As the woman at the helm of the New York City Health Department when the city became the epicenter for COVID-19 in the U.S., I’m excited and relieved that more than a year into this deadly pandemic we have three vaccines approved that hold great promise for bringing this global nightmare to an end.
It was inevitable that launching a nationwide mass vaccination effort would have serious challenges from supply issues to getting shots in arms, so it’s encouraging to see the speed at which people are being vaccinated is accelerating, as Americans step up to help one another navigate clumsy online vaccination portals and more vaccination sites are opened. The number of people wanting to be vaccinated is still outpacing vaccine supply, but all indications show manufacturers are on pace to accelerate production to meet that demand. However, we are destined to reinforce inequities in rates of vaccination among Blacks and Latinos if the imbalance between the momentum of COVID and the inertia of structural racism isn’t met with leadership that leans into equity.
In NYC, roughly a month after the first person was diagnosed with COVID and three weeks after the first person died of confirmed COVID, incoming death certificate information made it clear that Black and Latino New Yorkers were dying at twice the rate of white New Yorkers. We acted quickly on that information, relying heavily on community partners to convey lifesaving messages in ways that government could not. Most importantly, we continued to monitor transmission, hospitalization and death data to make sure those numbers were going down, especially in communities most affected.
Three months into national vaccination efforts, we only have race and ethnicity data for 54% of those vaccinated, according to the Centers for Disease Control and Prevention. Of states reporting race and ethnicity, vaccination rates for whites outpace those of Black and Brown Americans despite the fact that Blacks and Latinos continue to die at almost three times the rate of white Americans. This data represents the momentum of generations of structural racism that has collided with an unforgiving virus. This demands urgency in our actions, but not when our actions are limited to replicating the usual ways of doing things.
The Biden-Harris plan includes a number of measures to address racial inequities, ranging from strengthening data infrastructure to increasing access to high-quality healthcare, as well as providing additional resources for states and cities to intensify community engagement efforts aimed at vaccine hesitancy and targeting under-resourced communities for mobile vaccination efforts. These are all important, but they are not enough.
In order for these approaches to have maximum efficacy, they must be partnered with measurable, structural changes that only the federal government can do and manage now and over time. The federal government must require reporting of race and ethnicity within a specified timeframe as a condition of states receiving more vaccines. Replenishment should be based on the percentage of previous doses for which race and ethnicity is known. Additionally, the federal government must set performance expectations that states vaccinate Black and Brown people commensurate with the percentage of the population they represent in their state at a minimum and, ideally, at the percentage that they represent for COVID infections and deaths. States that meet or exceed those thresholds would receive additional vaccines (percentage to be determined by availability) above what they would have received in the next delivery as recognition of their efforts to meet the needs of communities most ravaged by COVID. Those additional, precious doses would be distributed to everyone in the state irrespective of race.
This approach reinforces the notion that achieving health equity requires urgency and necessitates hardwiring it into our workflows. It shouldn’t be inevitable that Blacks and Latinos keep getting pushed to the back of the vaccination line by the inertia of structural racism. By setting performance expectations that are not punitive, we reinforce the notion that when we lead with equity, everybody wins.