Health Care

Vermont has promised equal vaccine access for people of color. Will it be enough?

Note: This story is more than a week old. Given how quickly the Covid-19 pandemic is evolving, we recommend that you read our latest coverage here.

Dr. Harry Chen prepares a dose of Covid-19 vaccine at a Vermont Department of Health clinic in Winooski on Tuesday, Feb. 2. Photo by Glenn Russell/VTDigger

State officials have vowed to ensure that people of color in Vermont have equal access to the Covid vaccine. 

The data for Vermont and nationally is clear: People of color are disproportionately struggling with Covid. In Vermont, Black people have come down with the virus at 3.8 times the rate of white people. Asian, Hispanic and Vermonters of other races also have a higher chance of getting the virus. 

Although death data in Vermont is small, national data shows that people of color have died at significantly higher rates as well. As of this month, the Covid death toll is one out of every 825 white Americans, one in every 645 Black Americans and one in every 475 Indigenous Americans. 

Experts, advocates and officials in Vermont agree that data gives greater urgency to getting the vaccine to people of color in the state. But they don’t all agree on when and how those efforts should occur. 

The state has already begun some initiatives to help people of color who qualify for the vaccine to get it quickly and easily, including translation services, community outreach, and clinic locations and times held with Vermont’s communities of color in mind, said Tracy Dolan, deputy health commissioner.

The state has also held clinics specifically geared toward people of color who qualify for the vaccine, and has spread the news about those clinics through community partnerships, officials have said at press conferences.

Yet early data on vaccinations shows that so far, people of color haven’t gotten the vaccine at the same rate as white Vermonters. Data from the health department as of Feb. 4 shows that 9.1% of white Vermonters have received the vaccine, 7.3% of Hispanic Vermonters, 6.6% of Asian Vermonters and 6.1% of Black Vermonters — and only 1.9% of Native American Vermonters. 

It’s hard to discern the roots of that disparity because the state is only one week into its efforts to reach out to the broader population. The state data also doesn’t control for the age of the person vaccinated, while in Vermont people of color tend to be younger than white residents.

But Dolan said the data, along with the evidence so far from conversations with community groups, indicates “there is a disparity. There’s no doubt about that.”

“I think the access has probably been pretty good, and we're working on that,” she said. “But we did not expect that the uptake would necessarily be equal at this point.”

The priority question

Some argue that the state’s prioritization strategy has effectively put people of color lower on the list. Anne Sosin, program director for the Center for Global Health Equity at Dartmouth College, said the state’s decision to prioritize people by age — rather than put essential workers in an earlier category — has excluded many Vermonters of color who are at risk of getting the virus.

She said many other national organizations, such as the Advisory Committee on Immunization Practices, have adopted a framework that prioritized essential workers “in recognition of the fact that structural racism, not race, predisposes people to infection.”

People of color are disproportionately represented among the essential workforce. Sosin said excluding essential workers was intended to solve the “delivery problem” of identifying priority groups but didn’t consider issues of equity.

“The reason why we want to prioritize communities of color right now is because [they’re] at much greater risk of infection and of transmitting to other people,” she said. “An approach that only focuses on delivery barriers doesn't fully attend to concerns around equity.”

The state has often defended its decision to follow age banding by citing Vermont’s death data, which shows that the vast majority of people who have died from the virus have been 65 or older.

But the death data for Vermont has a relatively small sample size, with fewer than 180 deaths as of Feb. 4, and people of color are an even smaller number of those deaths, fewer than 30, because their population is so small in Vermont.

Dolan said national data might have led to a different conclusion about vaccine strategy, but “all we can say is that we're relying on Vermont's data right now to make the best decisions to save lives in Vermont.”

“We recognize that if we were looking at the whole country, that might be at a different prioritization, but in Vermont, our data is very clear, and it's about age,” she said.

Early in the discussion about vaccine prioritization, the Social Equity Caucus urged the state’s vaccine advisory panel to consider people of color for prioritization. They said the virus’ disproportionate toll on people of color has “brought into sharp relief the issue of health disparities in our country. Vermont has not been immune,” the caucus wrote in a letter to the panel.

The Brattleboro area BIPOC Health Justice Committee also wrote to the vaccine advisory panel to express concern about the current disparity in vaccine rates.

It suggested prioritizing several groups that have a disproportionate number of people of color for the vaccine, such as migrant workers, food-insecure Vermonters and essential workers. It also recommends vaccinating teachers because of the particularly high rate of Covid among children of color.

The caucus letter “drove conversations” on how the state should recognize equity issues, said state Sen. Kesha Ram, one of the people who signed the letter. But ultimately, the panel advised that the state provide equal access to people of color within each age group, rather than putting them into a higher category altogether.

Ram acknowledged that prioritization would face logistical challenges, including backlash from Vermonters who object to people of color being given any kind of special treatment, even one called for by the data.

“Anytime you mention those kinds of ‘identity markers’” of people of color, she said, “people will go to a really negative space, and the last thing we want or need is for BIPOC Vermonters to feel pushed even further away from the solutions and from the vaccine by the attitude of individuals in the system.”

Obtaining the vaccine

Some efforts to ensure vaccine equity began long before the vaccine was available. In the fall, Mercedes Avila, assistant professor of pediatrics at the University of Vermont, led a series of conversations in the New American community about the vaccine, and heard their questions and concerns. 

They began with focus groups with a total of 104 residents, then held educational sessions with about 170 people, with cultural managers and interpreters in many languages, including Nepalese, Bengali, Congolese, Somali and Arabic. Their latest round of conversations received a grant from the Vermont Department of Health.

Avila said many of them had the same questions English-speaking Vermonters had at the beginning of the vaccine process: Will it cost anything? Is it safe for pregnant women? Which vaccine will I be taking? 

But providing that information has increased urgency when most public health messaging and media outlets are in English. “Whenever we work with [limited English proficiency] Vermonters, we have to be proactive and not reactive,” she said.

The limited English proficiency community has also felt the effects of the virus and the economic impact of the pandemic. Avila said many of the people she spoke with lived in multigenerational households, making it “not really possible” to isolate. Others said they’d faced racial discrimination early in the pandemic because of the virus’ Chinese origins.

Those difficulties may continue into the vaccine process. Older people of color who live in multigenerational households may rely on their younger relatives to help obtain the vaccine, Ram said. That may prove particularly difficult if the younger person is an hourly worker.

The state health department has worked to provide vaccine resources in different languages and made videos with basic information about them, Dolan said. The department also worked with a translation service for its registration portal and offers translators for phone registration.

Avila said the early days of vaccine registration have proved difficult, even with those translation services available. Phone registration, in particular, tended to take longer. 

How is information presented?

Steffen Gillom, president of the Windham County NAACP, said the information for limited English proficiency individuals, and the efforts by the Department of Health to ensure equity, should be more prominent on their website and messages to the public. 

The state should consider if it’s presenting public health information through the lens of whiteness, he said. “For anyone participating, ask yourself, ‘Am I framing it through the view of white people? Am I talking to Black and Brown Vermonters?’”

He pointed out that data on the disparities between white Vermonters and people of color in Covid cases was difficult to find on the website, and the state’s vaccine dashboard didn’t show race by default. 

The state also reports limited data on race and ethnicity for vaccinations to the federal Centers for Disease Control, according to research by Documenting Covid-19, a project from Columbia University’s Brown Institute. The researchers requested contracts between states and the CDC and found that Vermont was one of the few states that does not report the race and ethnicity of every individual vaccinated.

The CDC uses individual-level data on vaccinations to determine the number of second doses needed for each state, among other things, 

Ben Truman, a spokesperson for the Department of Health, said Vermont immunization law prevents the state from sharing immunization records, so the race and ethnicity records are removed to protect people’s identity. He said the Department of Health shares that information in aggregate data.

Mia Schultz, president of the Rutland area NAACP, said she was concerned about what the vaccination experience would be like for people of color, who have faced centuries of discrimination and bias in medical treatment.

She said longstanding “issues of trust” in medicine have contributed to vaccine hesitancy. Her own 93-year-old grandmother has said she’s not sure about getting the vaccine. “That comes from a real place,” Schultz said. “This has to be approached with cultural humility.”

She said the state’s efforts should not just be “performative things.”

“There is a multipronged process where they do need to be bringing us back to the table in a way that is equitable, but they also have to be proactive and strategic and how that they're going to engage these communities in that way,” Gilliom said.

Shultz said providing more equitable access to people of color will help everyone in the state, including white Vermonters who may have difficulties with access.

“Having these conversations shouldn't just look like, we are doing some things special for Black and brown communities,” she said. We're doing something for all of our communities by making it more accessible.”

This story contains reporting from the Documenting Covid-19 project at the Brown Institute for Media Innovation, in collaboration with The COVID Tracking Project at The Atlantic

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