Coronavirus Vaccines: Can Shots Be Given Quickly And Equitably?

ACROSS AMERICA — The White House promised Tuesday that about 14.5 million doses of two approved COVID-19 vaccines are being sent to the states to help close bottlenecks in the drive to inoculate Americans against the disease that has claimed more than half a million lives in the United States since the first deaths were reported a year ago.

President Joe Biden has said that every American who wants a shot will be able to receive one by July, though demand for vaccinations continues to outpace supply.

In testimony Tuesday before Congress’ Energy and Commerce Committee, representatives of Pfizer and Moderna, whose vaccines have been approved, said they plan to deliver 300 million doses each by the end of the summer, and Johnson & Johnson aims to deliver another 100 million doses.

That’s enough to meet the Biden administration’s supply goal, but getting the shots into the arms of Americans is another matter.

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Jeff Zients, the coordinator of the White House COVID-19 response team, said in Biden’s exclusive op-ed on Patch that “the speed with which we can administer those vaccines will come down to how robust our vaccination program is.”

The distribution system was chaotic even before last week’s massive winter storm across a large swath of the country delayed the delivery of about 6 million doses of vaccine. White House press secretary Jen Psaki said Tuesday that about 14.5 million doses of the vaccine are going to states this week, an almost 70 percent increase in distribution over the past month. And Zients told the states’ governors that the number of doses sent directly to pharmacies will increase by about 100,000 this week.

So far, 75 million doses have been delivered, putting Biden’s original goal of 100 million shots in the first 100 days of his administration within reach. Pfizer and Moderna have promised to deliver 220 million doses by March 31.

Vaccine development was fast-tracked by the Trump administration’s Operation Warp Speed program, which began in late March 2020, and the first vaccines went into Americans’ arms in mid-December.

Since then, more than 65 million people have received at least one dose, and more than 19.8 million Americans are fully vaccinated, according to the U.S. Centers for Disease Control and Prevention.

That’s not enough to make a big difference in the spread of the coronavirus, according to health experts. And although COVID-19 cases are declining, experts attribute that to better adherence to mask rules and social distancing, as well as the passing of holidays and the inclination of Americans to say inside during the winter.

As more virulent variations of the virus are reported across the country, the administration’s plan to ramp up vaccine distribution to the states could be at odds with another focus: to make sure vaccinations in communities of color and to others especially vulnerable to COVID-19 don’t lag behind.

Biden administration officials believe it’s possible to do both.

Dr. Marcella Nunez-Smith, who chairs the White House’s COVID-19 Health Equity Task Force, noted in the Biden op-ed on Patch that equity underpins the administration’s response to the pandemic. People of color, low-income communities, rural communities and front-line workers are disproportionately affected by COVID-19, she noted, making it vital “they are given access to this vaccine at proportionate rates.”

There’s much ground to be made up there.

So far, the percent of white Americans getting the vaccine far outweighs shots given to other groups, representing about 64 percent of those who have received one or more shots, according to the CDC. That compares with 8.7 percent of Hispanic or Latino people and 6.4 percent of Black people.

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There’s some evidence that vulnerable communities are being left behind, Shereef Elnahal, a former New Jersey health commissioner who heads University Hospital in Newark, told Politico.

“We could see the inequities get worse before they get better,” Elnahal said.

The pattern of white Americans receiving vaccinations at greater rates than people of color is consistent across the 34 states that report data by race and ethnicity, according to a Feb. 18 analysis by the Kaiser Family Foundation. Some examples from the report:

• In Texas, 20 percent of vaccinations have gone to Latinos, though they make up 40 percent of the state’s population, 42 percent of COVID-19 cases and 47 percent of deaths.
• In Mississippi, Black people make up 38 percent of the population, 38 percent of reported cases and 40 percent of deaths, but have received only 22 percent of vaccinations.

Kaiser said its analysis is limited by the ability to compare data across states because they have different reporting standards — something the foundation said needs to be standardized to monitor and ensure equitable access to the vaccine.

The disparity is partially explained by vaccine hesitancy among Black Americans. But as part of the Biden administration’s push to reach underserved populations, more vaccine will be supplied to community health centers, where patients tend to be from minority groups, lower-income or homeless. And local jurisdictions are looking for creative ways to reach them.

Dr. Christian Ramers, a member of San Diego County, California’s coronavirus task force, told National Public Radio his county opened a vaccination center close to the border with Mexico to reach the area’s large Latino population, but the people who showed up were white, affluent and savvy enough with a computer to snag appointments.

"Even by physically locating the centers down south, a lot of those appointment slots are taken up by people that are from the north of the county and more technologically savvy," said Ramers, who also is an executive at Family Health Centers, whose 23 primary care clinics serve mostly minority and poor populations.

Mega vaccination sites respond to the goal to get Americans inoculated against the disease, but aren’t always efficient at serving minority communities, who may lack transportation or internet access to learn about and sign up for vaccinations, Ramers told NPR.

"There's immense pressure on using the vaccines as quickly as possible, and that tends to favor these mass vaccination sites, which really don't have the ability to target the communities that need it," he said.

The people who are eligible to get shots in the first vaccination waves varies among the states, but in general, those at the front of the line are:

• Phase 1a: Health care personnel and long-term care facility residents.
• Phase 1b: Front-line essential workers such as firefighters, police officers and corrections officers, food and agriculture, public transit, the grocery store workers, U.S. Postal Service workers, workers in the educational sector, and people 75 and older living outside long-term care facilities.
• Phase 1c: People age 65-74 living outside a long-term care facility; people age 16-64 with underlying medical conditions that put them at risk of serious or life-threatening complications from COVID-19; other essential workers in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety and public health.

With encouragement from the Trump administration, some states moved people 65 and older ahead in the vaccine queue, putting millions more Americans in competition for the shots.

The Biden administration has asked for $20 billion for vaccine distribution in a $190 trillion economic rescue plan that could be voted on this week in the House. The money would be used to:

• Launch community vaccination centers around the country and mobile units for hard-to-reach areas.
• Increase federal support to vaccinate Medicaid enrollees.
• Invest $50 billion to expand rapid testing, lab capacity and regular testing to help schools reopen.
• Hire 100,000 public health workers, nearly tripling the community health workforce.
• Help long-term care facilities that have experienced outbreaks and prisons for mitigation strategies.

The Associated Press contributed reporting.