People in racial and ethnic minority groups are disproportionately affected by COVID-19, but many also struggle with vaccine access and vaccine readiness. Here's why — and how to fix this problem.
For the past year, the COVID-19 pandemic has immeasurably disrupted our daily lives. It has led to millions of infections and over half a million deaths in the U.S. alone. The virus has been devastating for many but has disproportionately affected racial and ethnic minority communities.
Now that the U.S. has accelerated its vaccination rollout, hope for the pandemic's end seems to be on the horizon — except that vaccinations among marginalized communities in many states have lagged behind.
For instance, Hispanic people account for 55% of COVID-19 cases and 40% of the population in California, but they have only received 21% of vaccinations, according to the Kaiser Family Foundation (KFF). Similarly, in Washington, D.C., about 49% of cases and 76% of deaths have affected Black people, but they have only received 31% of D.C.'s vaccinations.
— "We need more respected community leaders to speak out to help educate, motivate and inspire others so they will feel more comfortable receiving vaccinations." Dr. Alvin Cantero, DNP, FNP-BC
Lack of accessibility, particularly for those in segregated or rural communities, stops several people from going to vaccine centers. An NPR analysis from February found a disparity in the locations of vaccination sites in the South. In Mobile County, Alabama, for instance, NPR tallied up 18 vaccination sites. Fourteen of those sites were located in mostly white neighborhoods.
"Additionally, the high cost of quality healthcare creates a significant barrier for low-income families and people who don't have insurance," Cantero says. To make matters worse, low-income families may not have the technology they need to book appointments, either.
Language barriers impose a further hurdle, particularly for immigrants who cannot read educational materials in English or might experience cultural or religious differences in the context of healthcare.
Patricia Cummings, the nurse who inoculated Vice President Kamala Harris, points to some minorities' distrust of the U.S. healthcare system.
"Firstly, the distrust has stemmed from misinformation related to the pandemic, especially during its initial phases," Cummings explains. "Additionally, many have shared that they are fearful of being used as guinea pigs."
Cummings refers to historical events such as the Tuskegee Experiment in which researchers studied syphilis in Black men who were tricked into thinking they were receiving treatment. In 1951, researchers used Henrietta Lacks' cells without her permission to develop drugs. Because of these collective historical traumas, some people in minority groups have remained skeptical of medical advancements in general, especially with a vaccine developed in less than a year.
Like many other communities, racial and ethnic minorities also encounter misinformation. Many have heard the false claim that the vaccine changes recipients' DNA among other conspiracy theories. On top of mistrust, misinformation only bolsters people's vaccine hesitancy.
The Importance of Improving Healthcare Access
Perhaps the most beneficial consequence of improving access to vaccines is reducing illness and death from COVID-19. This potential outcome can prove especially significant to minority communities who have a history of shorter lifespans and more illnesses which can sometimes be attributed to lack of high quality healthcare.
— "These obstacles interfere with education about the COVID-19 vaccines and can lead to a general lack of understanding about their importance, even despite the many deaths these communities have witnessed due to the virus," Cantero says.
Minority groups typically have greater exposure to COVID-19 due to factors like physical environment, housing, and occupation, according to the Centers for Disease Control and Prevention (CDC). A higher percentage of people from racial and ethnic minority groups live in crowded housing, and people in these groups disproportionately work in key work settings without opportunities to self-isolate.
Data from the CDC shows the stark disparity in hospitalization rates for people diagnosed with COVID-19. About 1,038 per 100,000 American Indian or Alaska Natives were hospitalized in relation to COVID-19. In comparison, hospitalizations across racial and ethnic groups in the United States were as follows:
About 867 per 100,000 Hispanic or Latino/a COVID-19 patients were hospitalized
About 793 per 100,000 Black patients were hospitalized
About 291 Asian or Pacific Islander patients were hospitalized
About 279 white patients were hospitalized
CDC data also shows that Black and Hispanic COVID-19 sufferers are disproportionately more likely to die from COVID-19. While Hispanic individuals make up about 20% of the population, they account for nearly 40% of COVID-19-related deaths. The American population is about 13.4% Black, but African Americans have accounted for over 20% of COVID-19 deaths.
This data shows how imperative it is to close the gap in these disparities and create an environment where COVID-19 infections and deaths are rare.
What Is Being Done to Address These Obstacles?
The disproportion in vaccination rates has not gone unnoticed at the federal level.
The day after his inauguration, President Joe Biden created the Health Equity Task Force which aims to recognize places with vaccination disparities and propose recommendations on how to close those gaps. In early March, the Biden Administration also announced that it would invest $250 million to encourage vaccination in underserved communities.
Healthcare providers can make tangible changes at the local level without waiting for federal funding. Cantero, for instance, is implementing several measures to ensure that people in minority communities in Houston do not miss out on vaccination opportunities.
— "We have the skills and tools we need and there are thousands of underserved communities that still need our help." — Dr. Alvin Cantero, DNP, FNP-BC
"The main step I am taking at Alvin Clinica Familiar is to educate and instruct my patients, families, and community leaders about measures to prevent COVID-19 infection as well as benefits of the available vaccines," Cantero says. He also created a bilingual program to help immigrants and their families gain access to vaccines.
But Cantero has stepped beyond his clinic walls to push even further for vaccine equity. He has connected with community centers like the YMCA and homeless shelters. Immigrants, homeless individuals, and veterans who frequent or stay at these organizations often do not have the resources or information to access vaccines. By reaching out, Cantero hopes to create a direct line from these community centers to vaccine sites.
Cantero has taken the fight to the legislative level as well. In Texas, where he practices, nurse practitioners cannot practice with full prescriptive authority. "The removal of this type of barrier can help address gaps in access to primary care," Cantero says.
Ultimately, healthcare providers should actively work to increase accessibility and repair trust with racial and ethnic minority groups. Vaccine equity could not only help end the COVID-19 pandemic but also lead to better healthcare outcomes for minority communities in the future.
Contributor:
Patricia Cummings, RN
Patricia Cummings has been a nurse for more than 15 years. She was born in Guyana and moved to the U.S. about 20 years ago. Cummings currently works as a clinical nurse manager at United Medical Center, which serves predominantly Black neighborhoods in southeast Washington, D.C. Cummings is pursuing a master of science in nursing at Walden University.