Confronting Inequities in the COVID-19 Vaccine Roll-Out

January 23, 2021

It was an astonishing scientific feat: COVID-19 vaccines developed, tested, and going into arms less than a year from the start of the pandemic. Yet the availability and uptake of the vaccine are poised to be uneven. A recent webinar asked what measures can be taken during the vaccine roll-out to avoid perpetuating inequities already worsened by the pandemic, in the U.S. and globally. (Watch video of the discussion below.)

Terry McGovern, chair of the Heilbrunn Department of Population and Family Health and webinar moderator, said research through the Global Health Justice and Governance program found that the pandemic has been most harmful to vulnerable populations, such as adolescents, migrants, LGBT people, sex workers, and criminalized groups. In the U.S., communities of color have experienced the highest rates of disease and death as the consequence of underlying health vulnerabilities concomitant with structural racism.

The good news is that clinical trials for the approved Pfizer and Moderna mRNA vaccines matched the demographic profile of the United States, with proportionate numbers of Black and Latinx people taking part. Side effects were largely mild and “outweighed by the protection that is conferred,” noted Micaela Martinez, assistant professor of Environmental Health Sciences. Moreover, while the cost of treating COVID-19 is the responsibility of patients, vaccines are free to all Americans.

But while the vaccines are safe, effective, and freely available, not everyone in the U.S. is ready to get vaccinated, with rates of vaccine hesitancy highest in communities of color. And even as the vaccine is going into millions of American arms, parts of the world may not see a vaccine for years.   

Overcoming Vaccine Hesitancy

While distrust in the vaccine is not unusual in most corners of the country, Black adults are less likely than any other group to say they want the vaccine citing safety concerns. Their legitimate concerns are rooted in a long history of medical experimentation and mistreatment, as well as a recent history of lies and politicization of science. It is now up to health officials to rebuild trust.

Machelle Allen, Senior Vice President and Chief Medical Officer at NYC Health + Hospitals, said her network of public hospitals is building knowledge about vaccine safety through a series of educational efforts—one-on-one conversations with hospital personnel, a social media campaign encouraging vaccine selfies, testimonials from Black and Brown influencers, and more. “We need the right messenger with the right message,” she said.

However, overcoming structural racism that underpins vaccine hesitancy should not be left to communities of color, said Allen. “It would be wrong as well as ineffective to ask Black communities to simply be more trusting. Clinicians, investigators, and pharmaceutical companies must provide convincing evidence sufficient to overcome the historical evidence to the contrary—that they are in fact trustworthy.”

In the Global South too antivaccine sentiment is high, stemming from a legacy of racism and colonialism, according to Latanya Mapp Frett, CEO of Global Fund for Women and adjunct assistant professor of Population and Family Health. Tailored, hyperlocal communications campaigns are needed to build trust, she said. But as a first priority, the Global South needs access to the vaccines. 

Vaccine Supply and the Global South

To end the global pandemic, the whole world needs access to the vaccine. So far, however, the vaccine supply has been limited to wealthy countries. The process of advanced purchase of these vaccines has meant that whatever country can pay the most at the earliest stage of production gets at the front of the queue, said Frett. Rich countries are hoarding the vaccine supply.” Of a total of 10 billion doses, the U.S. has purchased 2.6 billion doses—more than three times the amount needed for a population of 330 million people.

The COVID-19 Vaccine Global Access Facility (COVAX), an initiative co-led by the World Health Organization (WHO), Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Vaccine Alliance, is working to get vaccines to people in low and middle-income countries. Its goal is to deliver at least 2 billion doses to cover 20 percent of the most vulnerable people globally using vaccines purchased from manufacturers in India and China. An alternative scheme known as the “people’s vaccine” or the COVID-19 technology access pool would promote the open sharing of vaccine technology.

While COVAX has the support of major global institutions, its success isn’t assured. So far, the effort has raised less than half the $4.6 billion it needs. An internal Gavi report projected that some nations won’t have access to vaccines until 2024. “Low-risk people in the U.S. will be immunized before high-risk people in low-income countries,” Frett predicted. The effort might only “exacerbate inequalities,” noted McGovern, who added that the situation is eerily reminiscent of the moment antiretroviral drugs first became available to treat HIV in the mid-1990s. As Americans living with HIV quickly got lifesaving treatment, “the rest of the world had to wait years … We do not want to be in the same situation now with COVID.”

Watch the full video of the event: