WASHINGTON — President Joe Biden promised that COVID-19 vaccine distribution would be equitable, but health officials realized days into the new administration that they had a problem — the race and ethnicity of half the people who received the shot during the first month was not known.
They also learned that a small percentage of those who had been vaccinated were recorded as Black — a demographic group disproportionately affected by the coronavirus.
Working with states that have a patchwork of laws on the collection and reporting of demographic data, the administration says that information on race and ethnicity has improved.
The federal government now has data on race and ethnicity for 60% of vaccinations. All but two states — Texas and Vermont, both of which have laws that restrict what data can be shared with the federal government — are said to be providing the information.
“We’re not happy with 60%. That’s not where we want to land,” said Dr. Cameron Webb, senior policy adviser to the White House COVID-19 Health Equity Task Force. “But we think that there’s still ground for us to pick up and we’re working really closely with the states to keep pushing that forward.”
The data the federal government received from the states has confirmed concerns that the vaccine is not reaching underserved populations at an equitable pace. Vaccine access and convenience have been persistent problems, Black doctors and community leaders said, as have vaccine hesitancy and skepticism.
So far 7.7% of people who have received at least one vaccine dose are Black, according to available data.
That’s a slight increase from when the Centers for Disease Control and Prevention released demographic data from the first month of the vaccination program in early February that showed 5.4% of people who had received their first vaccine dose were Black. Black Americans make up roughly 13% of the U.S. population.
A CDC report this week said that government efforts to improve vaccine equity have been insufficient so far and that “Equity in access to COVID-19 vaccination has not been achieved nationwide.”
The Biden administration is hopeful that supplying community centers, deploying mobile units later this month to underserved areas and other efforts by community groups funded by grants will help increase vaccine access to minority populations.
“We are pushing as hard and as fast as we can. We think that speed and equity can go hand in glove,” Webb said in an interview with McClatchy.
But other experts say those two priorities — speed and equity — often conflict, and recommendations by the government on who to prioritize exacerbated the problem.
“What makes things difficult is that the program was started under a different administration, which basically said, states get to make their own decisions,” a CDC official said. “So unless states put a focus on equity, it can get pushed to the side in the rush to vaccinate people.”
On Jan. 12, days before the Biden administration was set to take office, outgoing Health and Human Services Secretary Alex Azar said that the federal program set up to administer COVID-19 vaccines would abruptly change course.
Discarding months of review from ethicists and independent advisory panels, who had put together blueprints for states to ensure equitable access, the Trump administration instead urged states to allow anyone over the age of 65 to receive vaccine doses — a position that was endorsed by the incoming president days later.
That recommendation reflected a bipartisan priority of getting as many vaccine shots into arms as quickly as possible.
But it also contributed to inequity in the nation’s vaccine distribution that now plague the Biden administration, which pledged at the outset to administer 100 million vaccine shots in its first 100 days in office.
“If you look at the populations that are 65 and over, they are more white,” said Dr. Julie Swann, head of the Department of Industrial and Systems Engineering at North Carolina State University and an adviser to the CDC during its response to the H1N1 pandemic in 2009. “And the population that is 65 and over is huge relative to the amount of vaccine that was available.”
As a result, vaccines were made available from the start to a disproportionately white population with greater access to the tools necessary to secure coveted vaccination appointments.
“The people who were able to do that were retired or had resources,” Swann said. “It is slower to prioritize. And right now you’ve got the pressure from these variants and relaxing guidelines. So there is this real tension between getting it out as fast as possible versus continuing to focus on equity and driving it.”
The CDC’s March 17 report declared that the country has failed to ensure that communities disproportionately affected by the coronavirus pandemic were given priority in the initial phase of vaccine distribution.
The study, which covered the first two-and-a-half months of the federal vaccination program, found that people in high-risk categories, including those in minority communities, had less vaccine coverage consistently across the country than those in low-risk categories.
Improving vaccine coverage in minority communities is “critical,” the CDC said, “because these populations have been disproportionately affected by COVID-19–related morbidity and mortality.”
“Additional efforts are needed to achieve equity in vaccination coverage for those who have been most affected by COVID-19,” the report concluded.
The HHS Office of Minority Health pledged this month to provide $250 million in funding to encourage vaccinations and COVID-19 safety measures among underserved and minority populations.
The CDC recently announced plans to invest $2.25 billion in bolstering public health services in minority and underserved communities. Some of that funding will go to improving data collection and reporting for communities considered high-risk, including racial and ethnic minority groups and people living in rural areas.
Biden said on Thursday that more than 500 mobile clinic events, which include vans and pop up sites, would help vaccinate those who do not live near a mass vaccination center or a pharmacy.
He said the administration is also supplying vaccines to community health centers to help reach those who have been hardest hit, including Black, Latino, Native American, and rural communities. HHS said last week that it was extending invitations to 950 centers to participate in the program.
“This is really important — because we believe that speed and efficiency must be matched with fairness and equity,” Biden said in remarks at the White House.
More than a dozen community-based organizations collectively received $255 million in CDC grant funding for equitable vaccine distribution in January while Trump was president. But those efforts are only starting to take hold.
It has taken months to build up the necessary staffing and infrastructure, said W. Franklyn Richardson, chairman of the Conference of National Black Churches, an organization that received a $1.6 million grant. He said the conference is “rushing” to get its program going.
Richardson said his organization will train 3,000 pastors on the science of the coronavirus vaccine, disparities in the Black community and the history behind vaccine distrust.
It is currently enrolling pastors in a 100-church pilot program. Churches in rural communities where there are no pharmacies are also being identified to serve as vaccination centers, Richardson said.
“It’s been discouraging to me to see how many African Americans are still reluctant, but I understand it, also who say they’re not gonna take it,” Richardson said of vaccine hesitancy. “It’s really a problem.”
Other awardees included the National Urban League, the National Council of Negro Women, UnidosUS, the Association of American Medical Colleges, the Asian and Pacific Islander American Health Forum and the National Alliance for Hispanic Health, HHS said.
The CDC is holding weekly meetings with the groups to discuss their projects, according to Dr. Janis Orlowski, chief health care officer at AAMC, which is focused on decreasing vaccine hesitancy among health care workers.
“The CDC looks at vaccine hesitancy not just as it relates to the COVID-19 vaccines, but through other vaccines — what works and what doesn’t work,” Orlowski said.
