Experts call for White House to craft a plan for equal access to COVID-19 vaccine

Black and Latino communities throughout the U.S. have borne the brunt of the COVID-19 pandemic, and health experts say the federal government needs to have a plan to distribute vaccines in these communities.

"They are going to have to make sure we have a sound distribution plan to make sure that we don't repeat the mistakes we did with testing," said Georges Benjamin, executive director of the American Public Health Association. Congressional Democrats had been calling for a national testing strategy from the White House, but the administration has largely placed the onus on states.

Benjamin said Congress should press the administration for a vaccine strategy, and that state and local public health should be consulted.

Federal officials also must prioritize building trust within these communities, experts said. This would mean devoting resources to educational campaigns for the public and working with community organizations and leaders to improve the COVID-19 response, including efforts to encourage people to take the vaccine once one is developed.

"Part of the vaccine hesitancy that you have in African-American communities or in black communities is a result of this systemic historical discrimination within the health care system," said Marya Mtshali, a lecturer at Harvard University with an interest in gender, race, and sexuality studies.

"The ways in which black bodies have been used for scientific research, and often in very abusive, exploitative ways, has caused a lot of hesitancy, concern, skepticism, and fear for a lot of black communities when it comes to medical institutions in general," Mtshali added.

While existing data is incomplete, current estimates show that black people account for 24 percent of U.S. COVID-19 deaths in which the race of the deceased is known, though they make up only 13 percent of the U.S. population, according to the COVID Racial Data Tracker, a collaboration between The Atlantic's COVID Tracking Project and the Antiracist Research & Policy Center.

In Mississippi, for example, 56 percent of the COVID-19 cases and 52 percent of the deaths were in black communities, although African-Americans make up 38 percent of the state's population, according to the database. In Louisiana, black people represented 54 percent of the deaths while making up only 32 percent of the population. The state does not report racial data for COVID-19 cases.

"We know from history that access to lifesaving vaccinations in our country, such as the polio vaccine, has not always been equitable," House Majority Whip James Clyburn said in a statement to National Journal. "Through my work with the Select Subcommittee on the Coronavirus Crisis, we will work to ensure that all Americans are able to access and afford approved vaccines and therapies."

House Democrats want to improve the COVID-19 response in communities of color in the next coronavirus legislative package. The House-passed HEROES Act would provide money to state and local health departments so they can build up culturally competent strategies for contact tracers and support awareness campaigns. The grant funds would also support identifying strategies to ensure that testing is accessible to racial and ethnic minority populations.

Republicans have panned the bill, which is estimated to cost around $3.5 trillion and contains several other provisions like state fiscal relief.

"It's critical that the Senate immediately take up the HEROES Act, which would provide additional resources and culturally competent public health information to help slow the spread and impact of COVID19 in communities of color," Rep. Robin Kelly said in a statement to National Journal. "If and when a vaccine is developed, this culturally appropriate infrastructure must be present in communities to maximize the impact."

When asked if Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander would support the provisions to build a workforce that could effectively provide services to minority communities, a committee spokesperson pointed to the Senate legislative package that passed out of committee last year aimed at lowering health care costs.

"The Senate health committee has already taken steps this Congress in the Lower Health Care Costs Act to improve access to care for low-income and minority individuals in our health care system," the spokesperson said. "That package contains five years of funding—more than $20 billion—for community health centers and related programs that expand access to health care and social services for low-income and medically underserved communities, as well as important provisions to reduce and prevent maternal mortality, an issue that disproportionately impacts Black women."

In order to get the vaccine to underserved populations, Harvard Global Health Institute Director Ashish Jha suggested waiving cost sharing for insured patients while providing free access to uninsured patients.

"The barriers are not just financial, so we have to make sure that the doctors and hospitals that disproportionately care for minority patients get early access to the vaccine, and to make sure it's not just the vaccine that is covered but the entire visit," Jha said.

Even before a COVID-19 vaccine is developed and available, Benjamin said there should be an educational campaign about the safety and effectiveness of vaccines. He said that anti-vaccination advocates are already messaging against taking a COVID-19 vaccine, and he has seen messages targeted at black communities.

"I've seen flyers, I've seen social-media posts targeting African Americans specifically, giving misinformation that the vaccine will give you the disease, that it will give you AIDS, that you shouldn't take it because it's a way of euthanizing black folks," Benjamin said. "I've seen all kinds of crazy things written as a way of trying to discourage people from taking the vaccine."

As the U.S. waits on a vaccine, there are still concerns around ensuring that black communities have access to COVID-19 tests and that there is effective contact tracing.

Uché Blackstock, an emergency-medicine physician and CEO of Advancing Health Equity, told House lawmakers that testing needs to be accessible in black communities, through means such as walk-up and mobile services. Her group, which she founded, provides consultations and workshops to health care organizations to address health inequities.

"Contact tracing in itself is a very sensitive area because when you contact-trace somebody they will have to tell you exactly who they've been in contact with," Blackstock told the Select Subcommittee on the Coronavirus Crisis in a June 4 briefing. "For that, we need to make sure we are engaging with black communities, and so I see a role for peer educators or community health workers really to be involved in the contact-tracing efforts.

"Messaging and outreach will be incredibly important," she added, "because the distrust that we have in black communities towards the health care system is going to be an issue in terms of access and then later down the road in terms of a vaccine."