Covid-19 Vaccine Is a Struggle for Those With No Hospital Connection

Many states chose to distribute the vaccine first to hospitals, which then became the primary deliverer of the shot to their own healthcare workers and others who qualified. In many cases, people have to have a primary-care doctor affiliated with the hospital, or receive care from the hospital, to receive a shot there.

That means that people living in poorer communities without major hospitals often face an even harder time finding access to the still-scarce vaccine. The problem highlights one of the challenges officials face in the effort to vaccinate people equitably.

When Texans aged 65 and older and with certain medical conditions became eligible for Covid-19 vaccines, Jovana Sanchez-Melendez, a 35-year-old university director of technology near Dallas who has an autoimmune disease, received an email from her doctor to sign up for an appointment.

Ms. Sanchez-Melendez received the vaccine quickly. But she said she couldn’t get appointments for her parents, who work in front-line jobs as a custodian and a construction worker and have medical conditions that make them high risk for Covid-19. Her parents weren’t patients of a hospital that had doses.

“You have to know somebody who knows somebody who knows how to get it, and even then it’s not a sure thing,” Ms. Sanchez-Melendez said. Her parents eventually found doses, with her father getting his first shot Wednesday, about a month after she received hers.

Similar dynamics have been reported across the country, in states as disparate as California, New York, Iowa and Alabama. The situation has improved slightly in recent weeks as more hospitals are starting to make room for nonpatient registrations, health officials said. Also, in some states, major retail pharmacies such as CVS are now distributing doses, widening access.

Dennis Andrulis, a senior researcher for the Texas Health institute, said that nationally 27% of white men, 31% of Black men and 41% of Hispanic men don’t have a primary-care doctor. He said hospitals also tend to locate in more prosperous areas, leaving poorer neighborhoods with fewer options.

“You have a history of neglect on steroids,” Dr. Andrulis said. “If people have access to a doctor in their community, and insurance, the door is going to be more open to them.”

Dr. Georges Benjamin, executive director of the American Public Health Association, said that some of the people who need the vaccine most—workers in dangerous, public-facing jobs—are least equipped to fight for doses if they don’t have a connection to a doctor. Bus drivers, custodians, grocery workers and others can’t spend their days refreshing computer screens looking for vaccine doses, the way people working from home on computers can, he said.

Many doctors and clinics without ties to a major hospital were left out of initial vaccine distribution efforts, Dr. Benjamin said. On Wednesday, he said the situation is evolving. “There is certainly an increase in availability, but many of the community-physician providers still don’t have easy access,” he said. “The retail pharmacies should help the situation some.”

In Texas, facilities giving priority to their own patients include some designated by the state as vaccine hubs. Hospitals said they have expanded access as they have been able to do so. A spokesman for UT Southwestern Medical Center, where Ms. Sanchez-Melendez received her vaccine, said it treats extremely sick patients and tried to give priority to those most likely to be hospitalized if they caught the virus. The hospital has allowed periodic access to sign-ups for nonpatients, and has set up a vaccination site in an area of southern Dallas historically underserved by healthcare.

John DeFilippo, a 72-year-old in Houston, signed up for vaccine appointments in January at the same time as his wife, Marylyn. Her doctor at Memorial Hermann Health System emailed her an appointment link. A few days later, he got a call from a representative at the hospital asking who his doctor was. Mr. DeFilippo had been treated at Memorial Hermann before and recovered from back surgery there, but his primary-care physician wasn’t directly affiliated. He said the hospital canceled his appointment.

A spokeswoman for the health system said it had such limited vaccine supply, and such a large qualifying population, that it has had to move through it in waves. “Like many health systems around the country, we started by offering vaccination to established, active patients,” the hospital said. “However, by mid-January, we were hosting a number of mass vaccination drive-through clinics around greater Houston.”

Mr. DeFilippo said he was surprised, not only by the hospital’s policy but also that it would dedicate resources during the pandemic to tracking down and weeding out nonpatients.

“I’m not a stranger to the hospital, but I guess I’m not enough of a customer,” he said. “She must have researched me and my doctor—all for one patient.”

He said he was later able to obtain the vaccine from a different hospital.

Write to Elizabeth Findell at Elizabeth.Findell@wsj.com