Thoughtful, targeted approaches are needed to increase COVID-19 vaccination rates in Black and Latinx communities, which often distrust the healthcare system and face barriers to vaccine access, new data show.
“Black, Latinx, and Native American individuals represent about a combined 60% of COVID-19 deaths, despite comprising significantly less of the United States population,” said Jacinda C. Abdul-Mutakabbir, PharmD, from the School of Pharmacy, Loma Linda University, in California.
“To put this into perspective, Black individuals represent 13.4% of the United States population, while Native Americans represent 1.6%, clearly showing the disproportionate outcomes here,” she explained during her online presentation at the 31st European Congress of Clinical Microbiology & Infectious Diseases.
The vaccine creates an opportunity to change the disproportionate way COVID-19 has affected racial and ethnic communities, said Abdul-Mutakabbir, but “a long history of mistreatment within the US healthcare system decreases their trust for the system to use fair practices when delivering these vaccines.”
For people in minority communities, often “the fear of cost associated with healthcare keeps them from being vaccinated,” she said. “Also, there is a lack of vaccines actually allocated to these communities, or inconsistent computer-based sign-ups that make WiFi mandatory, which in turn has created additional barriers for vaccination access.”
Loma Linda University maintains the largest mass vaccination site in San Bernardino County, the fourth largest county in Southern California. However, only 3.0% of the people vaccinated there have been Black. And although 8% of the state’s population is Black, only 2.7% of the Black population has been vaccinated.
In contrast, Black Californians have accounted for about 20% of COVID-19 cases in the state, and 20% to 30% of COVID-19 deaths.
To promote equitable access to COVID-19 vaccines, Abdul-Mutakabbir and her colleagues developed a “three-tiered approach.” First, they had local Black faith leaders hold summits ahead of the vaccination clinics. Next, at those summits, they had a Black pharmacist educate attendees about the vaccines. And finally, they held a low-barrier community vaccination clinic in a Black community, where the pharmacist oversaw the transport and preparation of the vaccines.
Because access, transportation, and internet are all barriers to vaccination, the clinic used paper-based registration and was held as a pop-up clinic at a local Black church. The team held two clinics for the first Moderna dose, one clinic for the second Moderna dose, and one clinic for the Johnson & Johnson one-dose vaccine.
During the Moderna first-dose clinics, 673 vaccinations were administered, and during the second-dose clinic, 366 were administered. Early data showed a return rate of 87%, but the team has yet to update the final numbers, Abdul-Mutakabbir reported. During the Johnson & Johnson clinic, 314 vaccinations were administered, nearly half to Black people. After the community vaccination clinics, the mass vaccination site saw a 0.6% increase in vaccinations for Black people.
Abdul-Mutakabbir’s team also held three community clinics in Latinx communities. During the first-dose Moderna pop-up clinic, 258 vaccinations were administered, and during the second-dose clinic, 253 were, for a 98% return rate. Approximately 92% of those vaccinated were Latinx.
The study findings are not surprising, said Rhea Boyd, MD, director of equity and justice for California Children’s Trust.
“The barriers to vaccination are known and clear,” she told Medscape Medical News. “Mobile clinics with paper appointments address a number of those barriers head on, like transportation, internet access, and accessibility. Having Black providers leading the effort and church leaders involved also has been shown to increase confidence in the operations and process.”
Information campaigns can help counter online disinformation. Ultimately, however, “the main barrier to vaccination is access,” Boyd said. “Address access and rates will increase.”
The health inequities seen in vaccination rates among Black and Latinx people “are a product of structural and systemic racism,” Abdul-Mutakabbir said. “To create equitable processes, it is essential that we evaluate how we approach each of these different minoritized groups.”
Abdul-Mutakabbir has disclosed no relevant financial relationships. Boyd codeveloped THE CONVERSATION, a national campaign to bring credible information about the COVID vaccines to Black and Latinx communities in partnership with KFF, BCAC, and Unidos US.
31st European Congress of Clinical Microbiology & Infectious Diseases (ECCMID): Abstract 3644. Presented July 9, 2021.
Tara Haelle is an independent science/health journalist based in Dallas.
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