On Our Minds

Welcome to On Our Minds, the latest feature from the Farley Health Policy Center, where we will share commentary on policies affecting health, trends from findings in data and research, and the issues that matter most in our communities. We invite you to share your perspectives and input. Drawing on expertise from our evolving network, we’re eager to work with you, learn from you, build and share policy commentary that brings us together and continues to move us forward.

COVID-19 Vaccination Roll-Out: Leading with Equity-Centered Policies

Musheng L. Alishahi

Musheng AlishahiIt has been almost six months since the first COVID-19 vaccine was administered in the United States. For many of us, those months have been challenging. We’ve spent time anxiously waiting for our elderly loved ones to get their second dose or constantly monitoring our state priority groups in hopeful anticipation of securing our own place in line. For others, those months were a continuation of their lives in the new normal brought on by the SARS-CoV-2 pandemic. The past year has brought death, despair, and a reckoning, exposing the fault lines of our society and healthcare system. As highlighted by Dr. Sandro Galea, we found ourselves existing in a time of three major crises: 1) a public health threat 2) racial injustice 3) an economic downfall.

As an epidemiologist and public health researcher, I’ve spent much of my time following the dynamics of this virus. From the early days of the pandemic, data strongly signaled the virus’ disproportionate impact on morbidity and mortality in Black and brown rural and urban communities across the US. Underlying social and health inequities in the U.S. have heavily contributed to increased risk and illness of COVID-19 in these communities. The deepening of these disparities coincided with our country’s racial awakening, brought to a tipping point after continued police violence against Black people in 2020. This is, in part, the context that led to a renewed focus on health equity in the US public health and healthcare systems.

The roll-out of the COVID-19 vaccine is one of the largest and most difficult undertakings our public health system has seen in decades. This task has no shortage of barriers from logistics to vaccine education, to equitable allocation and navigating a response to rare adverse events. This task was a prime opportunity for federal and state governments to lead with equity-centered policies and solutions: policies purposefully designed to address the needs of minority communities with input from the very communities they are meant to serve. The purpose of these policies is to bridge social and health inequities that have long plagued our social fabric. History has revealed that when we don’t lead with equity-centered policies, the system defaults to one that perpetuates existing inequities. These inequalities are evident in some of our nation’s agriculture/food policies which have disproportionately impacted cost and access to fresh fruits and vegetables among low-income communities, some environmental emissions policies which have contributed to high pollution in poor neighborhoods, and many other examples.

In the winter of 2020-2021, areas of the U.S. committed their resources to developing and deploying equity-centered vaccination policies; however, a critical gap remained: a disconnect between the intention of the equity-centered policies and the reality of what our current infrastructure could do quickly and effectively. It became increasingly apparent in the early months of the US’s vaccination campaign that solely implementing equity-centered policies could not overcome the longstanding divestment in the communities these policies were aiming to help.  These policies were not enough to overcome the structural issues deeply rooted in our systems. As winter ended and spring began and we faced an increase in coronavirus cases and deaths, racing against the clock to halt the growing prevalence of coronavirus variants, the need to get as many shots into the arms of people became a top priority. This unfortunately, continued to leave low-resource communities vulnerable thereby perpetuating further disparities and returning us to a system that doesn’t work for everyone. As an example, in Colorado, Hispanic people account for 41% of cases and 25% of deaths but have received only 10% of the state’s vaccines. This is not uncommon as Non-Hispanic white people are receiving a larger proportion of vaccines in relation to the proportion of cases and deaths due to COVID-19 all across the US.  

But there have also been excellent equity-centered policies implemented across the states that have significantly contributed to widespread access of the SARS-CoV-2 vaccine, including:

These policies work to combat disparities brought to light during the pandemic and are a step in the right direction for more equity-centered policies to follow. There are many gaps that remain as we think about social and health inequity. More work needs to be done to address the gaps in infrastructure, access to resources, education, and health for communities of color to thrive in the US. It is my hope that the lessons learned from this pandemic continue to inform how we shape the public health system of the future. As vaccines are distributed and schools and gyms reopened, as handshakes and hugs make their way back into our lives, and as we begin to heal and move forward and forget our Purell and Clorox habits, it is imperative that we do not forget the lessons this pandemic has taught us. I deeply hope that the urgency and commitment to health equity spurred by the pandemic and civil unrest will continue to be a top priority.