White Marylanders have received more than four times as many doses of coronavirus vaccine as Black residents, state data shows — a stark racial gap that has persisted even as more doses have arrived in the state and more people have become eligible to receive them.
Early discrepancies could reflect the state’s early prioritization of medical professionals and first responders, according to experts and state officials. Some cite increased vaccine hesitancy among minorities distrustful of the medical community. But as eligibility expanded to include older Marylanders and essential workers, many minorities, especially those in low-income areas, have faced barriers to accessing the highly coveted appointments in the state’s current system.
“I knew when this thing came out that we would have a problem with that,” said Victor Farmer, a 68-year-old traffic manager who lives in Northeast Baltimore.
Maryland’s Black and Latino residents were hit hard by the coronavirus, particularly early on. Their difficulty in getting the limited, life-saving inoculations further magnified the inequalities of the pandemic, and critics say the state’s vaccine program has contributed to them.
Baltimore and Prince George’s County, which have the state’s highest proportions of minority residents, are home to the three state-run mass vaccination sites, and efforts are underway to improve outreach. But the sites serve people from around the state, and the jurisdictions are among four whose health departments are projected to receive fewer than 200 doses per 10,000 residents through mid-March.
Gov. Larry Hogan, a Republican, said Thursday that Baltimore City “had gotten far more [vaccines] than they were really entitled to.”
But many of the vaccines that have gone to the city went to its 11 hospitals and their staffs. The city currently ranks third from last among the state’s 24 jurisdictions for the pe
rcent of its population inoculated, ahead of only Charles and Prince George’s counties.
Earlier in the week, Del. Robbyn Lewis, a Baltimore Democrat, said in an interview that other jurisdictions “have been preferentially resourced with vaccines.”
“It’s a political decision,” she said. “It is not a sound, well reasoned public health reason. And it undermines public trust in the system.”
Farmer spent a break Tuesday night idling in a truck in a Highlandtown parking lot with Tyrone Wilson after they closed lanes for road work on Pulaski Highway. Neither has gotten a shot, despite working in-person throughout the pandemic. March 5 will mark the one-year anniversary of the state’s first confirmed cases of COVID-19.
Wilson, 61, who lives near Dundalk, gestured toward the nearby Emergent BioSolutions plant that is manufacturing the Johnson & Johnson vaccine, which the U.S. Food and Drug Administration could authorize for emergency use this weekend.
The one-dose vaccine is expected to expand supply nationwide. But the drug maker has given no indication it will accept Baltimore Mayor Brandon Scott’s plea to buy vaccines directly for city residents. And Hogan declined to answer the mayor’s request to set aside doses for city residents at the newly opened M&T Bank Stadium mass vaccination clinic.
“It’s produced right here,” Farmer said, “but we’re not getting it.”
A reflection of society
Karen Kennedy planned to attend a funeral Friday for her 34-year-old niece who died from COVID-19. Due to crowd restrictions, only 37 people are allowed to attend the services at Howell Funeral Home.
Kennedy, a LifeBridge Health copy center operator, was offered a vaccine through work and has been delighted seeing people lining up for shots outside drug stores. But
she has suggestions for ways the state could improve the process.
“Put more in our neighborhoods and more longer hours,” Kennedy said.
Vaccination sites should be highly accessible, and appointments need to be convenient, said Dr. Georges Benjamin, executive director of the American Public Health Association. For instance, nighttime appointments should be available for those who can’t take off work during the day.
The current vaccination program disadvantages people who work hourly jobs and lack reliable internet access at home, said Benjamin, a former Maryland state health secretary. New appointments are often posted in the middle of the night or during traditional work hours.
“There are a lot of minorities that work shift work and aren’t able to get to the appointment [websites] before the appointments are all gone,” Benjamin said.
Through Friday, nearly two-thirds of the vaccine doses where the recipient’s race was known had gone to white residents, compared with only 16.2% for Black Marylanders.
About 31% of Maryland’s population is Black, according to U.S. census data, and they account for a third of the state’s confirmed infections and 35% of the deaths. White residents, about 59% of the overall population, represent 40% of the caseload and 52% of the death toll.
Likewise, Latino residents, 11% of the population, have received 4.1% of vaccine doses, yet account for 19% of cases and 9% of the victims.
“There’s nothing in the genetics of Black or Hispanic or indigenous communities that makes them more susceptible to COVID,” said Harald Schmidt, an assistant professor in the department of medical ethics and health policy at the University of Pennsylvania. “It’s simply a reflection of the fact that society is structured in a way that minority people are disproportionately represented among disadvantaged groups.”
A lack of clear change
Equitable vaccine distribution shouldn’t be about focusing on race, Schmidt said, but on targeting disadvantaged groups, which tend to predominantly include those who are minorities.
“Equity and vaccine allocation and race is not about giving a vaccine to the Obama family before the Clinton family,” he said. “That is not what we’re concerned with.”
Schmidt said states can address inequities in their vaccine allocation efforts first by finding the areas where disadvantaged residents live and dispensing vaccines in those locations, then using proper messaging and community outreach to get them signed up.
That’s what Maryland has been doing since officials first noticed disparities in the early vaccine distribution, said Dr. Jinlene Chan, Maryland’s acting deputy health secretary.
But that recognition hasn’t changed the state’s data.
Schmidt and Chan said the ongoing discrepancies partly could reflect who’s eligible to be vaccinated. Although about three in 10 Marylanders are Black, not all of them fit into the state’s current phases for vaccination, which target certain occupations and ages.
Minorities might not be as common in some eligible groups such as health care workers and residents older than 75, Chan noted. But they might be more prevalent among essential workers, Schmidt said.
Chan said the state isn’t aware of the specific racial breakdown among those groups currently eligible.
Regardless, Maryland officials recognize the divide in who is and isn’t getting the vaccine as an issue, she said.
In Baltimore City and Prince George’s County, the government has deployed sound trucks to educate residents about the vaccine and encourage residents to get it. The state also established a vaccine equity task force, which is holding two pop-up clinics at churches in the city Friday and Saturday to reach hard-hit communities.
Hogan has repeatedly pointed to a lack of doses supplied by the federal government as the root cause behind Maryland’s vaccine-related issues, including the consistent difficulties people experience getting appointments.
Even if the state targets disadvantaged Marylanders with certain clinics, those appointments could be scooped by other residents desperate to get vaccinated, Chan said.
”To the extent we can, we are looking at different strategies across each of the different access points,” she said. “We are trying to ensure that people who have maybe less access for a number of different reasons, that we do provide them access.”
‘They are not sending buses to come get us’
Many of those efforts are happening at a “grassroots community level,” said Chan, offering the example of Prince George’s County directly calling eligible residents to get them appointments at the Six Flags America mass vaccination site.
But the drive-through Six Flags site requires a car and has served more Montgomery and Howard county residents than those from Prince George’s.
Keith James, a retired construction worker with a disability, suggested the state set up a vaccination clinic in the Mondawmin Mall parking lot, where the one in three Baltimoreans like him who lack access to a vehicle could reach it by taking a bus or subway to the Mondawmin Station transit hub. He’s seen flu vaccination clinics there before.
“I can’t go to Six Flags, simple as that,” said James, 60. “They are not sending buses to come get us and transport us out there.
“It really is tough for the minority. … The Latinos and the Black population, sad to say, always seem to be last on the totem pole.”
Although the Six Flags site is open to all eligible Marylanders, some can’t access it, Chan acknowledged.
“We have layers of different types of access points, knowing that there is no single vaccination access point that is going to fit all the needs,” Chan said. “We absolutely recognize there is a really large proportion of our population that do not have access to transportation, that don’t have access to internet, and other important needs as part of the infrastructure we’ve been building.”
The increased use of in-neighborhood pharmacies, churches and mobile vaccination sites is aimed at making vaccines more accessible for everyone, Chan said.
Mass transit riders, including many essential workers, face a higher risk of exposure to the virus than their counterparts who can work from home and drive cars, said Lisa Shelton, 48, a former recovery center employee who lives in Milford Mill.
“You don’t know who you’re sitting next to, and it’s not always social distancing on the bus,” she said while waiting for a bus at Mondawmin. “You’re putting yourself at risk.”
‘Why not have vaccines in those hot spots?’
Shelton said she believes state officials are doing the best they can with limited vaccine supply, but she argued that more vaccines should be allocated to city neighborhoods ravaged by the pandemic. Four of the state’s 12 ZIP codes with the most confirmed cases of COVID-19 are in Baltimore City.
“Why not have vaccines in those hot spots?” Shelton asked. “It would make sense. People in the city aren’t just [as] important as the people all the way out there? That’s what it seems like they’re saying. If you have hot spots, why not have a place to get vaccines in those hot spots? It would lessen the severity. … It seems like a simple thing to me.”
Carlos Nufio initially doubted whether he wanted a vaccine. The Dundalk man, who was selling goods from the back of a vehicle in Highlandtown one night last week, said many Latino people felt the same way.
“People were saying you might be allergic to it or things like that,” Nufio said in Spanish. “But now I don’t have any doubts. I have some good friends, educators. They advised me, ‘Carlos, come on, you’ve got to get the vaccine.’”
Nufio credited the Rev. Bruce Lewandowski, pastor of the Sacred Heart of Jesus parish, for his efforts to educate the area’s large Latino and immigrant community about the importance of getting vaccinated. Sacred Heart will host a pop-up clinic Friday and is among the churches Chan said Maryland National Guard Brig. Gen. Janeen L. Birckhead and the state’s vaccine equity task force have partnered with to promote vaccinations.
Such hesitancy in minority communities is a factor, said Benjamin, the former state health secretary, but that by itself can’t explain the discrepancies. He described recently helping at a vaccination clinic in a Black community in Montgomery County.
“There was not a shortage of people,” he said. “People talk a lot about vaccination hesitancy, but that wasn’t an issue there by any means.”
Racial disparities in vaccine distribution have been an issue across the country, Benjamin said. But given the diversity of Maryland’s population, he said, “you would think that [the state] would have done better.”
Baltimore Sun photojournalist Ulysses Muñoz contributed to this article.