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As Biden pushes for racial equity in vaccination, data is lagging

Public health experts say that while delivering vaccines directly to underserved communities is helpful, the absence of comprehensive data makes it impossible to know whether vaccine distribution is truly equitable, and how to correct disparities.

By: New York Times | Washington |
Updated: February 10, 2021 1:38:51 pm
As Biden pushes for racial equity in vaccination, data is laggingSarah Gonzalez of New York, a Nurse Practitioner, gives Claudia Zain, 47, of New York, her first dose of the COVID-19 vaccine at a New York Health and Hospitals vaccine clinic in the Brooklyn borough of New York. (AP/File)

Written by Sheryl Gay Stolberg

Federal health officials are struggling to gather accurate data on the race and ethnicity of people being vaccinated against the coronavirus, hampering President Joe Biden’s push for racial equity in a pandemic that has taken a disproportionate toll on communities of color.

Biden has repeatedly said racial equity will be at the core of his administration’s coronavirus response. On Tuesday, White House officials announced a program to ship doses of vaccine directly to a network of federally funded clinics in underserved areas, beginning next week.

“Equity is our North Star here,” Dr. Marcella Nunez-Smith, a Yale professor who has been appointed by Biden to lead a COVID-19 equity task force, said during a White House virus team briefing. “This effort that focuses on allocation for community health centers really is about connecting with those hard-to-reach populations across the country.”

But so far, the federal government has gathered race and ethnicity data for just 52% of all vaccine recipients, according to a report issued last week by the Centers for Disease Control and Prevention. Public health experts say that while delivering vaccines directly to underserved communities is helpful, the absence of comprehensive data makes it impossible to know whether vaccine distribution is truly equitable, and how to correct disparities.

“I’m already very concerned that when we have a scarce resource that is first-come, first-served that we are going to have a situation where the privileged have access,” said Dr. Leana S. Wen, a former health commissioner for the city of Baltimore, adding, “We need to see what is happening in real time so that interventions can be directed accordingly.”

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, said the lack of data was alarming.

“The race and ethnicity data is important because we know who’s bearing the brunt of the pandemic, so there is a fairness and an empathy issue,” he said. “But there is also a disease control issue. If those are the groups most likely to get affected and die, those are the groups we need to make sure we are reaching with vaccine.”

There are various reasons for the gaps. Some states have laws barring the collection of race and ethnicity data, or policies limiting how such data may be shared. Sometimes the fields are left blank in forms that patients use to register for vaccination.

Dr. José Romero, the health secretary in Arkansas, said his state was missing race and ethnicity data for about a third of its vaccine recipients — despite his efforts to track that information.

“Shortly after we started getting into this vaccination, I started to ask for this data — I wanted it, we needed it, we were trying to get it and we were finding problems,” Romero, who is also chairman of the CDC’s Advisory Committee on Immunization Practices, said in an interview. He said several state epidemiologists were at work “filling in the gaps by cross-referencing against secondary sources.”

Just as the pandemic has laid bare racial disparities in health care, it has exposed disparities in who is getting vaccinated. Black people and Latinos are far more likely than whites to get infected and die of COVID-19. And in cities across the country, including here in Washington, wealthy white residents are lining up to be vaccinated in low-income Latino and Black communities.

People in underserved neighborhoods face a variety of obstacles, experts say, including registration phone lines and websites that can take hours to navigate, and a lack of transportation or time off from jobs to get to appointments. And people of color, particularly Black people, are more likely to be hesitant about getting vaccinated, in light of the history of unethical medical research in the United States.

The community health centers program is aimed at closing that gap. It will be relatively small at first; the administration is allocating 1 million doses for just 250 of the nation’s so-called federally qualified health centers. There are nearly 1,400 centers operating 13,000 sites serving almost 30 million patients — about 1 in 11 Americans, according to the Health Resources and Services Administration, which finances the program.

Overall, the pace of vaccinations is increasing, amid slow growth in supply, which continues to be a limiting factor. As of Tuesday, the seven-day average of vaccine doses administered across the United States was reported by the CDC to be about 1.49 million doses a day.

When Biden became president, the federal government was shipping 8.6 million doses of vaccine to states each week. That number is about to go up to 11 million — an increase of 28%, Jeffrey D. Zients, Biden’s coronavirus response coordinator, told reporters Tuesday. That tracks with expected increases in manufacturing.

The 1 million doses to the community clinics will be in addition to the supply being sent to the states. Separately, the White House announced last week that on Thursday, the administration will begin shipping an additional 1 million doses to 6,500 pharmacies.

Administering vaccines and gathering data is the responsibility of the states; each state has its own “immunization registry,” though they vary in sophistication. Even before the first coronavirus vaccines received emergency authorization, the CDC required states to sign “data use agreements” agreeing to share information about those vaccinated, including their race and ethnicity. Such data is supposed to be anonymized to protect privacy.

But some states balked. Seven states — including California, North Dakota, Texas and Vermont — are either sharing aggregate race and ethnicity data or refusing to share such data at all, according to researchers at Columbia University’s Brown Institute for Media Innovation and the COVID Tracking Project, which have collected 35 of the data use agreements.

Some states, like Montana and Texas, have opt-in requirements for patient health information to be disclosed, “creating a significant data gap in the process,” the researchers wrote. Idaho doesn’t collect race and ethnicity data, and other states, including New York, “have been secretive about the data they are withholding,” the researchers said.

In an interview last week, Gov. Andrew M. Cuomo of New York said he at first resisted signing the data use agreement because the Trump administration was asking for “all the indicators of immigration,” including Social Security numbers and driver’s license information, which he viewed as an effort to build “a potential list of targets” for deportation.

But once he was assured the information would be anonymized, Cuomo said, he signed.

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