Merrill Gay helped his elderly mother, sequestered alone at home, make an appointment last week to get a coronavirus vaccination.
Meanwhile, the thousands of child care workers who are members of the coalition he leads, the Early Childhood Alliance, have been told they will have to wait more than a month for their turn to make an appointment.
“A person living by themselves isn’t really high risk,” said Gay. “It’s really easy to slip into the, ‘Oh yeah, old folks are more likely to die from this,’ as opposed to looking at the data and [asking], ‘Well, demographically, are they really?'”
Older people are much more likely to die from COVID-19, and Gov. Ned Lamont and his administration have prioritized elderly residents for the COVID-19 vaccine. But the 65-and-older age group in Connecticut is 84 percent white, while the overall population statewide is 67 percent white. For some, that’s raised the question of whether the state’s plans to extend the COVID-19 vaccine to people 65 to 74 next adequately considers the other populations hit hardest by the virus: Black and Latino residents.
Gay’s mom is white. Meanwhile, child care, grocery and public transit workers — groups who are disproportionately Black and Latino — have been told they will have to wait at least another month to make an appointment. Those with underlying health conditions who are more harshly impacted by COVID also have to wait their turn, unless they are at least 65 years old.
“Patience remains the keyword: with 1.3 million CT residents [aged 65-74] and a limited supply of vaccine from the federal government, it will take time to vaccinate everyone eligible in this phase,” reads the Lamont administration’s biweekly vaccine update from Jan. 21.
Advocates say distributing the vaccine strictly by age misses populations that are also at high risk.
“It has to be seen through a racial lens. It has to be seen through an equity lens,” said Georgia Goldburn, who runs Hope Child Development Center in New Haven, which has staff that are disproportionately Black and Latino and don’t have the option to sequester at home if they want a paycheck.
“For me, it’s a much more nuanced conversation than whether it’s just an older person getting it versus a younger person getting it,” she said. “Any data that you look at that is basically using the same infrastructure to bring about a certain type of resources to the community, it’s always going to show the same result, it’s always going to point to the structural inequity, to the racial inequity that’s built into the system. So I’m not surprised that whatever structure mechanism that they have designed to make the vaccine available, that it is breaking out that white people are disproportionately receiving those vaccines, because that’s how the system was set up to function and to operate.”
Age is used by the Lamont administration to determine vaccine eligibility because age is proportional to COVID mortality. While the risk of dying from COVID-19 increases strongly with age across all racial groups, it does not do so at the same rate. White residents aged 65 to 85 have lower mortality rates compared to their Black and Hispanic counterparts, a CT Mirror analysis found. A white 65-year-old state resident has a similar rate of mortality to a 55-year-old Black person and a 60-year-old Hispanic resident.
Gregg Gonsalves, assistant professor of epidemiology at Yale University, said the disparities in COVID-19 mortality rates among white, Black and Latino residents is predictable since data have long shown disparate access to health care and shorter life expectancies for minority populations.
“We’re starting from a baseline that’s not equal to begin with,” he said.
Nevertheless, Saad Omer, professor of epidemiology at Yale University, recommended prioritizing groups based on age, in part because explicit considerations of race in eligibility criteria are open to legal challenges. “Race is not the only determinant of health outcomes,” he said.
If the state prioritized people with underlying conditions sooner, that would naturally make more people of color eligible, said Jennifer Tolbert, Kaiser Family Foundation’s director of state health reform.
Lamont told reporters last week that sticking primarily to an age-based rollout is the most expeditious approach.
“If everybody’s a priority, then nobody’s a priority,” Lamont, a Democrat, said. “We’ve got that prioritized based on age since that’s easiest to administer and the most direct – and please be patient.”
Health experts point out, however, that prioritizing efficiency may come at the expense of distributing it equitably.
“There are certainly equity issues when it comes to access to the vaccine,” said Tolbert, adding that targeting older populations can help ensure the hospitals also don’t get overwhelmed with COVID patients. “When you begin to include that younger adult population with high-risk medical conditions, that’s where you are more likely to start picking up more people of color, because we know that people of color are generally more likely [at younger ages] of contracting a severe case of COVID-19.”
Wizdom Powell, director of the UConn Health Disparities Institute, agrees.
“You might just presume that if you solve the problem for the 65-to-74-year-old age group, that you’re somehow addressing the disparity issue. But you’re actually missing a critical component,” she said.
Who has gotten the shot?
To date, vaccinations have been made available to those who are at least 75 years old, living in nursing homes or assisted living centers, or are front-line health care workers. Some public school teachers also mistakenly got vaccinated.
Overall, 8 percent of Connecticut residents have received the first round of the vaccine as of Monday afternoon, according to federal data. It is difficult to evaluate the vaccine distribution so far through an equity lens, however, because data for the race and ethnicity of vaccine recipients hasn’t been released yet in Connecticut.
“If we’re going to continue to work on dismantling systemic and structural racism, we do need to look at how we’re disseminating the vaccine and really keep an eye on who is actually getting the vaccine,” said Rev. Robyn Anderson, a pastor at Blackwell AME Zion Church in Hartford and a member of the governor’s advisory panel for the vaccine rollout. “Is there diversity in those who are receiving the vaccine? And if there’s not, people should be paying attention to that.”
The governor’s office did not respond to requests to discuss what they know about Black and Latino residents getting the vaccine, a timeline for when they will release data they are required to collect on which groups are receiving the shot, or the equity issues that some are concerned about with the state’s vaccine rollout.
A rundown by the Kaiser Family Foundation of the vaccination patterns in the 17 states that have publicly reported data has found that “vaccination patterns by race and ethnicity appear to be at odds with who the virus has affected the most.”
“Data to understand access to and uptake of the vaccine by race/ethnicity and other demographic factors will be central to efforts to ensure equity. These data are necessary to move past ‘color blind’ policies that reinforce systematic racism and inform decision makers on how to develop culturally responsive interventions and direct resources to ensure equitable distribution and uptake of the vaccine,” the national health care think tank reported on Jan. 17.
The Centers for Disease Control and Prevention requires states and its partners who are delivering the vaccine to collect such data, and a spokeswoman for the federal agency said she expects the demographic data to be available to the public in the coming weeks.
The state has released a breakdown of the ages of those who have received the vaccine so far as it prepares to open the door for people 65 and older in the coming weeks. That data show 21 percent of those over 85 have been vaccinated so far.
Vaccine rollout across the U.S.
While the federal government has provided guidance on which groups to prioritize, it has left to state leaders across the country the task of determining who gets to the front of the line for a vaccination.
Lamont, who is 67 and intends to get vaccinated when access is expanded to his age group, has somewhat followed the federal recommendations on whom to open up vaccination for next.
The CDC’s Advisory Committee on Immunization Practices’ most recent recommendations, issued in December, recommend that after inoculating nursing home residents and those 75 and older, access be opened to grocery store, day care and other front-line workers — and then those who are at least 65. Those recommendations point out that COVID has disproportionately impacted minorities in those jobs, and the large share of those over age 75 years old living with much younger family members. For example, while only 4 percent of white people over age 75 live with someone from another generation, 18 percent of Latinos do.
In early January, the Department of Health and Human Services under former President Donald Trump issued new guidance to states recommending they open vaccine availability to all people ages 65 and older and to those under 65 with high-risk medical conditions. This was done in an effort to speed up the number of people getting vaccinated.
President Joe Biden more recently is encouraging states to open access to those over 65 and older first.
A rundown by the Kaiser Family Foundation shows that as of last Tuesday, 10 states have already opened access for younger adults with high-risk medical conditions. The think tank also found that “the timeline to receive a vaccine for many – particularly front-line workers – will likely be extended. … While expanding who is eligible to receive the vaccine may help to accelerate the pace in some cases, the limited supply of vaccine means many who are now eligible will continue to wait in line for an extended period of time.”
Connecticut has received approximately 50,000 doses each week, and The New York Times reported last week that the national supply is only expected to grow slightly through March because of a lack of manufacturing capacity.
In Connecticut, there are indications that wait times can be long.
Gay, whose mother is 86 years old and is excited to get the shot, scheduled her appointment for a month out, as that was the only time available that wasn’t at 6 a.m. and a long drive.
Actress and Connecticut resident Mia Farrow directed a complaint to Lamont over Twitter for the two hours it took to register for a vaccine for mid-March. She eventually landed an appointment for February, but the vaccination site is two hours away from her home.
“Process is an unnecessarily complex labyrinth,” she tweeted.
Gonsalves, the epidemiologist at Yale, said access issues are starting to show for minorities across the country.
“Vaccine rollouts are slow, but also the inequities that we worried about are starting to be apparent around the country,” he said. “Data from some places is showing that people at highest risk of mortality are not the ones getting the vaccine.”
Pushback
The state’s approach has frustrated some health experts and clergy, as well as the day care and grocery workers waiting their turn.
“It’s a bit of a challenge to me that we simultaneously want to address thehesitancy of getting the vaccine in the communities of color, and at the same time we’re de-prioritizing them in some real ways in our decision making,” said Tekisha Dwan Everette, executive director of Health Equity Solutions and a member of the governor’s advisory panel for the vaccine rollout.
Everette is troubled by the decision to put child care workers and grocery store employees behind everyone 65 and older.
“It is a real problem,” she said. “I think this is a mistake.”
Anderson, the pastor in Hartford, agrees.
“Every day during the pandemic, they have been risking their lives. They should have been in the first group as front-line workers,” said Anderson, who also co-founded the Ministerial Health Fellowship, a coalition of religious leaders pushing for health equity in the state. “If you know there is a disproportionate number of people of color [in these jobs], why aren’t they at the forefront of getting this vaccine?”
There was an uptick last fall in COVID-19 infections in child care centers, providers were told by state officials. It is unclear just how many infections and deaths can be traced to child care facilities, grocery stores and other non-medical front-line services.
Goldburn’s day care in New Haven has had to close once during the pandemic after an infection by an employee — an accomplishment, she says, since her facility has remained open during the entire pandemic.
Some grocery store workers are disheartened that they will have to wait, said Ron Petronella, president of the union that represents thousands of grocery store workers and school bus drivers in the state.
“I would love it if our members could get the vaccine at the top of the line, that would be great. I mean, they should. They deal with the public every day. They’re in the people business, and when you’re in the people business in a pandemic, and you’re not supposed to be around people. Through no fault of our own, we’re being infected,” said Petronella, of U.F.C.W., Local 371.
A couple of his members have contracted COVID and died, and many more have been infected, he said. His workers are disproportionately Black and Latino.
His mom, who is white, has an appointment to get the vaccine next week.
“I wish everybody could get it tomorrow. That’s where I’m at. I want to get it,” he said, adding he doesn’t believe anything nefarious is going on. But, “I think by doing it by age, you’re going to get that disparity. And is it fair? Probably not, because minorities and people of color are dying at a higher rate than white people.”
Overcoming barriers
To ensure communities of color are not left behind, advocates say the state needs to get people of color feeling comfortable getting vaccinated and prioritize outreach to these communities.
“Without doing that, we stand to face what happened in Washington, D.C., where we saw that when the vaccine was open and available, white people were edging out all the appointments,” said Everette, of Health Equity Solutions. “It was very difficult for those who are Black or Latino to get appointments. I don’t want to make this a race issue, because it’s not race that’s the problem. It’s racism. It’s the context within which people don’t have access readily to the internet, or that older people are retired and staying home while you’ll find more older African Americans and Latinos still in the workforce.”
“How are we addressing equity in the process to ensure everyone has a fair and equitable chance to get their vaccine? I don’t know that we have the answer right at this moment.”
The solution should include more aggressive outreach in communities of color, Anderson said, ensuring that people know when they’re eligible to receive a vaccine and how to sign up.
“One of the things I really feel is that, especially as it relates to people of color, you need to have people on the ground,” Anderson said. “I know they’re doing all these seminars and webinars, which is wonderful, but somebody’s got to be there, to go door to door, or come to gatherings where there are people of color.”
In New Haven, outreach has been non-existent, said Goldburn, head of the Hope Child Development Center. Many of her staff members are interested in being vaccinated, but she doesn’t believe she will be signing up. Still, she has been looking for reasons to be persuaded otherwise.
Goldburn said she is hesitant because of the long history of structural racism that has left her with little confidence in the health care system.
“Truthfully, racism is built into the system. The people who historically have had access to the resources, whether it’s financial, economic [or] health resources, have always been white versus Black,” she said. “And so if we continue to use the same structure and mechanism to try to get to people, we’re always going to have the same results, unless there is an equity lens that’s built in.
“We hear people talking at the national level, at the state level, at the local level, that there has to be intentional outreach. I’m not necessarily experiencing it. And I am actively searching out for that information.”
