01 Mar The Solution to Vaccine Inequity is Already HereShare This Article
As cities across the nation and within the greater Chicago region began to launch vaccine roll–out and distribution—a much-anticipated end-phase to the COVID-19 pandemic—whispers of frustration have strengthened to become a critical public discourse of compounding racial/ethnic and health inequities for Black, Latinx, Arab and Indigenous communities. Health department officials, peer funders, and health institutions were genuinely surprised by the deep racial/ethnic inequities present in vaccine access. However, community-based organizations and leaders sounded the warning bells nearly one year ago at the start of the pandemic—they predicted precisely what we are seeing play out today in real-time. Despite repeated warnings, we now find ourselves facing a snowball of inequity compounded.
Yet, the foresight of community-based organizations is not a magical power that enables them to see into the future; it is the value of lived experience within communities who understand that effective service delivery requires nuance and trust, especially amid a pandemic.
Without a significant shift in how we partner with and in disinvested communities, achieving racial and health equity can only be an aspirational goal. The pandemic has made it clear that inequities in healthcare are not new nor isolated; they are being displayed in the high rates of COVID-19 infection and mortality and low rates of testing and, now, vaccine access for marginalized communities.
“Without a significant shift in how we partner with and in disinvested communities, achieving racial and health equity can only be an aspirational goal.”
Scenes of vaccine entitlement with affluent, white suburbanites taking many limited vaccine appointments in under-resourced urban communities, registration only through online portals, and lack of translated website and materials for non-English speakers are occurring in nearly every metropolitan region across the country.
These racial inequities are the most recent example of public health planning occurring in a vacuum, absent of community expertise, and reliant on the very structures that perpetuate systemic racism. The false dichotomy between accelerated, yet limited, vaccine distribution and equitable vaccine access for the most impacted communities is a lost opportunity to acknowledge how deeply anti-Black racism is woven into the structures that determine the health of entire communities, generation after generation.
To land on the side of expediency at the expense of communities of color only further the systems that privilege the privileged.
Reimagining public health so that all communities have the opportunity to be healthy requires us to fund equitably, understand the nuance within and between populations and be transparent with data. A strategic response to vaccine inequity grounded in racial and health equity begins with:
- Valuing community residents’ expertise, not only in actively using their insights to inform service delivery but also in funding them as true partners in creating healthy communities.
- Requiring service delivery innovation to address systemic barriers and holding institutions, including philanthropy and government, accountable to communities they have marginalized through decades of disinvestment and legal racism.
- Committing to collecting, sharing, and acting upon disaggregated demographic data, regardless of how disappointing the numbers are. It is precisely the disappointing numbers that best illuminate stark gaps in racial outcomes and move our efforts from equity to justice.
At the Healthy Communities Foundation, we believe that the solutions to addressing vaccine inequity are not theoretical but already in practice at the hyper-local level in our region. For example, months ago, we saw several of our partners pivot community health workers to provide direct outreach to residents by hosting webinars, returning voicemails to answer individual concerns about the vaccine roll–out. They also developed their own translated materials to disseminate information on the vaccine. Mainstream conversations have primarily focused on addressing vaccine hesitancy as the main barrier to roll-out.
However, to address hesitancy, our partners have repeated the importance of nuanced public health education campaigns that address the historical trauma of unethical medical procedures and testing of Black, Mexican, and Puerto Ricans in the early twentieth century. Our partners do this successfully from a lens grounded in acknowledging and confronting anti-Black and institutionalized racism.
Reimagining Access on Many Levels
When vaccines were beginning clinical trials, community-embedded organizations already understood that the digital divide extended beyond access to broadband internet. In fact, they had spent several months developing direct relationships with local health institutions to create telephonic registration processes to accommodate this need. Several factors compound this divide in our region—the economic barriers to acquiring a working device; lack of digital literacy to utilize the device; and, most importantly, lack of time to navigate confusing online vaccine scheduling systems that have already been “gamed” by those with more privilege.
“Until there is a willingness to critically examine the processes that institutionalize racism…the inequities we see surrounding vaccine access will only compound.”
Beyond the difficulty of getting a vaccine appointment, our partners also understand that travel to and from the vaccine site is a real transportation barrier for residents in the city and surrounding suburbs. They have worked collaboratively to establish vaccine sites directly in communities as well as provide transportation assistance. In a Chicago winter that has brought more than 30 inches of snow and several below–zero weather days, this planning has been critical to ensuring that communities can show up to appointments.
As vaccine ramp-up has focused on utilizing hospitals and large healthcare systems, currently enrolled patients have received vaccine access priority. Yet, in communities that have experienced massive unemployment and lack access to health insurance, free and charitable clinics – the healthcare safety-nets of communities – have partnered with local federally qualified health centers to provide vaccine access to those not connected to any primary care or large health institutions. Together, they are reimagining access by extending vaccine appointment hours for essential workers that cannot afford to miss a shift—a practice that remains unavailable for COVID-19 testing in hard-hit communities.
Beyond Vaccine Inequity
For decades, Black, Latinx, Arab and Indigenous communities have been sidelined, silenced, or made invisible in the moments that matter most to public health – in planning and preparation. Temporary community-centered responses are launched only amid a crisis when the inequities in death and illness are too significant to ignore. Yet, therein lies the contradiction.
When communities are finally brought into the fold, they are expected to solve massive public health issues with minimal, one-time funding that places restrictions on advocating for structural solutions to eradicating racism. We must invest in and partner with communities to move beyond crisis.
Until there is a willingness to critically examine the processes that institutionalize racism and shift practices, priorities, and systems, the inequities we see surrounding vaccine access will only compound. Furthermore, the 30-year gap in life expectancy based on race and place will only grow wider.
It is time for the public health infrastructure and philanthropy to acknowledge the value of community voice by partnering with and funding community-embedded institutions in ways that are no longer ad-hoc but sustained so that we can all be better positioned for the next health crisis.
- Abbasi J. Taking a Closer Look at COVID-19, Health Inequities, and Racism. JAMA. 2020;324(5):427–429. doi:10.1001/jama.2020.11672 4
- Kolata, G. “Social Inequities Explain Racial Groups in Pandemic, Studies Find”. NY Times. 9 December 2020, www.nytimes.com/2020/12/09/health/coronavirus-black-hispanic.html
- Gupta, A. “Keys to an Equitable Recovery: Better Data and “Trusted Messengers”. NY Times. 14 January 2021, www.nytimes.com/2021/01/14/us/covid-biden-race-gender-healthcare.html
About the Author
Nora Garcia is the Director of Programs at the Healthy Communities Foundation. She leads the foundation’s work on the intersection of health equity and social determinants, focusing on the impact of direct services, local networks, and policies on community health outcomes. Previously, she was a consultant to the Field Foundation of Illinois, the Pritzker Traubert Foundation and she managed the City of Chicago’s Peace Grants Program, a fund focused on youth violence as a public health issue. Her early non-profit experience included work on educational equity, youth development, and immigration reform. Nora earned an MSW from the University of Chicago. She was recently named a Terrance Keenan Institute for Emerging Leaders in Health Philanthropy Fellow.