Vaccinating BIPOC Communities Depends on Access, Not Hesitancy

Four months into the COVID-19 vaccine rollout, numerous media outlets have reported on vaccine hesitancy in the Black and Brown communities and its potential impact on slowed vaccination rates. The conversation is usually the same, beginning with a historical account of the medical abuse of Black Americans followed by a brief mention of systemic failures.

It’s completely missing the mark.

In our biweekly COVID-19 Vaccine Sentiment Tracker, Verywell, like other outlets, has identified that 60% of Black Americans and 62% of Latino Americans have either been vaccinated or would agree to take the vaccine, compared to 76% of White Americans. But we know statistics about vaccine hesitancy in communities of color is not the issue we should be focused on. These figures do little more than scapegoat Black and Brown communities for systemic failures in public health.

These systemic failures—manifesting in the vaccine rollout as crashing websites and inaccessible vaccine sites—are the entire problem. And while medical mistrust stemming from structural racism is still a major factor that leaves Black and Brown Americans behind in their quest to get vaccinated, the lack of a fair and equitable vaccination program is the biggest obstacle to achieving herd immunity.

I live and work in Harlem, New York. I received my vaccine at the Harlem Department of Health. When I walked in I had no expectations, but I was struck by stark differences in demographics between the providers and patients awaiting their appointments. It seemed to me that the number of Black and Brown providers far outnumbered Black and Brown patients.

This was particularly odd given that the coronavirus has disproportionately impacted communities of color, who tend to have higher rates of preexisting health conditions, are more likely to work essential jobs, and are less likely to be able to practice social distancing due to unstable housing. These factors, called social determinants of health, make it more likely for Black and Brown folks to not only come into contact with the disease but also experience more severe outcomes. Still, vaccination rates in Black and Brown communities remain much lower than White communities, despite the vaccine being more widely available.

According to the U.S. Census, nearly 80% of the population in central Harlem identifies as Black or Latino, but this number is not reflected in the community’s vaccination rates. New York Governor Andrew Cuomo has addressed these disparities by creating zip-code specific vaccination sites—an increasingly common trend in urban cities throughout the country—but it’s not enough. The gobbling up of vaccine appointments by those outside of the community is reflective of systemic failures that have plagued and continue to plague Black and Brown communities.

Access Is the Biggest Priority

I am a public health doctor and I assist underserved communities in developing vaccination sites. My experience this year has taught me that simply building a vaccination program in a Black or Brown community does not equate to higher vaccination rates. The key is to include community members in the vaccine distribution model.

Vaccination rates skyrocket when I talk directly to the people and learn about the types of obstacles they are facing, like the inability to make daytime appointments due to essential employment or difficulty in finding a caregiver to watch a child or an elderly parent.

The obstacles don’t end there. I have found that communities of color may be reluctant to visit a clinic because of concerns about receiving a hefty medical bill, unaware they can get the vaccine without insurance. Our survey shows Black and Brown Americans have lower insurance rates than White Americans (76% versus 88%), which means that they may not have relationships with the healthcare systems that distribute the vaccine. They’re less likely to have a primary care provider or other healthcare professional that can notify them of their eligibility and help them to sign up for an appointment.

Bridging this gap between having vaccine supply and actually accessing that supply requires that public health officials speak directly to people in the community at places like churches and schools. And vaccination sites need to operate 24/7 with qualified translators on hand.

Improving Vaccine Sentiment Is Only Half the Battle

According to Verywell’s data, vaccine acceptance rates among both Black and Latino respondents have increased by about 25% since we started in December. Similarly, acceptance rates among White respondents have increased by 26%. That means that vaccine hesitancy alone does not explain why White Americans are being vaccinated at nearly double the rate of Black Americans.

There is no guarantee that the momentum of vaccine confidence will result in more shots. To make this possibility a reality, low-income communities need:

• Free, high-speed internet so they can make an appointment
• Access to around-the-clock mobile vaccination sites to more conveniently accommodate parents and essential night workers
• Transportation to and from clinical sites as needed

The slow rollout of the vaccine in Black and Brown communities is not the fault of the community members themselves. In fact, the messaging about how important it is for them to get vaccinated can feel tone deaf when their health was not prioritized during the pandemic’s peak.

Vaccine hesitancy cannot explain away all the problems with unequal vaccination rates in the United States. Our slow crawl towards herd immunity is reflective of systemic failures years in the making.

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