Light at the End of the Tunnel, but COVID-19 Doesn’t Vanish with Emergency Authorization of Vaccines, Especially in Low-Income Communities of Color

by Richard Seidman, MD, MPH Chief Medical Officer, L.A. Care Health Plan

When the U.S. Food and Drug Administration granted Emergency Use Authorization to two COVID-19 vaccinations in December, less than a year after the pandemic began, it marked a major step toward ending the scourge that, so far, has taken more than 400,000* American lives. However, we have seen that having authorized vaccines and getting those vaccines into peoples’ arms are two very different things. We have also seen that some of the hardest hit communities will not be among the first to receive the vaccines.

As expected, the initial stage of the immunization rollout included a limited number of vaccine supplies, requiring prioritization. The prioritization guidance from federal, state and county health officials for the rollout made sense. The first phase of the rollout, phase 1A, prioritized frontline healthcare workers, and long-term care and skilled nursing facility staff and residents. We need to protect healthcare workers and the residents of facilities where we saw such devastating death rates earlier in the pandemic. They are the most vulnerable and should be vaccinated first.

But, as we move into phases 1B and 1C, consideration of hard hit communities, specifically low-income communities of color, should be given greater priority. In fact, L.A. County data shows age-adjusted death rates are more than three times higher in our poorest communities. On January 13, California moved into phase 1B, announcing that all people 65 years of age and older are eligible to be vaccinated. Phase 1C lowers the age further with people 50 to 65 years old prioritized, along with younger people with chronic conditions and essential workers. Neither phase nor the proposed tiers within each phase give additional prioritization to people of color or those living in poverty. Nor did the state’s recent order to expand prioritization to avoid vaccine doses going to waste, even though the virus has disproportionately impacted these communities.

The Centers for Disease Control and Prevention (CDC) acknowledges that COVID-19 has disproportionately affected racial and ethnic minority groups, and people living in poverty – they are more likely to become infected and more likely to die. These people often cannot afford to stay home. They work in low-wage, essential jobs – in grocery stores, restaurants, agriculture, and food production plants, and they are more likely to use public transportation. Many return to crowded, multi-generational homes that don’t allow for adequate physical distancing to prevent the spread of infection within their households. These people must be vaccinated as soon as possible if we are going to stop the spread of the virus. As the Chief Medical Officer of L.A. Care Health Plan, a health plan that serves individuals who fall into these categories, I am deeply concerned. L.A. Care is advocating at the state and local levels for vaccine administration plans that do more to prioritize traditionally under-resourced communities, which have the highest rates of COVID-19 cases and deaths. We must provide these communities with greater opportunities to be vaccinated.

We also have to acknowledge that some in these communities are skeptical and unwilling at this time to get the COVID-19 vaccine. This is especially true among Black Americans where vaccine hesitancy can be traced back in time, even prior to the Tuskegee Syphilis Study that began in 1932 and continued until the Associated Press exposed this tragic and unethical study 40 years later. The Tuskegee experiments, conducted without informed consent on hundreds of participants, tracked the natural history of untreated syphilis in African American men. This history, along with the history of racism and implicit bias in Black and Brown communities, has had a devastating impact. A Pew Research Center survey last month found that while 71 percent of Black Americans knew someone who had been hospitalized or died of COVID-19, only 42 percent would get a vaccine. The numbers are even lower in other surveys, including among Latinos. To ensure African Americans and Latinos fully benefit from the protection the COVID-19 vaccines provide, it will require appropriate messaging and messengers. Health plans and individual primary care physicians are trusted sources of information and need to do everything possible to spread the word, first, about how to avoid contracting COVID-19, and second, about the safety and efficacy of the vaccines. Celebrities, politicians, star athletes and other influencers can also play an important part in getting the word out.

Vaccine hesitancy is not limited to communities of color. There are “anti-vaxxers” who do not believe in any sort of vaccinations. However, some people, even some health care workers and other frontline essential workers, have expressed specific concerns about the speed at which the COVID-19 vaccines have been created and approved. It will be important to reiterate that these vaccines have been through rigorous trials, that multiple expert committees have reviewed them, and that the safety track record to date in the United States and throughout the world has been excellent. Misinformation contributed to too many cases and too many deaths. We must not let the same misinformation further hamper the vaccination process. L.A. Care, following the lead of our national, state and local public health experts, recommends that everyone who is eligible get the COVID-19 vaccine. Vaccination is the best way to protect yourself and your loved ones. But, it is still important to wear a mask, watch your distance and wash your hands.

As a health plan concerned about its members, L.A. Care is doing everything we can to assist with the vaccination effort, including planning drive-through vaccine clinics, addressing vaccine hesitancy, holding educational conferences for members, and encouraging staff to assist in the vaccination effort. In addition, it is advocating for the investment and effort that is going to be required to get as many people as possible vaccinated in low-income communities of color throughout Los Angeles County. COVID-19 has taken a tragic toll, but the vaccines offer hope for an end to the pandemic.

For more information about COVID-19, visit lacare.org/covid19.

*As of January 21, 2021