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Red flag raised about race disparity in Maryland’s early coronavirus vaccine rollout data

As Maryland health officials scramble to meet growing demand for the coronavirus vaccine, a red flag is emerging: Minorities, who’ve been hit hardest by the disease, have received shots at disproportionately low rates.

While observers caution it’s too early to draw conclusions about racial disparities in vaccine administration, the preliminary data has some health experts and lawmakers in Maryland concerned that the vaccination campaign isn’t effectively reaching the populations the virus has harmed most.

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The figures prompted them to demand more information and to emphasize the need for equity in the rollout, which has been criticized as slow and inaccessible to some populations.

Only about 16% of the first doses of the vaccine administered in Maryland for which race data is available have gone to African Americans, and 4.6% have gone to Latino people. Those groups represent 31% and 11% of the population, respectively.

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Black residents have accounted for approximately 33% of Maryland’s coronavirus cases and 35% of deaths from the disease; Latino residents 19% of infections and 9% of fatalities. As of Sunday morning, the virus had infected 341,452 and claimed 6,690 casualties.

White people, who account for about 40% of the state’s cases and 50.5% of deaths, have received 66% of the first shots administered for which race data was available. White residents make up about 58.5% of the population.

“When we see numbers that indicate disparity, they’re always concerning,” said Dr. Mark Martin, deputy director of the health department’s Office of Minority Health and Health Disparities.

Martin said public health officials must take a “deeper dive” into the data. He hypothesized that “vaccine hesitancy in long mistreated communities of color,” internet access issues and an under representation of minorities in health care may be contributing to the gap.

He said the health department plans to address the disparity through a mass vaccination campaign, promoted by the likes of athletes and academics, pastors and politicians, community and neighborhood leaders. Furthermore, the department will host virtual town halls and call on the sound truck to drive through communities blaring a message about the importance of getting immunized.

That the vaccine is being distributed at all marks a critical milestone in the coronavirus pandemic, with public health experts and medical professionals widely hailing the first two authorized products as safe to inject and capable of preventing people from contracting serious illness. It follows a nationwide surge in infections, hospitalizations and deaths from the disease caused by the virus, which threatens to sicken more people as a contagious new variant circulates in the United States and elsewhere.

But the rollout has gotten off to a slow start throughout the country, with officials citing a shortage of supplies and a lack of centralized planning by former President Donald Trump’s administration that has stalled vaccinators from quickly getting shots into arms. No state has fully vaccinated more than 3% of its population as of Sunday, according to figures from the Johns Hopkins Coronavirus Resource Center.

In Maryland, the vaccination campaign has focused on front line health care workers, emergency responders and, more recently, residents 75 and older as well as teachers. On Monday, eligibility opens up to include residents 65 to 74 years old and other groups of essential workers.

Baltimore City Council President Nick Mosby expressed concerns about the racial disparity but said it’s impossible to know the extent of the issue without more detailed data.

The Democrat, who early in the pandemic pushed Maryland officials in his role as a state delegate to release race data about the coronavirus, suspects socioeconomic and technology gaps exposed by the pandemic contribute to minorities receiving fewer shots. But Mosby wants to know more about the recipients of the 280,769 first doses administered as of Friday morning. He wonders how many are health care workers and first responders, and “when we take them out of the equation, how does the percentage look?

“I think that data will be more telling about the administration of this. And it could be worse,” Mosby said. “That’s why we have to press for data.”

Samantha Artiga, vice president and director of the Kaiser Family Foundation’s Racial Equity and Health Policy Program, co-authored a report released Thursday that “raised flags” about early vaccination data. She cautioned that the data was reported inconsistently state-by-state — and the majority don’t yet report race data about vaccines.

Artiga’s analysis relied on figures from 16 states that reported vaccination race data to the federal government and found “the share of vaccinations among Black people is smaller than their share of cases in all 16 reporting states and smaller than their share of deaths in 15 states.” It also found that the portions of shots for Black and Hispanic people is smaller than their shares of the populations in those states.

“The early data highlight the importance of prioritizing equity as we continue vaccination efforts,” Artiga said. “We’ve seen people of color have borne the brunt of the pandemic in terms of health outcomes and financial impact.” It will be necessary to reach all communities, she said, “if we want to achieve population level immunity.”

Various factors could be influencing the data, such as who has had access to injection sites. Internet access and computer proficiency have proven to be barriers, too. Research shows that people working in hospitals who have direct contact with patients are about 60% white and 40% people of color, about on par with the general population. At long-term care facilities, more workers are people of color, and one in four are Black, and some are low-income or non-citizens and may be more hesitant to take the vaccine, she said.

Hesitancy is a widespread phenomenon that follows generations of abuse of people of color within the health care system and can’t be cured with a quick fix, Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said during a virtual event Friday hosted by the University of Maryland School of Medicine.

A poll led by the Johns Hopkins International Vaccine Access Center and Morgan State University backed up Fauci’s assertion. Conducted in late November and early December, the survey found some hesitancy among almost 40% of African Americans living in senior housing, a large number of whom (about 1 in 5) were just unsure about being immunized, said Lois Privor-Dumm, the center’s director of adult vaccines.

Fauci used the panel discussion Friday, moderated by Black church leaders, educators and vaccine clinical trial volunteers, to appeal to clergy members and trusted community messengers to help spread awareness and faith in the vaccination campaign. He also recommended digging deeper at the source of the hesitancy and using “trust in the facts” as a way to combat fears.

“You can be an important part of the solution,” Fauci said. “People have great trust in their churches, and when the church takes the lead, it’s amazing how you can help turn around things.”

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Bob Atlas, president and CEO of the Maryland Hospital Association, said he’s not sure why the rollout has been uneven, but “any disparities in health care are a top concern” and “hospitals are providing equal access” to the vaccine.

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“The figures could indicate that Black and Hispanic front line hospital workers have questions about the vaccine,” Atlas said. “As time goes on, and education continues, more health care workers are expressing comfort in getting the vaccine and we expect the numbers to grow.”

Meanwhile, Maryland Sen. Clarence Lam, the state Senate’s only physician, said “early warning signs” of inequities could be exacerbated if the state doesn’t address them promptly. He said Maryland should make the immunization process as easy as possible for communities of color which lack access to the health care system.

“A lot of lower-income individuals that might be on Medicaid, and might not have a primary care provider, might not have interacted with a health system before,” Lam said. “I don’t think there’s been a real plan to reach them.”

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