Half of US states want to prioritize black and Hispanic people in vaccine rollout

Every US state has been advised to consider ethnic minorities as a critical and vulnerable group in their vaccine distribution plans, according to Centers for Disease Control guidance. 

As a result, half of the nation’s states have outlined plans that now prioritize black, Hispanic and indigenous residents over white people in some way, as the vaccine rollout begins.   

According to our analysis, 25 states have committed to a focus on racial and ethnic communities as they decided which groups should be prioritized in receiving a coronavirus vaccine dose. 

These include New Mexico, where collaboration with Native Americans is being prioritized; California, which has committed to ensuring black and Hispanic people have greater access to the vaccine; and Oregon, where health officials have said that ethnic minorities with have ‘equitable access’ to the shot. 

Some states have made even more specific plans to prioritize communities of color, with 12 states specifically mentioning efforts to partner with healthcare providers in areas with a large minority population to reach ‘diverse populations’, according to Kaiser Family Foundation.    

According to our analysis, 25 states have commmited to a focus on racial and ethnic communities as they decided which groups should be prioritized in receiving a vaccine

Twenty five states with publicly available plans for their rollout make 'at least one mention of incorporating racial equity into their considerations for targeting of priority populations' Pictured a nurse at Long Island Jewish Medical Center is inoculated on Monday

Twenty five states with publicly available plans for their rollout make 'at least one mention of incorporating racial equity into their considerations for targeting of priority populations' Pictured a nurse at Long Island Jewish Medical Center is inoculated on Monday

Twenty five states with publicly available plans for their rollout make ‘at least one mention of incorporating racial equity into their considerations for targeting of priority populations’ Pictured a nurse at Long Island Jewish Medical Center is inoculated on Monday

The CDC has also issued guidance on its Social Vulnerability Index (SVI) that uses 15 U.S. census variables to help local officials identify communities that may need support. 

It is being used in states such as Michigan where minority status and language spoken could be taken into consideration when deciding how high a priority you are for receiving a vaccine. 

States referencing black, Hispanic and indigenous residents as a priority in their Covid vaccine plans

California, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Utah, Washington, and Wyoming

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Maine, in particular, has developed a ‘Racial/Ethnic Minority COVID-19 Vaccination Plan’ in an attempt to give a preference to groups that ‘have experienced rates of disease that far exceed their representation in the population as a whole’.  

In the US, black and Hispanic people are almost three times more likely to die from Covid-19 than whites.  

It comes as the US added a second COVID-19 vaccine to its arsenal Friday, boosting efforts to beat back an outbreak so dire that the nation is regularly recording more than 3,000 deaths a day. 

Much-needed doses are set to arrive Monday after the Food and Drug Administration authorized an emergency rollout of the vaccine developed by Moderna Inc. and the National Institutes of Health. 

In the first stage of the vaccine rollout, most states followed the Centers for Disease Controls recommendation that health care workers and nursing home residents get the very first doses.

However, state-to-state variations are likely to increase in the next-priority groups, said the Kaiser Family Foundation’s Jennifer Kates, who has been analyzing state vaccination plans.

‘I think we’re going to see states falling out in different ways,’ with some putting older people ahead of essential workers, Kates said.

These differences could also be seen in the ways that states decide to prioritize sections of the population depending on race.

While the Kaiser report said that many state plans reported more ‘general or indirect methods’ of focusing on minority groups, several states have already lined them up as the next vaccine target groups.

A recent study from the National Governors Association also showed that ‘many states have incorporated health equity principles in their vaccination plans to varying degrees’.

It reported that California, Louisiana, New Mexico, North Carolina, and Indiana have listed fairness, equity, or both as key principles for vaccine distribution.

Oregon is also emphasizing health equity as a central pillar of its rollout, while North Carolina ‘specifically cited historically marginalized populations as an early-phase critical population group’.

In California, Governor Gavin Newsom has said that experts are 'making sure black and brown communities disproportionately are benefited' by the vaccine rollout

In California, Governor Gavin Newsom has said that experts are 'making sure black and brown communities disproportionately are benefited' by the vaccine rollout

In California, Governor Gavin Newsom has said that experts are ‘making sure black and brown communities disproportionately are benefited’ by the vaccine rollout

In Oregon, the health authority said that ‘Black, Indigenous, Latino/Latina/Latinx, Pacific Islander, and Tribal communities [will] have equitable access to vaccination’, after the head of the public health department, Rachael Banks, announced that vaccines would be ‘particularly focused on our communities of color who’ve seen unfair disproportionate impact from COVID-19’.

New Mexico is prioritizing collaboration with Native Americans while New Hampshire has also developed a health equity strategy.

New Jersey and California plan to prioritize minorities by working to remove barriers to accessibility such as transportation and wait times.

In California, Governor Gavin Newsom has said that experts are ‘making sure black and brown communities disproportionately are benefited because of the impact they have felt disproportionately because of COVID-19’.

Latinos make up 60 percent of Covid cases in the state, even though they are 40 percent of the population, according to the Guardian, with farmworkers being significantly effected .

Governor Andrew Cuomo echoed these thoughts in New York.

‘We know that our Black, brown and poorer communities have fewer health care institutions,’ he said last month. ‘Their communities too often have health care deserts.’

Dr. Robert Redfield, Centers for Disease Control and Prevention Director, issued a recommendation that multi-generational families living in the same household are among the vaccination priorities as it will include 'Hispanic, Black and Tribal Nations families'

Dr. Robert Redfield, Centers for Disease Control and Prevention Director, issued a recommendation that multi-generational families living in the same household are among the vaccination priorities as it will include 'Hispanic, Black and Tribal Nations families'

Dr. Robert Redfield, Centers for Disease Control and Prevention Director, issued a recommendation that multi-generational families living in the same household are among the vaccination priorities as it will include ‘Hispanic, Black and Tribal Nations families’

And in Kansas, health officials have said they will be keeping communities of color in mind as they make further decisions on the vaccine, according to 41 Action News.

‘We have a wide representation by tribal organizations, ethnic and racial minority groups,’ said Dr. Lee Norman, secretary of the Kansas Department of Health and Environment.

‘Different socioeconomic groups and beyond that, faith leaders, medical bioethicists to look at it with many sets of optics.’

Alongside California and New Jersey, Kansas will also focus on accessibility issues by targeting transportation hubs to spread information about the vaccine, and looking into sending mobile vaccine units to communities where many people may not have a car.

The decision to make blacks and Hispanics a priority has been backed by the CDC, which has also recommended a focus on racial equity in the next vaccine group, suggesting multi-generational families living in the same household should be included.

‘Often our Hispanic, Black and Tribal Nations families care for their elderly in multigenerational households and they are also at significant risk,’ CDC director Robert Redfield said.

The CDC has previously stated that race and ethnicity are risk markers for other underlying conditions that affect overall health outcomes, including access to medical care and exposure to the coronavirus at work.

In the US, black people - and Latinx people - are almost three times more likely to die from Covid-19 then whites. Pictured above, the overall deaths up until December 8

In the US, black people - and Latinx people - are almost three times more likely to die from Covid-19 then whites. Pictured above, the overall deaths up until December 8

In the US, black people – and Latinx people – are almost three times more likely to die from Covid-19 then whites. Pictured above, the overall deaths up until December 8

Pictured, nationwide coronavirus deaths by race and ethnicity

Pictured, nationwide coronavirus deaths by race and ethnicity

Pictured, nationwide coronavirus deaths by race and ethnicity

It also follows recommendations from Melinda Gates who claimed that ‘Black people (would be) next, quite honestly’ after healthcare workers in receiving the vaccine as ‘they are having disproportionate effects from COVID-19.’

In the interview with Time in June, Gates added: ‘We are seeing black men die at a disproportionate rate. We know the way out of COVID-19 will be a vaccine, and it needs to go out equitably.’

President-elect Joe Biden has also shown in his choices for his healthcare team he may be placing an emphasis on racial equity when it comes to the vaccine rollout.

As well as a Latino politician for health secretary Biden’s selection of Yale University’s Dr. Marcella Nunez-Smith is being read as a sign that his administration will work for equitable distribution of vaccines and treatments among racial and ethnic minorities.

‘We cannot get this pandemic under control if we do not address head-on the issues of inequity in our country,’ Nunez-Smith said Tuesday. ‘There is no other way.’

That challenge faces widespread skepticism among minorities that the health care system has their best interests in mind.

Early indications are that the vaccines are highly effective, said Altman of the Kaiser Foundation. But polling indicates a strong undertow of doubts, especially among African Americans.

‘While states will be able to make the final decisions on who gets the vaccine, there has to be guidance around those decisions so that they are fair and equitable across the country,’ Altman said. ‘You don’t want to have the kind of variations that people will look and say, `This just wasn’t fair.’

Healthcare workers were the first to be vaccinated across all US states. Pictured, registered nurse Debra Henry vaccinates registered nurse Janine Harvey on Wednesday

Healthcare workers were the first to be vaccinated across all US states. Pictured, registered nurse Debra Henry vaccinates registered nurse Janine Harvey on Wednesday

Healthcare workers were the first to be vaccinated across all US states. Pictured, registered nurse Debra Henry vaccinates registered nurse Janine Harvey on Wednesday

In the US, black people – and Latinx people – are almost three times more likely to die from Covid-19 then whites, according to the CDC, due to economic disparities.

Rates of hospitalization and death from Covid-19 among Blacks, Latinos and Native Americans are also two to four times higher than for whites.

Yet a recent Kaiser survey showed that more than one third of black Americans remain hesitant to get a vaccine.

It found that black Americans are among the groups least likely to want to get vaccinated against coronavirus, even if a scientist deem vaccines safe, effective and the shots are given for free.

The troubling paradox is not lost on public health authorities, politicians or hospitals.

The first two Americans to receive the coronavirus vaccine, live on television, were black caregivers, optics that illustrate a daunting challenge facing the nationwide campaign: persuading skeptical African Americans to get inoculated.

Mistrust among black people is deep-seated. Experts largely attribute it to medical experiments that were conducted during the eras of slavery and segregation. 

Yet, if states decide to give racial minorities priority, it could potentially lead to a reverse-discrimination lawsuit that would slow down distribution to all. 

A recent piece in the Journal of the American Medical Association from experts Lawrence Gostin of Georgetown University, Harald Schmidt of the University of Pennsylvania and Michelle Williams of Harvard University, noted that the plan may not pass any challenge made at the Supreme Court. 

The group suggests that instead there should be a ‘racially neutral vaccine allocation criteria’ that would focus on ‘geography, socioeconomic status, and housing density’ but still work to help minorities. 

Nationwide there have been more than 17.4million cases and 313,669 deaths. 

How is each US state distributing vaccines to racial and ethnic minorities? 

Alabama: The health department has said it will monitor vaccinations administered to understand current saturation by county based on available information on vaccine distributed and by race.

Communicators will confer with local entities to help ensure equitable access to immunization sites from this date.

Alaska: The state is yet to announced who will receive the vaccine following the first two tiers which include hospital-based front-line healthcare workers at highest risk for COVID-19 infection; long-term care facility residents and staff; EMS/fire personnel providing emergency medical services; community Health Aide/Practitioners (CHA/Ps); and individuals who are required to perform vaccinations.

However, the state has received 11,700 doses of vaccine for the Alaska Tribal Health System directly for the state’s native tribes.

Arizona: The state has proposed placing essential workers one step ahead of those 65 and older to receive a vaccine but all will be able to receive a shot in phase one.

‘These criteria have been provided as a proposed framework to ensure that all populations have equitable access to COVID-19 vaccination,’ it said

Arkansas: Essential workers will receive the vaccine ahead of those 65 and older in Arkansas, as per the CDC guidance.

California: California has committed to ensuring black and brown people have greater access to the vaccine.

It plans to prioritize minorities by working to remove barriers to accessibility such as transportation and wait times. Governor Gavin Newsom has said that experts are ‘making sure black and brown communities disproportionately are benefited because of the impact they have felt disproportionately because of COVID-19’.

Colorado: Higher-risk individuals aged over 65 and essential workers will both be included in phase two of the rollout in the spring.

Connecticut: Essential workers and adults over 65 will be vaccinated in the spring.

The state said, ‘Public health messages and products will be tailored for each audience and developed with consideration for health equity’.

Delaware: Over 65s and essentials workers will both be included in phase two of the rollout.

Florida: People 65 and older and those with pre-existing medical conditions will be vaccinated ahead of essential workers in Florida.

People from racial and ethnic minority groups are still listed among the state’s critical populations.

‘The Department’s Office of Minority Health and Health Equity has been engaged in vaccination planning and existing networks and data will be utilized to inform these efforts,’ it states.

Georgia: Georgia does not reference race or minorities in its initial plan but says over 65s and essential workers will be included in its first phase.

Hawaii: People from racial and ethnic minority populations are listed among Hawaii’s critical populations.

‘Current evidence has shown how COVID‐19 2 disproportionately affects particular racial and ethnic minority groups, including Black, Hispanic or Latinx, American 3 Indian and Alaska Native, and Native Hawaiian and Pacific Islander communities,’ it noted.

It will rank those most vulnerable by 15 social factors including unemployment, minority status, and 31 disability.

Idaho: People from racial and ethnic minority groups and tribal communities are named among critical communities

‘In Idaho, 13% of the population is Hispanic, but 33% of COVID-19 cases are members of the Hispanic population,’ it noted.

Illinois: Populations at higher risk such as racial and ethnic groups will be among the first to be vaccinated.

The plan gives no further details on how they will be prioritized.

Indiana: People from racial and ethnic minority groups and people from tribal communities identified as being of increased risk of acquiring or transmitting COVID-19.

‘Targeted outreach to rural areas and other specific communities, such as Amish or Potowatomi Indian populations, will also be necessary to provide direct outreach to those who may not have access to information or fewer healthcare resources in less populated areas of the state,’ its plan says.

Iowa: In Iowa, lists and maps have been provided to include several demographic databases to determine the number of people 65 years or older, people from racial and ethnic minority groups, people with disabilities and people living in rural communities.

They will all be considered in the next phase of vaccinations.

The state said it will implement ‘communication strategies about vaccine allocation to minimize perceptions of lack of equity’.

Kansas: Health officials have said they will be keeping communities of color in mind as they make further decisions on the vaccine, according to 41 Action News.

‘We have a wide representation by tribal organizations, ethnic and racial minority groups,’ said Dr. Lee Norman, secretary of the Kansas Department of Health and Environment.

‘Different socioeconomic groups and beyond that, faith leaders, medical bioethicists to look at it with many sets of optics.’

Kansas will also focus on accessibility issues by targeting transportation hubs to spread information about the vaccine and looking into sending mobile vaccine units to communities where many people may not have a car.

Kentucky: The state plans to carry out a survey of African American and Hispanic Kentuckians in order to establish the best way to target communications to them as a critical community.

Louisiana: Louisiana will target racial and ethnic minorities as high priority during the first phase of a digital communication campaign about the vaccine.

‘In addition to major newspapers across the state, the plan will also place ads in ethnic and minority publications, specifically those that serve the Vietnamese, Hispanic and African American communities,’ it adds.

It will do the same for radio stations.

‘A notable proportion of nursing home workers are Black (27.8 percent), as are home care workers (Black: 29.7 percent and Latinx: 17.5 percent). A sizable proportion of such workers are over 65 as well (Black: 9.1 percent and Latinx: 11.3 percent),’ its plan states.

Health equity is incorporated in every step of planning, the report notes.

Maine: Maine has developed a specific ‘Racial/Ethnic Minority COVID-19 Vaccination Plan’.

‘COVID-19 has not affected all groups in Maine equally. Some groups—such as racial and ethnic minorities—have experienced rates of disease that far exceed their representation in the population as a whole,’ it states.

‘Maine’s approach to ensuring timely access to COVID-19 vaccine for members of racial/ethnic minority groups will evolve following consultations with members and leaders of those groups.

‘ECOVID-19 rates for racial and ethnic persons in Maine are disproportionately high. Even though this population accounts for roughly 5% of the population (see table below), this group accounts for 25% of COVID-19 cases in Maine,’ the report continues.

‘Maine is placing special emphasis on ensuring all Mainers, especially those from diverse racial and ethnic backgrounds, have accurate information on COVID-19 vaccine and can access that vaccine, once available. Members of the Maine COVID-19 planning team have consulted with Tribal leaders, the Maine Migrant Health Program, and the District Liaisons and we acknowledge that more needs to be done to reach these populations.’

Maryland: ‘The COVID-19 pandemic has had a disproportionate impact on people of certain races, ethnicities, ages, health status and socioeconomic status. It is essential that equity be incorporated into the implementation of a COVID-19 vaccination plan,’ Maryland says of its distribution.

‘Based on Census data, of Maryland’s estimated six million residents, 31 percent are Black or African American, 11 percent are Hispanic, 0.6 percent are American Indian/Alaskan Native. Additionally, approximately 9 percent live in poverty. Those 65 years of age and older make up 15 percent of the population while those with heart disease, kidney disease, diabetes or respiratory disease (e.g., asthma, COPD, etc.) make up approximately 25 percent of the population. Communication will be essential to ensure these populations are reached as part of the vaccine program.

‘Messaging should be tailored and developed for each audience to ensure communication is effective,’ it says of its outreach to these communities.

Massachusetts: The state says it will provide equitable access to COVID-19 vaccination for all critical population such as racial minorities to achieve high COVID-19 vaccination coverage in these populations in the jurisdiction in phase two

They plan to do this through their messaging.

Michigan: Michigan will vaccinate essential workers before over 65s, who are more likely to be white.

It will consider the minority status and language spoken in deciding it what order you should receive a vaccine.

Minnesota: The state has said it will strive for fairness and protect against systematic unfairness and inequity as a key principle in distribution.

‘Other attributes to be considered in prioritization include: people with certain medical conditions, people with disabilities, and people from certain racial and ethnic minority groups who are disproportionately affected by COVID-19,’ its report states.

Mississippi: The states identified its 1,666,665 people from racial and ethnic minorities as 11,000 from tribal communities as critical populations.

Missouri: Individuals at high risk for adverse health consequences including minority groups will have vaccines by late winter.

Montana: ‘Government-to-government relations and communications with tribal nations and health partners are important and critical throughout this process,’ the Montana plan states.

Racial and ethnic minority groups and tribal communities are considered at risk and will be targeted with a communications campaign.

Nebraska:  Organizations that work with the African-American and Hispanic and Latino community, as well as other community-based organizations, have been named as partners in their vaccination plan.

Nevada: Nevada as established a specific plan for its tribal communities.

‘Special consideration needs to be made for the under- and uninsured populations and underserved racial and ethnic minorities in Nevada, to ensure they receive equitable vaccine access during the COVID-19 vaccine response,’ it states.

‘Community outreach processes are built into the pandemic influenza planning structure and are being adapted to fit Nevada’s COVID-19 vaccine response accordingly.’

New Hampshire: Racial minorities are listed among vulnerable groups and equity is promised.

New Jersey: ‘Throughout the pandemic, the State of New Jersey has been concerned about the disproportionate impact of COVID-19 on vulnerable populations, such as those in congregate settings, and communities of color,’ reads the state’s plan.

‘To bridge this inequity gap, NJDOH has enhanced partnerships with State and county correctional facilities, expanded testing at LTCFs, correctional facilities, and State psychiatric hospitals, and piloted “boots on the ground” testing at senior high rises, and among persons experiencing homelessness and seasonal farm workers.

‘Although these efforts cannot wholly reverse centuries of systemic, structural, socioeconomic, and health inequities, we recognize the need to continue shining a light on increasing equity in public health actions, particularly in the development of continued COVID response and planning.’

New Mexico: The department of health will provide outreach to racial and ethnic minority community leaders to determine best vaccine clinic models and specific ways to establish efficient vaccination

The Indian Affairs Department has also developed a plan for tribal partners.

‘We urge the CDC not to force every sovereign tribe to make a binary choice about vaccine procurement and distribution. We also urge the CDC to consider data not reflected in the template to enable tribal partners to determine the best path toward effective vaccine distribution and administration in their communities,’ it states.

‘Community Health Workers with New Mexico pueblos, tribes, and nations and promotoras in Hispanic communities are an essential part of health care and outreach. These essential workers will be integral to getting the COVID-19 vaccine message in their communities.’

New York:  New York State’s COVID-19 vaccine distribution plan will be based on standards that prioritize people at higher risk of exposure, illness and/or poor outcome. Unrelated factors, such as wealth or status, will not influence distribution.

North Carolina: The state says it will look to minorities in phase two of the distribution.

‘Although we do not list race or ethnicity groups as the sole criteria for prioritization, prioritizing groups for outreach by risk of exposure and chronic conditions in Phase 1 and 2 promotes equity,’ says its plan.

‘Historically marginalized populations are disproportionately represented among the high-risk populations, frontline and high-density occupational setting workforce, and congregate living settings. For example, nationally African Americans and Latinx people comprise 40+% of long-term care workers.

‘In North Carolina, 51% of homeless people and 52% of incarcerated people are African American. Further, prioritizing essential workers for outreach promotes equity. A national survey by Kaiser Family Foundation found higher proportions of African American and LatinX populations are essential workers as compared to white populations.’

North Dakota: They have developed maps by country to show minority groups and native American communities to focus on.

Ohio: ‘The Ohio Department of Health Equity Specialists will collaborate with the Governor’s Minority Health Strike Force to ensure that there is equitable access to vaccines, especially for racial and ethnic minorities,’ it states in its plan.

Oklahoma: The department of health said it ‘anticipates that populations including people from racial and ethnic minority groups, tribal communities, people with underlying medical conditions and/or disabilities, and those who are under or uninsured will likely be present among all priority populations’.

Oregon: ‘Though data in Oregon is clear that people of color have been disproportionately affected by COVID-19, the data to accurately describe these inequities is often not available,’ said of its plan to focus on minority groups.

‘Some of the most concerning disparities occur in seasonal influenza vaccination where Hispanic/Latino people have vaccination rates 17 percentage points lower and African Americans 6 percentage points lower than whites.

‘As we approach a respiratory season where influenza and COVID-19 patients will require the same limited pool of healthcare resources, these disparities represent critical needs that must be addressed in COVID-19 vaccine planning.’

Pennsylvania: The Commonwealth has said it will ‘redress some of the socioeconomic and racial inequities brought about the pandemic which has disproportionately affected the Latinx and Black or African American community’.

‘While racial and ethnic minorities tend to be underrepresented as clinicians, they are overrepresented as other low wage healthcare personnel,’ states its plan.

‘So, by including a broad definition of healthcare personnel, it incorporates those racial and ethnic minorities in forward-facing roles who would otherwise not be prioritized if there was solely a focus on clinicians.

‘Additionally, because individuals who have certain preexisting health care conditions are being prioritized within Phase 1A, and racial and ethnic minorities tend to have a higher prevalence of many of these conditions, this approach further mitigates inequities.’

Rhode Island:  Minorities are identified as critical communities, but no specifics are given.

South Carolina:  The only mention of ethnic groups is that a Minority Outreach group will be update of the plan.

South Dakota: They have developed maps by country to show minority groups and native American communities to focus on.

Tennessee:  The only mention of ethnic groups is that there will be outreach to minorities.

Texas: Texas’ plan mentions minority groups as critical populations but makes no reference to equity.

Utah: Utah says that racial/ethnic groups will be vaccinated in phase two in March or April.

Vermont:  Racial and ethnic groups are listed among the CDC guidelines for vulnerable groups. No other mention is made in the plan.

Virginia: Virginia has not outlined a racial or ethnic group plan.

It states that the initial distribution will ensure 480,000 health care personnel (HCP) and long-term care facility (LTCF) residents receive a first dose of the vaccine

Then at-risk people will receive a dose.

Washington: The department of health is developing a prioritization and allocation framework in consultation with public health and health care partners to include first responders; critical and essential workforce sectors; business groups; black, indigenous, and people of color communities; education systems; and other governments, including tribal nations, local governments, and local health jurisdictions. 

West Virginia: Its plan gives no specific reference to minority group vaccinations.

Wisconsin: Ethnic and racial minorities are simply reference as a vulnerable population.

Wyoming:  ‘For the COVID-19 vaccination plan special populations will include any individual, group or community with physical, mental, emotional, cognitive, cultural, ethnic, socio-economic status, language, or circumstance-related barriers to understanding or responding similarly to the general population,’ the Wyoming plan states.

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