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Inequitable vaccine distribution could lead to ‘a catastrophic moral failure’


With only so many COVID-19 vaccine shots to go around during a fledgling effort to inoculate humans against the virus, world leaders are seeking equitable distribution, and at least one fears the worst.

“The world is on the brink of a catastrophic moral failure — and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” WHO chief Tedros Adhanom Ghebreyesus said this week of early international allotments of the vaccine.

In the United States, President Joe Biden signed an executive order meant to ensure equitable distribution on Thursday, his first full day in office. He has promised “to make sure there are vaccination centers in communities hit hardest by the pandemic, such as Black and Latino communities, as well as rural areas.

That’s easier said than done, and early data about the vaccine rollout shows it may not be headed in the right direction. Worldwide, Tedros pointed out that fewer than five dozen total doses of the vaccine had reached one poorer country, while richer nations obtained millions. In the U.S., a Kaiser Health News analysis of state health department data shows that Black Americans — who have been dying of COVID-19 at higher rates than others — are getting vaccinated at lower rates so far, among a host of early issues that include an inadequate supply. Meanwhile, states found out that a reserve U.S. supply promised by the former administration did not actually exist.

See also: Who gets the COVID-19 vaccination first? Only 12 states follow CDC

Essential workers without a health provider and those who have no full-time employer, including contractors and “gig” workers, have found it hard to obtain the vaccine in some early cases. Health care workers are the first group eligible for vaccines in many states, but contractors in the field who float from one workplace to another have been denied access.

The American Staffing Association, whose members include staffing firms that place nurses and other health care workers, last week felt the need to release a statement that points out CDC infection-control guidelines established pre-coronavirus times explicitly include “contractual staff not employed by the health care facility.” Edward Lenz, senior counsel for the Alexandria, Va.-based ASA, told MarketWatch that it’s hard to tell how many temporary health workers have been turned down for vaccination, especially because the distribution process is decentralized.

“It is completely anecdotal,” Lenz said. “But we’ve heard enough from our health care staffing members.” He added that for some hospitals and facilities, “it may simply be that they don’t view it as their obligation to [provide vaccines for temp workers.]”

Widespread promises that essential workers will get priority for the free vaccinations are not a guarantee that it will actually happen. Not all of them are employed with benefits, so they lack access to vaccines through health providers, and some of them may be hard to reach because they live in rural areas, or because their immigration status makes them wary of officials.

Read: America’s 1% will be pulling out all the stops to get their hands on COVID-19 vaccine

Other front-line workers at high risk during this pandemic are agricultural, grocery, delivery and service workers, many of whom are minorities or immigrants. Los Angeles City Council President Nury Martinez is hoping that those workers receive priority, saying last week as she and other city and state officials announced Dodgers Stadium as a mass vaccination site that “If we don’t consider equity, the people who will get [the vaccine] first are the ones who can work from home and send their kids to private-school pods.”

Equity is “a life-or-death outcome and people at the lowest economic rung must have upper-level access,” Martinez told MarketWatch this week. “Equity is not a goal, it is a necessity.”

Community-based organizations could play a key role in ensuring the rollout is equitable. Maria Lemus is executive director of Vision Y Compromiso, a national organization that among other things trains promotores — commonly known as community health workers, although some of them help with more than just health needs — to reach groups that have scant resources, don’t speak English and in some cases may be undocumented immigrants.

Lemus has attended meetings of California’s Community Vaccine Advisory Committee and has advocated for promotores to be prioritized for vaccination.

“The partnership piece with community organizations needs to be explored, otherwise you’re just touching the tip of” the communities that may be underserved, she said. 

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Nadine Burke Harris, surgeon general of California and co-chair of the state’s Community Vaccine Advisory Committee, said the state is keeping that in mind. The state has allocated $30 million for communications efforts, including in different languages, and partnering with community-based organizations that have “trusted messengers” like promotores, she said.

“We’re working with the infrastructure we used for the Census,” Burke Harris told MarketWatch. “We still have a lot of existing relationships with CBOs.”

Rural areas that have limited access to hospitals might be served by mobile vaccination units, but Burke Harris pointed out that the Moderna Inc.
and Pfizer Inc.
vaccines must be kept at certain temperatures.

In some cases, smaller might be better than bigger. West Virginia, one of the states that’s leading the nation in vaccination rates, has seen success by partnering with mom-and-pop pharmacies instead of CVS
and Walgreens

For more: Walgreens and CVS on a hiring spree for COVID-19 vaccine rollout

As for gig workers, Uber Technologies Inc.
Lyft Inc.
and other app-based companies do not consider them employees but have asked government officials to prioritize them for vaccinations.

“As you can imagine, everyone is advocating to be higher on the list,” Burke Harris said, adding that “if they’re in the transportation sector, they will be included in that group.” In California, transportation sector workers are on Tier 2 of Phase 1b, which she said is coming soon. Counties are going at different paces, though, so distribution to the state’s residents is uneven.

Equity task forces and committees are common. Biden’s administration has one that’s promising to work with Black community groups such as churches as it tries to fulfill the new president’s promise of prioritizing those in the hardest-hit communities.

Likewise, Florida Gov. Ron DeSantis has asked the state’s officials to find places of worship and other locations where vaccines can be given to underserved communities, according to the Florida Department of Health, which notes that the state also has a vaccination partnership with Publix supermarkets. From Texas to Louisiana to Illinois, many states have also declared their intention to consider equity in vaccine distribution.

But good intentions are running into reality. California, where an estimated 31 million-plus people are 16 and older and therefore eligible for vaccination, had distributed just 3.75 million doses and administered about 1.5 million statewide as of Tuesday, according to the most recent data on the state’s online dashboard. It had just 4.1 million doses available.

Up-to-date news: Get the latest on COVID-19 and vaccination efforts

New York City is shutting down its vaccination hubs at the end of the week because it has run out of vaccines, Councilman Mark Levine announced in a tweet Wednesday.

“Keep in mind, the real challenge about this work is that we need more vaccine,” said Burke Harris, California’s surgeon general.


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