Q&A with Denise Herd on equity-based vaccine distribution

Sara Grossman

Campaigns Coordinator
Interview

Tuesday, March 23, 2021

Denise Herd headshotDenise Herd is OBI's Associate Director, a longtime member of its Diversity and Health Disparities faculty research cluster, and a Professor of Public Health at UC Berkeley. Herd’s scholarship centers on racialized disparities in health outcomes, spanning topics as varied as images of drugs and violence in rap music, drinking and drug use patterns, social movements, and the impact of corporate targeting and marketing on popular culture among African American youth. 

California is currently prioritizing distribution of the vaccine based on age. Can you discuss how that seemingly neutral policy may be contributing to racial disparities in vaccine inoculations? 

One of the most basic problems with prioritizing vaccination based on age is that Black people, Native people, and other people of color generally have shorter lifespans than other Americans. That's a result of systemic racism, but it means that racial disparities will exist when prioritizing age without taking into account other factors, like race and geography. 

For example, in Connecticut, the northeast section of Hartford has a life expectancy of 68.9 years, compared to 84.6 years in West Hartford Center. And so automatically that means that if you're prioritizing people who are 75 years and older, you’re missing a substantial part of the population in these kinds of areas that tend to be populated by people of color. I think that's one of the major problems. 

The other problem with prioritizing distribution based on age alone, is that minority groups are experiencing Covid at different ages. Among the Latinx population, for example, it's actually the people who are younger who have the highest rates of Covid. So those people who are 35 to 49 years old that are Latinx have the highest rates of Covid, followed by those that are 18 to 34. We're looking at a lot of young people who are getting Covid much more than others and who are dying of Covid and among the Latinx population, the elders are actually healthier than the younger people, and I'm assuming that's because of work exposure and so forth. So you're missing the people in that population who are at most risk of getting Covid and also at most risk of dying. That’s why distributing the vaccine by age is...one of the factors that are particularly hurting disadvantaged people and people of color.

What are some other barriers facing communities of color in terms of getting vaccinated. And, on the flip side, what are some of the reasons that white and Asian groups are currently accessing the vaccine at higher rates? 

For one, we’re seeing that wealthier communities are vaccinating people at higher rates than poor communities, which is automatically racialized. In general, wealthier communities, tend to be white and have a lot of advantages. I mean, if you think about how vaccines are distributed, they're distributed in healthcare facilities, they're distributed in retail facilities. And poor disadvantaged communities don't have as many of those resources.

We're all familiar with food deserts, right? But think about health deserts and think about retail deserts. So if your community doesn't have as many pharmacies or CVSs or hospitals or clinics, then your access to vaccines is limited.

But there's also personal access and folks who have good jobs and health insurance, which is another way of accessing the vaccines. If you have a job where you can work at home, where you can be on the phone for three or four hours to schedule your appointment, and you can take time off from work, you're in a far different position than somebody who's not going to be able to take that time, to even make an appointment, let alone to go to an appointment. 

Furthermore, people living in under-resourced communities often don't have transportation. In contrast affluent people often travel outside of their own neighborhood to get the vaccines. There have been cases in New York, Washington, DC and Baltimore, where they were opening up community vaccination sites, but most of those vaccination slots were taken up by wealthier white people who drove out of their neighborhoods to get vaccinated. And so we've got people without access to transportation, or they have public transportation that’s not great, and they can’t easily access vaccine sites meant for them. That's another limiting factor. 

Finally, the digital divide is very important: having access to a computer and the internet. I’m thinking about unhoused people who are probably less likely to have something like a laptop or a desktop, or even if they have a phone, how are they going to charge that phone? So I think that digital access is incredibly important in terms of who can get vaccinated.

Do you have any recommendations for a better way, other than age, to distribute the vaccine? What factors would you look at or what factors would you prioritize if not for age?

Early on there were discussions about prioritizing people who were more likely to get Covid and more likely to die from it, such as healthcare workers and other essential workers. Of course I think healthcare workers are a definite priority because they are coming in contact with people who are sick and they need to be protected so they can take care of others. 

But beyond that, we also need to be looking at geography, as I said earlier. Racial segregation has meant that disadvantaged populations are congregated in certain areas. All health disparities vary by zip code. If we look at a place like Berkeley, there are two zip codes with the majority of all the health problems. And these are the same zip codes with the majority of population is Latinix or African American.

Segregation has already paved the way for disadvantage, and it should also pave the way for who gets prioritized.

More broadly, some states also talked about using the CDC Social Vulnerability Index as a guide. And that's an index that looks at social and economic factors. It looks at race and ethnicity. It looks at language, housing, status, disability status. And so I think in December, 18 states were talking about using those kinds of metrics as a guide for how to determine who was going to get the vaccine first. 

Do you have any sense of why our political leaders have chosen to prioritize age, particularly in a state like California which has the reputation of being more progressive? 

If we look at death rates from Covid, it has indeed been older people who have experienced high death rates. And that is certainly concerning and shows that we need to prioritize that group, particularly those who live in residential facilities and are at the highest risk of infection. At the same time, we are also seeing very high infection and death rates in communities of color, and yet Americans seem unwilling to prioritize those disadvantaged populations. People in the US are more willing to uplift the needs of one group but seem uncomfortable uplifting those of another. There was an actual case I read about in Washington, DC, where, when they prioritized poor neighborhoods to receive the vaccine rollout, people in wealthier neighborhoods were very, very upset. And in fact, they got the majority of vaccines that were initially slated for poor neighborhoods, but they were upset that they weren't first.

And so we've seen a lot of people jumping the line, wealthier people who are able to influence friends and networks and things like that to get the vaccine first. There was even a case of a couple that flew from British Columbia to the Yukon and got vaccines that were supposed to be given to indigenous elders. 

The vaccine is also being privatized very heavily. Some assisted living facilities are advertising that if you come and join, you can get the vaccine. Some retail outlets have used the vaccine to attract customers. So I think prioritizing the most vulnerable people, people of color, disabled people, and so on—that flies against the kind of market orientation that we have in the US and the privilege that the wealthy and white people in general have enjoyed in this country.

When it comes to racial disparities in vaccine distribution, one thing we haven't talked about yet are the high levels of mistrust towards the medical profession that exist within communities of color, particularly Black communities. Can you offer some context for that mistrust? 

Yes, there have been a lot of historical examples of oppression, scientific racism, and medical experimentation on Black populations and on people of color. For example, we're all familiar with the Tuskegee experiment where groups of men were just allowed to die of syphilis even after treatment became available. But there's also been a history of sterilization abuse among women of color in this country. And, and not just in this country. In Latin America, some similar syphilis experiments went on in Guatemala, and sterilized Puerto Rican women, indigenous women and black women. 

But there's also present-day mistreatment in medical facilities. For example, there’s an idea rooted in slavery that Blacks don't feel as much pain. And I'm not sure if you're aware of the recent case of, I think it was Dr. Susan Moore, who died of Covid-19. And before she died, she was having trouble accessing good care for Covid. She felt like a drug addict because her doctors were refusing to give her medication for pain and wanting to discharge her earlier. So between the historical and the contemporary context where people are mistreated even now, I think that provides the context for why there's medical mistrust among communities of color.

Do you have any insights into how medical practitioners and people in the public health space can begin to address that both on the interpersonal level, but also on the policy level?

I think it’s important to recognize that communities of color mistrust medicine for the same reasons that other people mistrust medicine, particularly in regards to our last president, who dispensed a lot of misinformation about Covid. If you have a president saying the solution is to drink bleach, if you have a president downplaying the dangers of Covid and you have all that circulating in the media, then I think that causes a lot of people to question science. 

There were some polls that showed some people were concerned Trump was going to release a vaccine just so that he could get re-elected, that it wasn't really going to be safe. I think Americans in general began distrusting messages from experts.

So when you have people who are isolated from medical care, they don't have health insurance, they don't have a regular source of medical care, then they don't have the opportunity to be as literate about their health as they could be.

There is a major campaign online right now, #HighRiskCA and also in other states, which is being led by disability justice activists who are campaigning against the age-based distribution of the vaccine. Can you offer context into the ways that people with disabilities have been historically left out or deprioritized in moments like this and why that's problematic?

There are really so many ways that people with disabilities have struggled to access care, in general, but in particular moments like this. Just take mobility, for example, in terms of getting around, it's very difficult to get to a vaccination site. But also, people with disabilities are often disadvantaged socioeconomically and they may be disadvantaged in terms of feeling well enough to access health-promoting resources. So if you're chronically ill, if you're in a wheelchair, then your access to healthcare facilities, and your ability to wait on the phone three or four hours is limited. You're also less likely to be employed or employed in such a way that affords you the opportunity to take advantage of something like vaccination.

I think those would all be contributing factors. People with disabilities may share some of the same vulnerabilities as people of color in general. And then they have other disadvantages. We also have to think of intersectionality, and in fact a high rate of people with disabilities are people of color. So they are experiencing the double whammy of disability and marginalization from being a person of color.

One of the key frameworks of the Institute is targeted universalism. Can you talk about how a targeted universalist approach might be beneficial or helpful in this public health scenario?

Targeted universalism means setting universal goals that you pursue by having targeted processes to achieve those goals. So, in this case, it's recognizing that we need the universal goal of vaccination, but also recognizing that we need to go to the hotspots. We need to go to the people in places where the virus is spreading the fastest and where it's the most lethal.

In this case, I think it's really clear that everybody needs to be vaccinated in order to stop the pandemic. But it's also clear that we've got people who, for human rights reasons, reasons of compassion and inclusion, but also very practical reasons, need to be targeted for vaccination because they are the people who are still most vulnerable to contracting and spreading the disease in society if they don't get help first. We’re not going to get out of this pandemic unless the most vulnerable people in the US and in the world can get taken care of. Otherwise we're going to have kind of a chronic Covid syndrome. So I think that's where the targeted universalism framework comes in, paving the way for how we can really deal with Covid-19 in a just way.

Is there any topic you wanted to talk about that I didn't ask about? 

I just wanted to say that some people have been making the connection that the focus on vaccine hesitancy is obscuring other social and economic disadvantages people of color are facing. People are saying that sure, there's some hesitancy, but the barriers people are facing like having to wait on the phone for three hours, makes people give up because it's so difficult. You wait on the phone that long and then there's no slot. As I said, I think the source of both problems is the same thing—systemic racism, both historically, and contemporarily—and those shouldn't be pitted against each other. We don't want to blame the victim here. 


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