snapped up by more privileged people.

“It’s important to do both,” said Joneigh Khaldun, chief medical executive and chief deputy for health at the Michigan Department of Health and Human Services, who sits on the Biden administration’s equity task force. “Only focusing on mass vaccinations without focusing on neighborhood-based strategies is not the way to approach the vaccination process.”

The biggest bottleneck right now is a vaccine shortage, she said. “I often feel like I’m trying to divide up a penny here in the state, you know?”

Nunez-Smith, who was raised in the U.S. Virgin Islands, has said her father’s paralysis from a stroke in his 40s underscored, for her, how communities are marginalized by geography and race in the health system.

It’s not clear how quickly her task force will produce recommendations. Its members include a people with a mix of careers, racial backgrounds and affiliations.

One is Mary Turner, a Minnesota nurse who has worked with Covid patients at North Memorial Health Hospital in Robbinsdale, and has warned about shortages of medical supplies for health care workers. The data on Covid-19’s inequities can be seen in the hospital, she said.

“The people I saw dying in my ICU were the elderly and the people of color,” and people with underlying conditions, she said in an interview. “Logically, in my mind, the people who are doing all the dying are the ones that should be vaccinated.”

©2021 Bloomberg L.P.

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