Last week I wrote about the need to focus on action — not just words — when it comes to equity in vaccine distribution.
The lip service I wrote about is in abundance in Seattle. Everyone knows the right words to say to lend the appearance of a commitment to equity. As Dr. Ben Danielson said last week at a Seattle City Council meeting on vaccine distribution equity, the impact of lip service is a threat to the health and safety of our communities.
“What we learn in our experiences working — especially in the Northwest — is that these days, the appearance of equity has been the biggest barrier to equity actually happening in our systems, especially in health care,” said Danielson, the former medical director of the Odessa Brown Children’s Clinic and a longtime pediatrician. “No more statements about equity. Name the ways in which you are shifting power and show us and be accountable to us for those shifts.”
But what are the best ways to shift that power to achieve vaccine distribution equity?
Luckily, our region’s Black, Indigenous, Pacific Islander and other people of color-led organizations, as well as disability justice leaders, have answers — they just need to be heeded.
In last week’s City Council meeting, leaders of multiple organizations laid out strategies to ensure that those who most need the vaccines can get them.
First, as I talked about last week, we have to start with good data. As the speakers pointed out, data on who is getting the vaccine is still lacking. Last week the state department of health finally released initial data on vaccine distribution demographics, but said that the around 1 in 10 patients with missing demographic data and the high number of people in the category “other,” “impact our ability to make conclusions based on these data.” But even with the data we do have, it’s clear that African Americans, Latinos, Pacific Islanders and Native Hawaiians are under-vaccinated relative to their population and high case counts and in some cases, death rates.
In addition, while the state says vaccine providers are required to collect and submit demographic data, community leaders said there are no consequences for not doing so and Seattle Times reporting found that some providers aren’t asking for race data at all. Requiring that the data be collected and reported, and creating repercussions for vaccine providers that fail to do so would be a good first step toward accountability.
It must be the responsibility of all vaccine providers — mass vaccination sites, hospitals and clinics — to be accountable for equity, not just health providers that serve communities of color.
Second, an equitable vaccine rollout requires that we trust in the expertise, relationships and skills of the community health clinics and organizations who know their communities best.
Instead of community health clinics getting their allocations last — or not at all — put them at the front of the line. The recent success of the Seattle Indian Health Board (SIHB) in vaccinating Indigenous communities is a model for how this could work. According to SIHB CEO Esther Lucero, the state set aside 5% of vaccines for tribal communities.
The vaccine allocation allowed SIHB to successfully vaccinate Indigenous elders as well as others, using messaging and outreach that was culturally appropriate and responsive to the needs of the population.
This model could be replicated for other groups as well, knowing that if we are left to a “Hunger Games” approach, the most marginalized will always lose.
Community partners should be at the table making decisions on how best to serve their communities, not just be recipients downstream, as Sea-Mar Senior Vice President and Chief Operating Officer Jesus Sánchez said during the council meeting. The recent success of pop-up vaccine clinics, like the ones organized by the Pacific Islander Community Association, the Somali Health Board and the Ethiopian Community in Seattle, should be copied and expanded.
Third, going forward, resources need to be placed where they will most impact equity. Ideally, prioritizing equity would be at the beginning, not the end, of the planning process. We have had a year to prepare for the vaccine rollout, and yet we find ourselves, once again, scrambling. Community leader and caregiver Trang Tu said during the City Council meeting, “Right now, the focus on speed and scale in delivery comes at the cost of sacrificing equity and fairness.”
This is unacceptable.
If community health clinics and organizations need low-temperature freezers, more staff, money or other infrastructure to successfully vaccinate their communities, those resources should be allocated to them.
Other equity approaches should be piloted, such as distributing the vaccine by ZIP code, to protect against people with the most resources gaming the system and showing up to clinics meant to serve the most marginalized populations.
And most of all, those who are closest to the communities being served should be the ones driving the resource allocation and decision making.
As Lucero said, “It’s about a transfer of resources, power and authority, and that’s where we need to live if you want to make a difference.”