(TNS) — In many ways, devastating disparities have defined the coronavirus pandemic.
In California, Latino, Black and Pacific Islander residents have been disproportionately killed by the virus. Black and Latino workers have lost their jobs at higher rates during the pandemic. Those who remained employed were more likely to be working the kind of jobs, considered essential, that are often low-paying and put them at greater risk of exposure.
In Sacramento, the outbreaks have been stark — ZIP code by ZIP code, low-income neighborhoods and communities of color have seen explosive COVID-19 rates that have remained steady through the last 10 months of the pandemic.
Latino households were subsumed by the virus; Black, native Hawaiians and Pacific Islander residents died at higher rates compared to white residents. In the early weeks of the pandemic, health officials acknowledged lagging behind when it came to spotting and triaging infections in communities where residents have historically been disconnected from health services and economic opportunities.
The county is in the midst of beginning a massive COVID-19 vaccine roll out operation, but community advocates are already warning that the sluggish pace of inoculation thus far, if coupled with inadequate messaging, persistent public mistrust and limited resources, could severely hamper vaccination efforts in the coming months to protect the most vulnerable members of Sacramento.
"We are concerned and are worried about what the county is doing. They should be talking about (general public vaccine distribution) now," said policy director Doreena Wong at Asian Resources, Inc. "People need to know what to expect, people need a timeline.
"It's no wonder that people are hesitant when there really hasn't been that much information about it shared locally."
Community advocates do not necessarily fault county public health officers alone for the slow, uneasy roll out. There's been waffling, unclear messaging from the Trump administration, delays in vaccine shipments from manufacturers. Gov. Gavin Newsom has repeatedly emphasized the need for doses to be distributed equitably, but state officials are still finalizing vaccine phases and recommendations. Guidance about how to store and use the vaccines is being updated weekly.
Focusing on The 'Hardest Hit' Communities
The monumental task of vaccinating hundreds of thousands of Sacramentans will require the county to artfully and purposefully orchestrate vacillating public sentiments, limited healthcare resources, staffing and storage issues, usable vaccination sites, equity and prioritization concerns, and the constant feeling that there are just not enough doses, to name a few — all at a never-before-seen scale and timeline.
"We need to focus distribution on communities hardest hit," said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network. But crucially, she said, "We have to understand this is not a quick process. We can't start building trust with people in March."
Dispelling myths and misinformation about the vaccine and its side effects are going to require a Herculean education campaign, Wong said. Celebrities need to be publicly supporting the vaccine, she said, and public messaging in different languages will need to flood the airways. Employers will need to encourage their workers to get vaccinated, and give them the flexibility and time off to do so. Those who do receive doses will need to normalize the process and share their experiences on social media. Community centers and churches will need to be transformed into vaccination sites. The planning for all this must begin now.
"If we wait, it's almost like with COVID-19 testing. It took awhile for things to even get translated in Spanish, for COVID-19 things like wear a mask and wash your hands," said Rachel Rios, executive director of La Familia Counseling Center. "We can't do that again, and I don't think the county will ever let that happen again.
"It's not as easy as putting a sign out and telling people to get vaccinated," she said. "We have to do deeper dives."
By the end of this week, Sacramento County Public Health Officer Dr. Olivia Kasirye said she expects to have at least 7,000 people get vaccinated, mostly frontline healthcare workers and longterm care residents, per state recommendations. The conclusion of this first phase of vaccine distributions, which Kasirye hopes will wrap up by the end of this month, will give way to the much more complicated process of inoculating a plethora of other prioritized groups in California — older residents, those in congregate living, and essential workers in education, food, emergency services and more.
Even the prioritization of who gets the vaccine first in California has been criticized by some health advocates. Many would like to see a place-based approach, where neighborhoods most impacted by COVID-19 or communities that are poorer, underserved and already face a higher rate of health issues, could get the vaccine earlier.
Some have argued it would be easier to roll-out logistically than the current model: It's much easier to verify someone's ZIP code, for example, than verifying who their employer is and what they do. It's a model that would give places like Oak Park and Del Paso Heights — where COVID-19 has infected thousands of homes — the kind of direct attention and service that advocates say was lacking in the early days of the pandemic.
"Prioritization and focus has been on an industry's risk of exposure, and what we believe the value of this work is to society, and that's not necessarily an equity approach," Savage-Sangwan said.
Building Community Trust in COVID-19 Vaccines
Even with the vaccines that have been distributed thus far, there have already been hiccups. Some nurses and doctors, many of whom have seen firsthand the worst effects of the virus, are hesitant to receive COVID-19 vaccines. About 20 percent to 40 percent of L.A. County's frontline healthcare staff who were offered the vaccine declined it. Sacramento County officials aren't tracking vaccine hesitancy, but the trend is reflected statewide. Among skilled nursing staff, acceptance ranges from 50 percent to 80 percent, according to Deborah Pacyna, spokeswoman for the California Association of Health Facilities.
If healthcare workers — perhaps the group most likely to support public health measures and back the scientific research behind the vaccines — are expressing uncertainty, buy-in from the broader community could be an uphill battle. A study in November by COVID Collaborative, NAACP, and UnidosUS found just 14 percent of Black Americans and 34 percent of Latinx Americans trusted the vaccine.
Some communities may be particularly uncertain about the vaccine, given past instances of medical institutions exploiting particularly Black and Indigenous people for experiments. The apparent sudden arrival of the Pfizer-BioNTech and Moderna vaccines have left some skeptical.
"To go from no vaccines to, 'Oh my goodness, they're here' by the end of the year, that startled a lot of people," said Dr. Hakeem Adeniyi, medical director at the Sacramento Native American Health Center. Even the name Operation Warp Speed contributes to the belief that the vaccine process was rushed, "even though it went through all the same steps that usually take place for vaccines," he said.
Adeniyi is one of about 40 staff members who have received their first dose of the Moderna vaccine. As more people are able to get access, health officials will have to prioritize "recognizing Black and Indigenous POC have had to deal with injustices, and (make) sure we're not offering something we can't stand behind."
Exactly how everyday Sacramentans will have access to vaccines remains to be seen. While some will be able to receive vaccines through their personal doctors or from pharmacies at CVS, Safeway, Walgreens or Raleys, the county will be ultimately responsible for filling in the gaps, opening up smaller clinics for those who might otherwise not have access.
La Familia has been running a walk-in community-based COVID-19 testing site every Monday for months now, testing about 550 people each time. Rios said she would love to offer vaccines to the community as well, but has yet to hear concrete plans from the county.
Kasirye said on Tuesday that the county is considering the logistics of converting some community-based test sites into vaccination sites, and has already bought refrigerators to help smaller clinics and centers store vaccines. While the Pfizer-BioNTech doses must be kept extremely cold, the Moderna vaccines can be frozen to temperatures consistent with a typical freezer, which would make it easier to distribute in non-hospital settings.
"With the vaccine, we know that — just like with the testing — when we move it to a community location with community trust, we know that more people are apt to do that," Rios said.
In the next couple of weeks, Kasirye hopes to convene an advisory committee of community-based agencies to help offer guidance on public messaging and outreach. "We just got this vaccine," she said. "We're all ramping up and trying to get it out as quickly as possible, and over the next couple of weeks it'll pick up quite a bit."
The consequences of too many already vulnerable populations rejecting the vaccine, or holding out for a few months, will be dire. The longer it takes to get to herd immunity, the more people will be infected with COVID-19 and the more people will die from the disease. Stay-at-home restrictions will continue to remain in place. People, months behind on bills and rent, will fall deeper into debt and poverty.
"Those same populations that were left out of being tested or discouraged or afraid, those will be the similar populations that will be ignored again," Wong said.
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