Welcome to Covid Court, where POLITICO’s Renu Rayasam makes decisions on how to overcome the pandemic without losing his mind.
The federal and state governments are directing more vaccines to minority and poor communities, through community health clinics, public health services, mobile vans, and partnerships with churches and other faith groups. The Biden administration is also sending more vaccines directly to pharmacies, although they don’t reach all poor communities. And some local authorities limit vaccines to people living or working in a specific community, so affluent tech-savvy people able to travel from other areas cannot make all of the appointments. The Centers for Disease Control and Prevention is also hosting a three-day public forum, starting Monday, on building confidence in vaccines, including in minority communities with higher rates of reluctance.
But so far, efforts don’t necessarily translate into large numbers of vaccinations in hard-to-reach populations who by definition are hard to reach.
Getting thousands of people with cars to a sports stadium is easier than sending hundreds – and sometimes dozens – to a vaccination clinic in a church. It is also not clear whether the delays linked to the weather conditions of last week will also affect the populations and whose canceled appointments will be postponed quickly.
Not all special pop-up clinics are for underserved people. Florida Gov. Ron DeSantis, a Republican, has come under fire for setting up one in an affluent, mostly white, community in a GOP-leaning area. DeSantis has made reaching people 65 and over its priority.
But Florida reversed course a few days later. The state will get four federally supported vaccination centers in low-income communities of color. The locations were selected using a federal “vulnerability” index, which other communities also use to determine where to focus resources.
The concern to vaccinate many people to stay ahead of the variants is real, at odds with the demands of fairness. Marcus Plescia, chief medical officer for the Association of State and Territory Health Officials, said states are under a lot of pressure to get through priority groups as quickly as possible. “It’s not an approach that results in a lot of fairness,” he said.
One of the hurdles is that the United States has never had to run a vaccination campaign on this scale and at this speed – let alone while facing such glaring disparities in deaths. Black Americans are dying from the virus at a rate nearly twice that of whites. For Latinos, it’s 2.3 times higher.
The 2009 H1N1 pandemic influenza vaccination campaign had many of its own problems – although luckily the the epidemic was not as deadly as feared. The 1950s polio campaign was also massive, but it only involved children and adolescents.
“They’re trying to do something we didn’t have a system in place for – mass immunization of adults in this country,” said Paul Offit, a vaccine expert at Children’s Hospital in Philadelphia. “And they build it on the fly.”
Viral mutations have complicated matters. Some are more contagious and the vaccines do not seem to work as well on the one detected in South Africa.
Peter Hotez, another renowned vaccine expert at Baylor University, said the urgency to avoid damage from variants means the United States needs to vaccinate closer to 3 million people per day – about double the current rate, although supply constraints could prevent the country from hitting. this goal as quickly as it deems necessary.
Hotez also called for diversifying the places where people can be vaccinated, including places that are both trustworthy and convenient for underserved groups, and expanding eligibility. “The way to deal with this is to liberalize some of the restrictions” on who can receive a vaccine, he said.
Variants likely mean more cases – and more deaths. While new infections and hospitalizations have been on the decline for weeks, the number of cases remains high. Health experts have warned that the variants could bring a new push as they take hold across the country.
“Every day that someone doesn’t have the vaccine, they are all the more vulnerable,” said Carmel Shachar, who heads the bioethics center at Harvard Law School.
“We’ve lost part of the cushion,” she says. “And we didn’t have a great pillow.”
But Hastings Center bioethicist Nancy Berlinger worries that concern over variants, which aren’t unexpected with a virus, could prompt states to sacrifice fairness for speed.
“In healthcare, there’s always a tension between doing it fast and doing it right,” she says. “We do not achieve community immunity by focusing only on healthy, mobile and informed people,” she added..
President Joe Biden is committed to doing better when it comes to speed and fairness – by increasing supply and reaching underserved communities. At his Milwaukee town hall last week, he announced that community health centers, “which take care of the toughest neighborhoods in the toughest neighborhoods in terms of disease” will receive one million doses per week.
A number of states have carried out outreach activities with communities of color working with churches and other faith-based organizations.
In Illinois, for example, the health department has held virtual town halls and used “community health ambassadors” – or local public health workers – to reach people who are hesitant about immunization.
“As the state strives to improve access, we are also working to increase acceptance,” a spokesperson for the department said.