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Health Disparities

Amid access hurdles, grassroots efforts underway to get COVID-19 vaccine to at-risk people of color

Donis Hernández spent three hours Wednesday trying to register his 77-year-old father for a COVID-19 vaccination appointment.

The Las Vegas construction worker and his dad have been waiting for this moment. Hernández works at construction sites where four of his co-workers have contracted COVID-19. He worries about his dad, who lives with him.

But when he finally got through on the newly opened online portal for seniors, appointments already were booked through June.

“He's frustrated because he wants the vaccine,” said Hernández, 41, whose family fled violence in El Salvador more than a decade ago and received temporary protected status. “He's afraid of contracting COVID.”

As states open vaccinations to those 65 and older and those with health issues that put them at greater risk of serious illness, groups nationwide are strategizing grassroots efforts to ensure access for people of color who have suffered disproportionately during the pandemic.

The process has proven to be a struggle, and early findings show states that rank high on COVID-19 vulnerability indexes are falling behind on vaccinations.

That includes states like Nevada, where Hernández lives. A coalition of diverse nonprofits, each focusing on specific racial and ethnic groups, formed the One Community Campaign, an outreach effort to reach and educate at-risk populations about the virus and the vaccines through campaigns on radio, billboards and print and digital fliers in multiple languages.

Part of the coalition is the Arriba Las Vegas Workers Center, which supports Latino domestic workers and other laborers.

The center’s health and safety in construction department has been repurposed into a COVID-19 prevention hub, which teaches those who work housekeeping jobs to sanitize and protect themselves after cleaning a home where the virus was present.

“We’re going to be pivoting in the future to assist folks with making online (vaccine) appointments,” said Bliss Requa-Trautz, executive director. “To be able to make an appointment for the vaccine right now, you need to have a computer, you need to have internet in your home. You need to be comfortable scanning a copy of your identification and uploading it.”

Many lack those resources. The center only recently helped about a third of its members get acquainted with Zoom, and the undocumented feel especially wary about scanning identification, Requa-Trautz said. And there's an added challenge: the online registration portals aren’t in Spanish, so the center has stepped in to provide clients with translation services.

“They have not released (vaccine registration) information directed toward Spanish-speaking community members, which is 33% of our population in Nevada,” she said. “That’s probably going to be an indicator of what initial data is going to look like in terms of who is accessing or not.”

A health care worker with the University of Nevada, Las Vegas School of Medicine tests a patient for the coronavirus at a drive-through testing site March 24, 2020, in Las Vegas. UNLV Medicine, the clinical arm of the UNLV School of Medicine, started conducting COVID-19 testing by appointment for people who meet the Centers for Disease Control and Prevention guidelines.

Nevada ranks high in COVID-19 vulnerability – one of the top 18 states, according to a tool developed by nonprofit Surgo Ventures and referenced by the Centers for Disease Control and Prevention.

Surgo’s index analyzes vaccine distribution rates and scores states on COVID-19 community vulnerability using socioeconomic, health and household income data.

On average, more vulnerable states have so far administered less of their allotted vaccines. Texas, Florida, Alabama, North Carolina and Georgia are the top five most vulnerable, according to the index.

USA TODAY's Vaccine tracker:Tracking COVID-19 vaccine distribution by state: How many people in the US have received a shot?

Inequities in Florida's vaccine rollout 

Stark racial disparities in vaccine access also are becoming apparent. In Florida, about 350,000 white people have received the first dose, compared with about 27,000 Black people, according to the state's vaccine tracker.

Black people have accounted for less than 5% of the more than 775,000 Florida residents who received the first doses of vaccine, according to state data.

Black churches in the state are converging in an effort to battle those troubling statistics. The Statewide Coronavirus Vaccination Community Education and Engagement Task Force, chaired by Tallahassee’s the Rev. R.B. Holmes, Jr., aims to get 60% to 70% of communities of color vaccinated by the end of the year.

The task force is working to designate 40 vaccination sites across the state by the end of the month, specifically at trusted sanctuaries such as Black churches, community centers and Florida’s four Historically Black Colleges and Universities.

Pearl Henry receives a dose of the Pfizer COVID-19 vaccine at Bethel AME Church Sunday, Jan. 10, 2021, in Tallahassee, Fla.

Florida disparities:As many Black Floridians die, very little COVID vaccine gets to them

“The whole idea of the task force on a statewide level is to make sure African Americans and other minorities will not be left behind as they continue to roll out the vaccines,” said Holmes, of the capital city's Bethel Missionary Baptist Church. 

“The government cannot do this by itself. The government needs to partner with faith-based groups that have the respect and credibility in these communities. We know that Black churches are well-respected in communities across the state of Florida. We know that HBCUs are respected and trusted ... those are venues that people trust.”

On Jan. 10, a century-old anchor of Tallahassee’s Black community, Bethel AME Church, administered 500 Pfizer vaccine doses to seniors. A concurrent effort was held at Saint Matthews Baptist Church in Jacksonville.

President-elect Joe Biden has made vaccine access for communities of color a key feature of his ambitious $1.9 trillion plan to confront the pandemic. The plan calls for creating more vaccination sites, such as mobile clinics, to get vaccines to hard-to-reach, marginalized communities in underserved urban and rural areas.

Neighborhood-level outreach

Throughout the South, which has been hit hard by COVID-19, health activists are leading neighborhood-level education and outreach efforts to fight deep-seated vaccine hesitancy sown by mistreatment of Black people in medicine.

Trusted community figures are publicly taking the vaccine to show its safety. In Augusta, Georgia, for example, 105-year-old Ruth B. Crawford, a longtime educator offered up her arm at the town's East Central Health District's drive-thru clinic.

The Mississippi Urban League, which runs the Mississippi Roadmap to Health Equity initiative, is planning a digital campaign to provide education surrounding the vaccine to correct myths and ease fears. There's misinformation fueling the fire, such as a rumor certain vaccines are being injected into Black folks and other types into white folks, said the urban league's director Beneta Burt.

Ruth Crawford, 105, gets her COVID-19 vaccination during the mass inoculation event at Craig-Houghton Elementary School in Augusta, Ga., on Jan. 11, 2021.

"This vaccine really shines a light on our need to be healthier, to build a healthier community," Burt said.

The state is also high in COVID-19 vulnerability. The Mississippi Delta is a region burdened with health conditions that put people at higher risk for COVID-19. The area, with a population that is 50% Black, has a disproportionately high rate of cardiovascular disease, and the state suffers the highest obesity rate in the nation.

Many members of Burt's community also lack a medical home – a primary care practitioner – and instead visit the emergency room for treatment, a hallmark of disparities in health care access.

"We want to be proactive in helping fill those gaps," Burt said, adding the league is working on partnerships to help address obesity and lack of health care access, both of which have placed Black Mississippi residents at higher risk for the novel coronavirus. 

"This is an important opportunity, I think, for this country to reevaluate how it looks at health for everyone and how improved health has to be done across the board. And it has to be done in conjunction with communities."

Supply, demand – and barriers

Public health experts warned broadly opening early vaccine access could undercut efforts to ensure the nation’s most vulnerable residents get vaccinated.

If states immediately grant access to those above 65 and tens of millions of younger adults with qualifying conditions such as obesity, diabetes and heart disease, vaccine demand will quickly outstrip supply, said Dr. Andrew T. Pavia, a pediatric infectious diseases chief at the University of Utah School of Medicine.

“If we throw it open as (outgoing Health and Human Services) Secretary Azar has suggested to 180 million people, but we have perhaps enough vaccine to vaccinate maybe 40 million by the end of this month, there’s a huge disconnect and that creates a lot of problems,” said Pavia, an Infectious Diseases Society of America fellow.

A member of the Mississippi National Guard gives directions to a patient who received a COVID-19 vaccination at a drive-thru site at the Pike County Health Department in McComb, Miss.

Recommendations from the CDC's Advisory Committee on Immunization Practices were designed to maximize impact, equity and practicality when vaccinating the public. Groups were prioritized to match anticipated supply, but the revised government plan “has kind of thrown out that practicality aspect,” Pavia said.

The new approach might favor “those in general who have more resources,” said Dr. Julie Vaishampayan, chair of the Infectious Diseases Society of America’s public health committee.

“They are going to be healthier and able to stand in line. They’ll probably have better mobility. They’ll have internet access,” Vaishampayan said. “So we need to really double-down on our work to try to reach those who don’t have all those resources.”

Vaishampayan is a public health officer in Stanislaus County, California, a community with a large Latino population. Her county works with community groups to make sure people who don’t speak English or don’t have internet access have a fair shot at getting vaccinated.

She said only people from eligible groups such as health care workers initially could schedule vaccines. That will change now that California has opened vaccination to adults over 65.

“It’s going to be a little bit harder while we’re trying to manage long lines” and crowded clinics, Vaishampayan said.

Meanwhile, back in Las Vegas, Hernández is waiting for his dad to get his COVID-19 shot.

"The only thing I can do is make sure I'm always wearing my mask," the father of two said through a translator.

Asked if he feels safe going to work until then, Hernández said "no," but he still goes.

"I consider myself an essential worker in construction and have been working throughout the pandemic," he said. "And as a TPS holder, if it weren't for the (worker's) union, then I would be without any sort of support right now."

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Contributing: Tom Corwin, Augusta Chronicle

Reach Nada Hassanein at nhassanein@usatoday.com or on Twitter @nhassanein_.

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