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With concern growing about the racial disparities in COVID-19 immunizations, Gov. Phil Murphy reiterated his commitment to equitable vaccine access Wednesday and said the state would establish vaccination sites at churches and community organizations to better reach Black and brown residents.
While Murphy offered no immediate details, the steps are part of the state Department of Health’s Vulnerable Populations Plan. The evolving strategy also envisions pop-up vaccination sites, immunization vans and “possibly door to door vaccination in cities hard hit by COVID-19,” DOH communications director Donna Leusner said Wednesday.
New Jersey officials are also working with drugstore chains CVS and Rite Aid to expand public access to coronavirus vaccines statewide, something Murphy said would launch next week and could particularly benefit underserved communities. State and local efforts are already underway to answer questions and address concerns raised by minority groups.
“We know this virus has had an outsized impact on our Black and brown communities, and in communities that have been historically under-resourced, especially in terms of medical care,” Murphy said at his media briefing Wednesday. “This is, as of three days ago, Black History Month, and I think that we all share a common goal to use this month wisely to help make COVID-19 history.”
Achieving greater equity will be a challenge, especially for the Garden State, where white residents appear more than three times more likely to get immunized than Black residents. According to the state’s vaccination data, white residents have received 48% of the doses administered; Hispanics have gotten 5% of the shots; and Black residents have received 3% of the COVID-19 vaccines so far. (No racial or ethnic data is available for 19% of the doses provided.)
Not just in New Jersey
The problem is certainly not limited to New Jersey. Experts note that a combination of long-standing mistrust of the medical establishment among minority communities, general concern about the development of this vaccine and logistical challenges nationwide have resulted in major racial disparities in coronavirus immunization rates. The Boston Globe found white residents in that region were twice as likely as Latinos, and more than three times as likely as Black residents to live within a mile of a vaccination site.
Dr. Denise Rodgers, a vice chancellor and professor at Rutgers Robert Wood Johnson Medical School in New Brunswick and a public health leader in Newark, said vaccine hesitancy is a real and legitimate concern. But Rodgers, who serves on the Department of Health’s vaccine advisory panel, said that’s only part one of the problem.
“What I am increasingly convinced of is that there is an equally important part two, (that) the mechanisms put in place to allow people to get the vaccine further disadvantage people in Black and Brown communities,” Rodgers said. Minority residents may be less likely to have the computer equipment, internet connection and time needed to register through the state’s complex online system, she said, and it is hard for someone working for an hourly wage to make the repeated calls required to get through to the state’s overwhelmed telephone hotline.
“Even for people who want to get the vaccine, we have a system in place that makes it very difficult for them,” Rodgers said, underscoring the need for more direct vaccine outreach in Black and brown communities. While limited vaccine supply has slowed the state’s efforts to implement some of these strategies, she said health commissioner Judy Persichilli has repeatedly prioritized the need to protect vulnerable individuals.
The racial gap in COVID-19 inoculations is particularly concerning given the outsize impact the coronavirus has had on minority communities nationwide and the elevated risks they face, given that many work in what are now considered essential jobs and live in situations more conducive to spread.
In New Jersey, state data shows Latinos comprise 19% of the state’s population, but one in four of the roughly 700,000 cases diagnosed since March. Black residents make up 14% of state population and 12% of its COVID cases. White residents are 67% of the population, yet only 40% of the cases. Of the 21,500-plus coronavirus-related deaths recorded here, 19% involve Hispanics, 17% Black residents and 56% white residents. New state data shows COVID-19 was the top cause of death for Latinos, Blacks and Asians in 2020.
While the federal Centers for Disease Control and Prevention required states to report race and ethnicity along with other vaccine data, nearly half of what has been collected lacks these details, Politico found. Of the 23 states now sharing these demographic details, New Jersey had the second-largest gap — after Pennsylvania — between the COVID-19 vaccination rate for Black residents and the rate for white residents, according to an analysis published last week by nonprofit Kaiser Health News.
What CDC data shows
Using the CDC data, Kaiser found that white residents in New Jersey — 6% of whom have received at least one of the two required shots — are being vaccinated at more than 3.4 times the rate of Blacks, 1.7% of whom have had at least one dose. Whites are 4.2 times more likely than Blacks to get vaccinated in Pennsylvania and 2.3 times more likely in Delaware, Kaiser Health News found; New York data was not included.
Given the long history of government lies and mistreatment of Black citizens — like the Tuskegee Study, which involved decades of syphilis experiments on African American men in Alabama — experts agree vaccine hesitancy among minority residents is understandable. The rapid development of the COVID-19 vaccine, which was politicized under the former Trump administration, creates additional educational challenges, they note.
“This is a journey, especially for people of color who have seen the medical establishment mistreat them or someone in their family over and over again” because of open or implicit racial bias, explained Dr. Shereef Elnahal, president and CEO of Newark’s University Hospital and the former state health commissioner. “The first thing to do is approach the community humbly and recognize and legitimize those issues.”
As part of this process, Elnahal said leaders from University Hospital have led virtual forums for the community and partnered with mayors in majority-minority communities in the region on question-and-answer sessions. Working with trusted local organizations and faith leaders, they also are planning in-person events when infection is less of a concern, he said.
Must demonstrate trustworthiness
Elnahal said that while there are plenty of reasons for Black and brown residents to mistrust the medical system, that doesn’t mean they should avoid the COVID-19 vaccine. “There are good answers to all (their vaccine) questions. But if you go in there with guns blazing, with all the facts but without addressing all the reasons for that visceral response,” people will remain skeptical, he said. “We have to demonstrate that we are trustworthy.”
The state Department of Health has scheduled a trio of virtual town halls to address concerns from specific minority communities, starting with a forum targeted to African American and Caribbean residents set for Feb. 11. A second event is planned for the Latinx community on Feb. 15 and a third, entirely in Spanish, will be scheduled soon, the department said. Officials are also working with health care facilities to help them educate their workforce about the vaccine and encourage immunization among the staff.
Statewide forums are only part of the solution, public health leaders said. The Trenton Health Team, a community partnership that serves as a regional hub dedicated to expanding access to medical care is also hosting online sessions to answer residents’ questions about the vaccine. That included a Spanish-language forum on Wednesday with experts from the nearby Henry J. Austin Health Center and Rutgers University’s Institute for Health.
“The process of sharing info about the vaccine needs to happen at smaller, community levels,” Trenton Health Team’s executive Gregory Paulson said. “We first need to make it OK that people have questions,” he said. “And it’s our responsibility to give them the opportunity to get answers to those questions from trusted and accurate sources.”
Finding the right messenger is important, Paulson and Elnahal agreed, as community members are more likely to trust a source that shares their background or lived experience than someone from an outside institution, like government. And the process takes time and patience, they said.
“We can’t overcome generations of well-placed mistrust with a few isolated messages,” Paulson said. “We need to really learn about and honor the perspective in which our community members are asking these questions and help them understand.”