MedStar Mobile Healthcare, a Fort Worth, Texas, regional emergency medical service, hit what leaders there considered a home run recently, vaccinating 757 people in a single day at Mount Olive Missionary Baptist Church, a predominantly Black church on the city’s east side.
Meanwhile, a mass vaccination clinic at Texas Motor Speedway in north Fort Worth used 16 drive-thru lanes to vaccinate 10,000 residents per day.
Both approaches are essential, said Mount Olive Assistant Pastor Louis Stewart. “It’s not an either-or situation.”
Nationwide, health equity advocates and public health experts agree that to outrun the virus and its variants, states and communities must operate mass vaccination sites for those with the time and transportation to get there, while simultaneously launching hundreds of smaller neighborhood efforts designed to meet the needs of the people who have been most devastated by the virus: low-income communities of color.
To varying degrees, states designed their vaccination campaigns to prioritize vulnerable populations. A new study from the Centers for Disease Control and Prevention uses county-level census data to assess states’ relative success at meeting those goals. Alaska, Montana and Arizona, all states with strong tribal community vaccination programs, were the most successful. At the bottom were Rhode Island, Florida and Idaho.
Now that age limits for COVID-19 immunization have been dropped in most states, speed and efficiency are more important than ever, public health experts say.
The federal government is establishing 441 mass vaccination sites across the country with the aim of collectively vaccinating a million people per day. At the same time, vaccine drives organized by state and local health agencies, community health centers, nonprofits and faith-based organizations are proliferating.
Many of the local efforts are funded in part by nearly $10 billion in federal grants aimed at expanding access to vaccines and better serving communities of color, rural areas, low-income populations and other underserved communities under the Biden administration’s $1.9 trillion American Rescue Plan enacted in March.
But advocates worry that in the rush to vaccinate the nation’s roughly 250 million adults as quickly as possible, the people most vulnerable to the ravages of the virus will get left behind.
Black and Hispanic Americans are more likely than White Americans to contract COVID-19 and three times as likely to be hospitalized for the illness. Black and Hispanic people also are at least twice as likely to die from COVID-19 compared with White people, according to the CDC.
“So far we’re finding the same inequities in vaccine distribution that we find in the health care system as a whole,” said Andi Mullin, director of state and local technical assistance at Boston-based health equity advocate organization Community Catalyst.
“In nearly every state in the country, White people and wealthier people are getting vaccinated in higher proportions than lower income people and people of color, despite the fact that COVID-19 has had a more devastating impact on these communities,” she said.
Hard to Measure
Part of the difficulty with tracking vaccine equity is that only 53% of the nation’s vaccination records include race and ethnicity, according to the CDC.
“We know that some states are doing a better job than others at reaching people of color,” said Nambi Ndugga, an analyst with the Kaiser Family Foundation’s Racial Equity and Health Policy Program. “But until better data is available, it’s difficult to compare one state to another.”
The completeness of race and ethnicity data in vaccination records varies widely, Ndugga said. In North Carolina and Texas, for example, health officials require vaccine providers to collect race and ethnicity data. But in most other states, the decision to ask people for their race and ethnicity is left to providers.
To get around the lack of data, the CDC compared states’ success at reaching vulnerable people using county-level census data on poverty, education levels, housing, transportation, unemployment, race and ethnicity, and language barriers.
In a March 17 report, the agency gauged whether states were reaching a greater or lesser proportion of socially vulnerable people. Officials looked at the number of residents vaccinated in each county, then cross-referenced that figure with the county’s social vulnerability rating.
“The main takeaway,” lead researcher Michelle Hughes told Stateline in an interview, “is that while states showed a wide range of success, the majority had the lowest vaccine coverage in counties with high levels of social vulnerability.
“This is just a first look in the first 2.5 months of the vaccination program,” she said. “But it tells us we need to ramp up efforts to ensure fair and equitable access to vaccines.”
The CDC analysis found that Alaska vaccinated the highest relative proportion of vulnerable residents, followed by Montana, Arizona, West Virginia, Minnesota, Oklahoma, Maine, Alabama, Nebraska, North Carolina and Texas.
All other states vaccinated an equal or lower proportion of vulnerable people compared with higher-income, less vulnerable residents. At the bottom of the scale, Idaho vaccinated the lowest relative proportion of vulnerable residents, followed by Florida, Rhode Island, New Jersey, Kansas, California, Maryland and North Dakota.
As of April 1, 99.6 million Americans had received at least one dose of a COVID-19 vaccine—more than one-third of the adult U.S. population.
Of those, 66% were White, a significantly higher proportion than the 60% share that White Americans represent in the general population. Hispanics, who comprise 19% of the population, represented only 9% of those vaccinated. And Black residents, who make up 13% of the population, represented only 8% of those vaccinated.
Declining Hesitancy
Although demand for COVID-19 shots is declining in some states, a growing share of Americans say they plan to get vaccinated, according to a recent survey by the Pew Research Center. (The Pew Charitable Trusts funds both the Pew Research Center and Stateline.)
In March, 69% of people surveyed said they planned to or already had received a shot, up significantly from the 60% who said in November that they planned to get vaccinated.
In the same survey, 61% of Black Americans said they planned to get vaccinated, up sharply from 42% in November. Since the vaccination campaign began in December, differences in acceptance rates among Black, White, Hispanic and Asian American adults have been shrinking.
As vaccine hesitancy declines, some public health experts argue that vaccine providers should focus on the millions of people who are eager to get a shot and not get bogged down trying to persuade those who aren’t.
“We shouldn’t be targeting vaccine-hesitant people,” said Dr. Leana Wen, an emergency physician and visiting professor of health policy and management at George Washington University's Milken School of Public Health. “Our emphasis at this point has to be on getting as many shots into arms as possible.
“If there are people in vulnerable communities who want the vaccine, it’s a missed opportunity not to make it easy for them to get the shot as soon as possible, because they could get sick or die. We need to focus on vaccine distribution that is convenient and accessible.”
‘Secret Sauce’
The first time the MedStar crew in Fort Worth set up a mobile COVID-19 vaccination site at a fire station in January, only 39 people showed up.
“That was okay,” said Matt Zavadsky, chief transformation officer for MedStar. “We were testing logistics and were not prepared to handle many more inoculations than that at that point anyway.”
But after rolling its fully equipped mobile vaccination operations into a different neighborhood every week since then, the team has started vaccinating at least 300 residents per day at each site.
Still, MedStar estimated that its supply of vaccines and staffing levels meant workers could deliver three times that many shots in a day. Demand was the limiting factor.
It wasn’t until they got a call from the Mount Olive Missionary Baptist Church that it became clear what was needed to boost turnout. Pastor William Glynn and Assistant Pastor Stewart already had gotten their vaccines and had been urging their congregation to do the same for months.
“We figured out the secret sauce,” said Zavadsky.
“We had not previously understood the importance of working with local community influencers to ensure people feel confident enough about the vaccine to turn up for a shot,” he said. “Now we know we can’t just schedule a clinic and expect them to come.”
Once MedStar scheduled the Mount Olive clinic, the pastors used a Sunday services webcast to urge everyone to come. They posted messages on their Facebook page, and they reminded everyone who attended Wednesday Bible study and Saturday prayer calls of the importance of protecting themselves and their community by getting vaccinated, Stewart said.
As an added incentive, the pastors promised to hold an in-person Easter Sunday service in the sanctuary for the first time since the pandemic began. Anyone who has received both shots could attend.
On Wednesday, March 10, the church’s COVID-19 vaccination clinic was scheduled to start at 8 a.m. When he arrived at 6:30 a.m., Stewart said, more than 150 people were already lined up.
“I asked the first person in line when he got there, and he said 5 a.m. They were all pretty eager to get their vaccine,” he said.
But it helped that everyone knew how to get to the church and that they would be among friends and trusted church leaders when they got their shot, Stewart said. “None of those people would have made it to the racetrack to get a vaccination.”
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