Vaccine Rollout – New Vaccine, Outreach Efforts Addressing Equity
Johnson & Johnson submitted an Emergency Use Authorization application for its one-dose COVID-19 vaccine on Thursday. The application, which will be reviewed by the Food and Drug Administration at its February 26 meeting, seeks approval for adult use of the vaccine.
It is important to highlight how states and communities are working to ensure an equitable vaccine rollout, as we know that illness has disproportionately affected low income and black and brown Hoosiers, and that access to vaccines will be affected by an array of barriers. For example, a recent study of 69 counties by the University of Pittsburgh found that black residents were significantly more likely to live more than a mile from the closest vaccination site.
With less vaccine than demand, it is important to understand these potential barriers to equity, how to equitably prioritize access, and perhaps more importantly, how to implement interventions to support these equity priorities quickly and decisively. Proactive outreach and potentially targeted penalties for those facilitating line jumping are two suggestions from bioethicist Govind Persad. Below are a links to a few additional recent studies, reports, and news stories on equitable prioritization and implementation.
Bus Routes to Mass Vaccination Sites The NFL has offered up use of their stadia as mass vaccination sites. In Charlotte, North Carolina, the local transit system has set up two free, direct routes to the local football stadium for people with vaccination appointments.
Early Eligibility for Vulnerable Zip Codes Ted Doolittle, who holds the position of Connecticut Health Advocate, recently wrote a column titled “Making COVID vaccination more fair.” We know from studies like this one done in Indiana that living in different communities results in drastic differences in health risks and life expectancy, with higher health risks burdening communities with higher shares of black and brown residents. As Doolittle puts it, “[Age] 60 in Hartford equals 75 in West Hartford….We just need to remember that in terms of life expectancy and health outcomes, 75 does not equal 75 across the state.” He continues with a suggestion for how to balance a convenient, streamlined sign up approach with prioritization based largely on age brackets, but with targeted early access for lower aged populations using factors such as community income averages or the Social Vulnerability Index:
This is the middle of a pandemic, and we need to keep the pressure up and vaccinate fast, so we can’t spend a lot of time debating the exact formula for how low the zip code family income cut-off should be, or exactly how much to reduce the cut-off age for those zip codes. And, we can’t add a lot of nuance or complexity to the vaccine eligibility process – the vaccination program is already an administrative challenge and we shouldn’t burden those who run the system with any more categories than needed.
For instance, income statistics are available down to the census tract level, but people signing up for a vaccine know their zip code, not their census tract; so because it’s an emergency and we need to keep the solution simple, let’s use residence zip code income here. For what it’s worth, in terms of keeping it simple but delivering some semblance of equity here, my thought would be to clip 10 years off the 75-year limit for all residents of zip codes in the lower one-third of family income.
Health Ambassadors & Door to Door Outreach Natalie Shure highlights the success that Central Falls, Rhode Island has had during the pandemic with its Health Ambassadors program:
And now, as the city rolls out the vaccine, the health ambassadors’ role is more important than ever. As part of a pilot program to stress test vaccine distribution, the State of Rhode Island opted to focus first on Central Falls—zeroing in on a highly distressed ZIP code, and affording local officials latitude within it. To kick off the program, [Health Director] Fine and the vaccination team—complete with health ambassadors who’d already been stationed there—set up a clinic at the public housing authority, knocking on doors and vaccinating everyone who accepted a shot. Both Fine and Central Falls Mayor James Diossa both got their first shots on-site, to demonstrate the vaccine’s safety. But Fine believes the health ambassadors helped things go as smoothly as possible: “The ambassadors were there with the teams interpreting, and because of their very local presence, I think it was more comfortable for people.”
Once the vaccination teams had worked through the public housing buildings, the ambassadors resumed their stations around town—this time, enrolling and teaching residents about vaccines and when and how to get one, like on one Saturday morning at the Kiwanis Club parking lot. And each morning before the start of their shifts, they have a bilingual Zoom meeting to discuss what they’re hearing about the vaccines, how to get people excited for them, how to assuage anxiety or quell rumors swirling about them. Fine encourages them to discuss their own experiences getting vaccinated to reassure their neighbors. In one meeting I was invited to, one health ambassador described how he was running into fewer and fewer people who had misgivings about the vaccine, and more and more people excited to get theirs.
Accountability: How do you know if equity outreach efforts are working? Accountability and transparency measures must be included in such initiatives. Mississippi recently unveiled a notable and innovative accountability/communication tool, posting a breakdown of the percentage of black residents receiving vaccines at an array of vaccination locations, including private clinics, community health centers, hemodialysis centers, hospitals, state drive through clinics, and through the state’s pharmacy long-term-care partnership.
Vaccine confidence – Improved access doesn’t solve concerns about vaccine safety and efficacy. Those issues must be met with outreach and engagement. The National Academies has released a recent consensus report Strategies for Building Confidence in COVID-19 Vaccines.
Workplace Safety – Employee Vaccine Mandates & OSHA Guidance
Last week, the Federal Occupational Safety and Health Administration released new guidance on mitigating and preventing the spread of COVID-19 in the workplace. The guidance does not impose new requirements, but does offer employers suggestions on ways to fulfill their obligation to ensuring their employees remain safe from COVID while at work. See two summaries of the guidance from employment lawyers here and here.
What about employers mandating that their employees get COVID-19 vaccines? Leading public health law scholars Marc Rothstein, Wendy Parmet, and Dorit Reiss weigh in in this recent American Journal of Public Health article. They suggest that, instead of imposing vaccine mandates, most employers should encourage vaccine uptake through offering vaccines on site, giving time off, etc., and that they educate their employees about vaccination benefits.
Supreme Court on Regulating Religious Gatherings
Late Friday night, the Supreme Court issued an order in what has come to be known as the South Bay II case critiquing California’s approach to regulating religious gatherings during the COVID-19 outbreak. This likely will results in states pulling back further on attempts to address religious gatherings as sites of COVID-19 spread. Public Health Law expert Lindsay Wiley offers this explainer for non-lawyers.