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Health

Black and Hispanic people get monkeypox more but get less care. Here’s what’s being done to address inequities

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CNN
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The organizers of Atlanta Black Pride, an LGBTQ celebration held each Labor Day weekend, have big plans. There will be parties and performances, workshops and financial literacy classes, brunches and a boat ride. This year also brings an event that no one ever expected would be necessary: a vaccination clinic.

“We actually got a head start, and we started early, even before the festival, with monkeypox vaccinations for people that are here in Atlanta,” said Melissa Scott, one of the organizers.

The festival will also offer Covid-19 vaccines on location.

The monkeypox vaccines won’t protect people right away, because two doses are needed, but Scott said the festival is the perfect opportunity to reach a large group of people who have been disproportionately affected by the outbreak.

As of Friday, there are nearly 20,000 probable or confirmed cases of monkeypox in the US, according to the US Centers for Disease Control and Prevention.

The virus is spread through close contact and can infect anyone. But cases in this outbreak have mostly been among gay, bisexual and other men who have sex with men, and no one’s been hit harder than those who identify as Black or Latino/Hispanic.

Nearly 38% of monkeypox cases are among Black people, yet they represent only 12% of the US population. Hispanic or Latino people make up 19% of the US population but account for 29% of the cases as of August 27, according to the CDC.

Not all US cities keep or publish demographic data. But among those with the most monkeypox cases, people of color are often overrepresented among the sick and underrepresented among the vaccinated.

In Philadelphia, for example, 55% of monkeypox cases are in Black people, 16% are in people who identify as Hispanic, and 24% are in those who identify as white. Yet 56% of the shots have gone to white individuals, 24% to Black people and 12% to Hispanic people, according to the city’s website.

In Atlanta, as of mid-August, 71% of monkeypox patients identified as Black, 12% as white and 7% as Hispanic, while 44% of the vaccines have gone to white people, 46% to Black people and 8% to Hispanics.

And in Houston, Black people are overrepresented among the sick, making up 32% of all the cases, but they are only 23% of the population. Only 15% of people who have gotten the vaccine identify as Black, according to the Houston Health Department.

However, while Hispanic people account for 21% of the cases in Houston, they make up 45% of the city’s population and 32% of those who have been vaccinated. White people are 24% of the population, 17% of the cases and 39% of those who have been vaccinated against monkeypox.

In Los Angeles County, the health department says 40% of cases are among Hispanic people, yet only 32% of first vaccine doses have gone to members of that community. Hispanics make up 49% of the county’s population.

White people are the most vaccinated against monkeypox in Los Angeles. They’ve gotten 41% of the first doses, and they account for 29% of the cases. White people make up a quarter of the population of the county.

Black people are overrepresented among the cases. They make up 9% of the population in the county but 11% of the cases. Only 9% of those who got their first vaccine dose identify as Black.

It is not totally clear what’s driving the differences, but this isn’t the first disease to see such inequities, said Dr. Chyke Doubeni, chief health equity officer at Ohio State University. Unless something drastically changes, he said, we’ll see the same pattern in the next outbreak.

“I would say as a public health community, we’re very good at repeating the same mistakes multiple times,” he said. “It’s the same story, the same underlying causes. There are barriers to care and information. Systems that require people to stand in line for hours for a vaccine do not work for people with hourly jobs, for instance.”

For months, community leaders have repeatedly called on the Biden administration to step up its efforts to protect this population. On Tuesday, the administration announced that it was launching a pilot program aimed at LGBTQ communities of color.

“It’s important to acknowledge that there’s more work we must do together with our partners on the ground to get shots in arms in the highest-risk communities,” said Robert Fenton, the White House national monkeypox response team coordinator.

“Equity is a key pillar in our response, and we recognize the need to put extra resources into the field to make sure we are reaching communities most impacted by the outbreak.”

The administration will send thousands of vaccine doses to organizations that work with Black and brown communities. The initiative will also work with state and local governments to set up vaccination clinics at key LGBTQ events that attract hundreds of thousands of people, such as Atlanta Black Pride, Oakland Pride in California and Southern Decadence in New Orleans. They will send enough vials to vaccinate up to 5,000 people at each event.

Federal health officials say they also will work with local leaders to identify smaller gatherings for pop-up vaccine clinics, like house and ballroom events that are popular with younger people. They’ve set aside an additional 10,000 vials for those equity initiatives.

Pride Month events in June went by without pop-up clinics. One pilot vaccination program that the administration launched with local public health organizers at the Charlotte Pride Festival and Parade last weekend ended up administering only about a quarter of the doses allocated, but officials still called it a “great success.”

“It’s important to also respect sort of the strategy that Charlotte may have had in terms of how to get the word out,” Dr. Demetre Daskalakis, the White House’s assistant monkeypox response coordinator, said Tuesday. “And so, 500-plus vaccines is a great success – it’s not a clinic, and so really, going to Pride and getting vaccinated – any number, especially that, I think is remarkable.”

The outreach seems to be working in Fulton County, Georgia, which includes Atlanta and several large suburbs.

Black people make up 79% of monkeypox cases there but are only 42.5% of the population, according to the last census. Since the start of the outbreak, the county Board of Health said, it has initiated its own efforts to engage directly with organizations that work with Black and brown communities. Officials have set up clinics, posted QR codes in bars that link to appointment information, and extended hours at clinics so people don’t have to take time off from work to get vaccinated.

As a result, nearly 70% of the monkeypox vaccines that the county has given have gone to people of color, the board said. In comparison, only 10% of doses nationwide have gone to people who are Black, 22% went to Hispanic or Latino people, and 44% went to people who identify as white, according to the Biden administration.

“Communities of color have been hit particularly hard by monkeypox,” said Dr. Lynn Paxton, Fulton County’s district health director. “So efforts targeting health equity have been especially crucial for the Board of Health.”

The Biden administration said equity is a key priority with its monkeypox strategy.

“Our vaccine strategy is to meet people where they seek services, care or community, especially in communities of color,” Daskalakis said.

The extra efforts have been prompted by several obstacles to access to treatments, vaccines and culturally sensitive education material, public health experts say.

Sean Cahill, director of health policy research at the Fenway Institute in Boston, a health organization that works with sexual and gender minorities, says he has been frustrated by these unnecessary barriers.

For example, the monkeypox treatment Tpoxx is still considered experimental, so patients and doctors have to fill out paperwork required by the CDC to get it. For months, not one of the forms was translated into a language other than English. The CDC made the Spanish-language form available on its website in the second week of August.

“For patients who speak Spanish or Chinese or don’t speak a lot of English, it can be a real challenge for them to complete these forms,” Cahill said. It’s even harder for people who don’t have access to a computer or printer.

“There’s just some logistical issues that have been a constant challenge to help patients, and there needn’t be,” he added.

Throughout the outbreak, organizers have been critical of the Biden administration’s response to the public health crisis, especially where people of color are concerned.

“As soon as we started receiving a vaccine, we should have had a conversation with Black and brown community-based organizations to lead the way to vaccinate the most at risk,” said Daniel Driffin, an HIV patient advocate and a consultant with NMAC, a national organization that works for health equity and racial justice to end the HIV epidemic.

To get a vaccine appointment, particularly in the beginning of the US outbreak when vaccines were in much shorter supply, people essentially had to follow their local health department on Twitter to find out when they were available, Driffin said. The appointments would often fill up in minutes.

“Your health status should not be dictated by Twitter or Instagram,” Driffin said.

He added that it’s especially difficult for some people to get appointments to get tests or treatments.

“Especially here in Georgia, where many individuals, especially men, Black and brown people, may not have access to regular medical care. So where are they supposed to go?”

This is not, of course, the first health outbreak to disproportionately affect Black and brown communities.

Black people account for a higher proportion of new HIV diagnoses and cases compared with other races and ethnicities. Hispanic and Latino people are also disproportionately affected by HIV.

The CDC says racism, stigma, homophobia, poverty and limited access to health care continue to drive these disparities.

These same communities are overrepresented in the Covid-19 pandemic. People of color have a disproportionate number of cases and deaths compared with White people when accounting for age differences, according to the CDC.

The CDC has regularly said that more needs to be done to help these communities, and public health officials’ inclination to want to help is good, Doubeni said.

“But typically, they don’t say ‘Oh, we have a problem. Let me see how I can work with the community to see what is beneficial for them,’ and they especially don’t do this from the beginning,” Doubeni said.

On more than one occasion, Doubeni said, he has watched government public health officials spend months to create education materials in English. Only after those materials come out will they start working on a Spanish version.

“I think it’s all well-intentioned, but unfortunately, it doesn’t always begin with an end in mind,” he said.

He tells people that because of institutional racism, and for social and economic reasons, those who are in communities of color may have to be persistent to get the treatment they need.

“Don’t take no for an answer,” Doubeni said. “People should not be ashamed to have to seek treatment for monkeypox. It has nothing to do with them as a person per se. We can control this outbreak and keep it from running out of control. And it’s your right to get the answers you need.”

Atlanta Black Pride organizer Scott said she’s been pleased with the local public health department’s targeted outreach. One of the event’s goals has always been to strengthen the community’s health while encouraging everyone to have fun.

“We’re trying to make sure we reach the people who need it most,” she said.

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Science

Open science, done wrong, will compound inequities

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Ten years ago, as a new PhD graduate looking for my next position, I found myself in the academic cold. Nothing says “you are an outsider” more than a paywall asking US$38 for one article. That fuelled my advocacy of open science and, ultimately, drove me to research its implementation.

Now, open science is mainstream, increasingly embedded in policies and expected in practice. But the ways in which it is being implemented can have unintended consequences, and these must not be ignored.

Since 2019, I’ve led ON-MERRIT, a project funded by the European Commission that uses a mixture of computational and qualitative methods to investigate how open science affects the research system. Many in the movement declare equity as a goal, but reality is not always on track for that. Indeed, I fear that without more critical thought, open science could become just the extension of privilege. Our recommendations for what to consider are out this week (see go.nature.com/3kypbj8).

Open science is a vague mix of ideals. Overall, advocates aim to increase transparency, accountability, equity and collaboration in knowledge production by increasing access to research results, articles, methods and tools. This means that data and protocols should be freely shared in high-quality repositories and research articles should be available without subscriptions or reading fees.

Making all that happen is expensive. Wealthy institutions and regions can afford this better than can poorer ones. At my university, in a high-income nation, I know I am privileged. In a collaboration to introduce open science at Ukrainian universities (including those displaced by conflict post-2014), I’ve been privy to difficult conversations about how to pay publication fees that are three times a professor’s monthly salary, and how to meet data-sharing requirements to be eligible for funding when institutional support is lacking. And privilege comes in many forms. For instance, the fact that career-advancement criteria don’t reward open practices puts early-career adherents at a disadvantage.

Failing to address structural inequalities directly means that the advantages of those who are already privileged will grow, especially given that they have the most influence over how open science is implemented.

A particularly pressing issue is open access (OA) publication fees, in which the benefit of free readership is being offset by new barriers to authorship. To support OA publishing, journals commonly charge authors, and charges are rising as the practice expands. My group and others have found that article-processing charges are creating a two-tier system, in which richer research teams publish more OA articles in the most prestigious journals. One analysis of 37,000 articles in hybrid ‘parent’ journals and their fully OA ‘mirrors’ (with the same editorial board and acceptance standards) found that the geographic diversity of authors was much greater for non-OA articles than for OA articles (A. C. Smith et al. Quant. Sci. Stud. 2, 1123–1143; 2022). Another analysis found that authors of OA articles were more likely to be male, senior, federally funded and working at prestigious universities (A. J. Olejniczak and M. J. Wilson Quant. Sci. Stud. 1, 1429–1450; 2020). Worse still, citation advantages linked to OA mean that the academically rich will get even richer.

That open science can increase inequity should alarm science reformers. At the very least, they should commit to monitoring how researchers are affected.

To be sure, equity is not the sole priority for many advocates. When my team first announced its project, some critics objected. They argued that the key aims of open science are to improve research integrity by making processes and products more amenable to inspection, and boosting efficiency by making others’ work reusable. Still, as our work has shown, equity is often cited as a key aim (T. Ross-Hellauer et al. R. Soc. Open Sci. 9, 211032; 2022).

Even those rooting for equity often argue that we should first enable access and then consider unintended side effects, such as marginalization of authors from low-income countries. But how change is implemented will have long-lasting consequences. Once new forms of inequity are in place, it will be too late to fix the system efficiently.

How can we ensure that open knowledge creation becomes fairer than it is now? First, we need more shared understanding and global dialogue. Open science is an umbrella term for a coalition of diverse practices with sometimes conflicting aims of transparency, participation and equity. We desperately need to untangle these.

Second, reform should encompass the research system as a whole, rather than country- or region-based policies that target specific practices. The UNESCO Recommendation on Open Science is an example of how this can work. Our recommendations include more focus on shared infrastructure, as well as on who participates and how. That means discussing ways to have open access without publishing fees, plus making open practices easier, cheaper and more valued by promotion and grant evaluators.

I do think that open science can bring much good. Like many of its advocates, I aim to make research more accessible and collaborative and to establish a system that rewards current merit, not past success or current privilege. Any potential for open science to compound inequalities must be vigilantly monitored by the academic community — otherwise we idealists risk scoring an own goal.

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Health

Future Covid-19 cases and deaths will reflect US health system’s racial inequities

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Most public health experts believe Covid-19 will never be eradicated. But the risks have become more tolerable: Six in 10 Americans are now fully vaccinated, and new antivirals are coming that reduce the chances of a person ending up in the hospital because of the virus.

The next stage of the pandemic is still taking shape. It’s too soon to say whether the omicron variant that has caused so much recent concern will drive a new wave of infections around the world. But, whether or not omicron becomes dominant, some Americans will be more at risk from Covid than others going forward. And in any version of endemic Covid — where, for many, Covid-19 can be akin to the flu, undesirable but manageable — some people, especially the elderly and immunocompromised, will face a higher risk by default.

The lifesaving promise offered by vaccinations and effective treatments can only be realized if people actually have access to them — and only if they are treated fairly and equitably when they do see a doctor.

Unfortunately, Americans do not have equitable access to medical care. Across 25 different measures of health status, including life expectancy, infant mortality and prevalence of chronic illnesses, Black Americans fare worse than white Americans on 19 of them, according to a May 2021 Kaiser Family Foundation report. American Indians and Alaskan Natives fare worse on 17; Hispanic Americans see poorer outcomes on 14 of the metrics.

The experience of the past two years has only served to underline how fundamentally unfair the US health system is.

Vaccination is still the most effective way to protect everyone against Covid-19, and the vaccines are free, regardless of insurance, immigration status. But, after months of public health campaigning, 30 percent of the US is still unvaccinated. Vaccination rates among Black adults (65 percent) are slightly lower than among white adults (70 percent); Hispanic adults (61 percent) have an even bigger gap. People who are uninsured, who are also disproportionately Black and Hispanic, are the least likely to be vaccinated. All of these trends reflect existing inequities in the US health system, where historically underserved groups have less access to health care.

In addition to the major determinants of age, health, and vaccination status, at least three other factors will determine how much risk Americans face from Covid-19.

Risk factor No. 1: Insurance coverage

The first risk factor is lack of insurance coverage, which is already the variable that appears most strongly correlated with whether someone received the vaccine. About 10 percent of people living in America, 27 million people, do not have health insurance — the most fundamental inequity in the US health system.

The Covid-19 vaccines are a prime example of how powerful insurance status is in determining whether or not a person receives necessary medical care. Only about 44 percent of uninsured Americans under 65 have received at least one dose of the vaccine, compared to 65 percent of the insured under 65. Of all the subcategories polled in July by the Kaiser Family Foundation for its Covid-19 vaccine monitor — from race to age group to political party — the uninsured had the lowest vaccination rate, even though the Covid-19 vaccines are actually free to everybody regardless of insurance.

Kaiser Family Foundation

That puts the uninsured at a higher risk out of the gate, given how much vaccination reduces the risk of developing a serious case of Covid-19 or getting infected in the first place.

If a person does get infected, timely treatment is the best way to head off severe symptoms. The new Covid-19 antivirals from Merck (which reduces the risk of hospitalization by about 30 percent, according to the latest data) and Pfizer (which reduced hospitalization rates by as much as 90 percent in clinical trials) are most effective when people have mild or moderate symptoms.

But uninsured Americans delay seeking care because of the perceived costs of doing so. More than 30 percent of uninsured Americans said in a 2019 KFF survey that they’d either delayed care or went without it because of the cost, versus less than 10 percent of people with insurance. Even small out-of-pocket costs, as little as $10, have been shown to prevent people from taking medication as prescribed.

And the slow uptake of the Covid-19 vaccines suggests that, even when care is free, the presumption that it will still be costly to somebody who is uninsured can keep those people away from the doctor or pharmacy.

Risk factor No. 2: Access to medical care

The second risk factor is a person’s ability to access health care; the new antivirals appear most effective at earlier stages of the disease, which means patients need to be able to be seen by a doctor in a timely manner in order to head off more severe symptoms.

Geography and socioeconomic characteristics are linked with whether people can actually find a doctor. Roughly 80 percent of rural America was considered to be medically underserved in a 2019 government analysis. People who live in urban centers also receive worse quality of care than people who live on the fringes of metro areas (i.e., suburbs), per a federal Agency for Healthcare Research and Quality report. Low-income Americans are less likely to have ready access to a primary care doctor than their wealthier peers.

The number of Americans with an established primary care doctor has been declining in recent years. At the same time, studies have found that people who do not have that kind of relationship with a physician develop more serious symptoms before they do seek care, which tends to lead to worse health outcomes. Their health problems are also more likely to persist if they don’t have a primary care doctor to follow up with after an acute emergency.

We have seen the importance of these established patient-physician relationships in the vaccination drive as well. Unvaccinated Americans have said in surveys that they are most likely to be persuaded by their personal doctor.

Risk factor No. 3: Equitable treatment

But having an insurance card and physically walking into a doctor’s office are only the first two steps to receiving effective treatment. Once there, a patient needs to be treated fairly by their doctor — the third risk, if they don’t receive that equitable treatment.

And, unfortunately, there is a growing body of evidence that, separate from insurance status and other variables, Black and Hispanic patients in America do not receive the same quality of care as their white counterparts. Health care providers are less likely to view their symptoms as serious and less likely to prescribe necessary medications to treat their illness. Already, Black and Hispanic Americans have experienced higher rates of death and hospitalization during the pandemic than their white peers.

“Given that people of color are less likely to have health coverage, are more likely to face barriers to accessing care, and receive poorer quality of care, they are likely to face disparities in obtaining care and treatment for Covid-19,” Samantha Artiga, director of the Racial Equity and Health Policy Program at the Kaiser Family Foundation, told me.

There is a racial component to the first two risk factors. Black and Hispanic Americans are more likely to be uninsured than white Americans. They are also less likely to have reliable access to medical care.

But race alone can determine whether or not an American receives appropriate medical care. Black and Hispanic Americans are more likely to say they’ve had negative experiences with a health care provider than white people, with higher shares reporting that their doctor did not believe them or that they were refused a test or treatment they thought they needed.

“Race is a factor, and I would say that it’s distinct from other barriers because it erodes care quality for patients of color directly and indirectly,” Kumi Smith, a University of Minnesota epidemiologist, told me. “Directly through implicit or explicit racial biases held by providers, indirectly through the racially disparate ways that societal resources and benefits are distributed across society. So in a way, patients of color, especially Black patients, suffer the consequences of racism twice over.”

According to multiple studies that have tried to look at the problem empirically, the discrimination that people of color describe in those surveys is real. Studies have shown that Black people are less likely than white people to be prescribed pain medications and are subjected to longer wait times in the emergency department.

New research looked at prescriptions for heart medications — the kind of routine care for serious but treatable illness that we hope Covid-19 antivirals will become — and once again found the same racial disparities, even when controlling for other factors such as insurance status.

The study, led by Utibe Essien at the University of Pittsburgh, examined patients with atrial fibrillation who were treated at the local Veterans Affairs hospital system. It found that Black and Hispanic patients were less likely to start taking medication for their condition. These patients were being treated at an integrated hospital system (eliminating the access issue) and the researchers focused on a subgroup of patients who enrolled in Medicare Part D to cover the cost of their care (eliminating the problem of uninsurance).

Yet disparities persisted in the treatment received by Black and Hispanic patients. Essien has written on this issue of “pharmacoequity,” which attempts to capture the full extent of the disadvantages that people of color face in receiving necessary medical care.

“Race is not just foundational to the challenges of underinsurance and access but access to treatments, from monoclonal antibodies to antiviral therapies,” he told me.

These inequities have been with us for a long time. They will continue to be with us in the future. And so long as Covid-19 continues to circulate, many Americans of color will face a higher risk from the virus as a result.

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Health

Racial inequities in L.A. COVID vaccine rollout raise concern

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Just weeks into California’s rocky rollout of the coronavirus vaccine, evidence is emerging of inequities in who is getting the medicine, prompting growing demands that vulnerable communities receive more attention.

Los Angeles County officials said they are concerned about low vaccination numbers among healthcare workers in South L.A. and other communities of color, while advocates for essential workers worry that California’s new vaccine priority plan slows their ability to get inoculated despite the dangers inherent in their jobs.

The county Department of Public Health released demographic data Tuesday showing a significantly lower rate of vaccinations for healthcare workers who live in South L.A., home to large populations of Black and Latino residents, compared with other regions.

Public Health Director Barbara Ferrer told the Board of Supervisors that her agency was “particularly concerned” about the low vaccination rate among healthcare workers living in South L.A. In response, the county will open six vaccination sites there, including at the outpatient center at Martin Luther King Jr. Community Hospital, St. John’s Well Child & Family Center and three Rite Aid pharmacies.

“There may be many issues that contribute to the lower vaccination rates that we’re seeing in some communities, but the one issue that we don’t want to have accounting for a lower vaccination rate is that there wasn’t good access to places for people to get vaccinated,” Ferrer said.

The data presented did not include vaccinations given by the Pasadena and Long Beach health departments, by Walgreens or CVS, or by large health systems, including Kaiser Permanente. But it showed the number of doses given to workers who live on the Westside, the west San Fernando Valley, the South Bay and parts of the San Gabriel Valley were relatively higher than in South L.A.

But even with the incomplete snapshot, Supervisor Hilda Solis said it was clear there was a disparity among Black healthcare workers who’ve been vaccinated compared with other racial groups. She said the rates among Native American residents and Latinos were also far too low.

“I know there’s large numbers of other populations that are getting the vaccine at higher rates than others, and I would just ask: What are we going to do?” Solis said.

Among the county’s healthcare workforce, Black employees requested to be vaccinated at far lower rates than any other racial or ethnic group, another concerning trend.

Among just over 4,000 Black employees, just under one-third have received the vaccine. More than half have not requested it, according to Department of Health Services data.

Other racial and ethnic groups are seeing much higher rates of vaccination.

Among 7,500 Latino healthcare employees at the county Department of Health Services, about half have received the COVID-19 vaccine and an additional 15% have requested it. The majority of Asian American and white employees have also either received or requested the vaccine.

Dr. Christina Ghaly, the agency’s director, said it’s a trend seen not just among the county’s healthcare staff but also at private hospitals and clinics in L.A. County.

Black employees have said they didn’t get vaccinated because they still had a lot of questions about the vaccine, such as whether it can cause COVID-19, she said. (It cannot; the vaccine does not include the coronavirus.)

Ferrer said some people would rather wait a while before getting the vaccine until they see other people get it, and she said that’s OK.

“We do feel very confident that the data at hand says it’s very safe and effective,” Ferrer said.

Experts have long expected that vaccine hesitancy would be an issue, including among those who have dealt with long-standing, systemic racism in the healthcare system, fueling mistrust in some communities.

Just 32% of Black adults nationwide say they would definitely or probably take a COVID-19 vaccine, according to the Pew Research Center.

“We have a long history in this country and other countries that make it difficult for people to trust some of the medical advances that we’re promoting,” Ferrer said.

The inequities come amid growing debate over the state’s rollout plans. Vaccine remains in short supply and appointment slots have reportedly filled up at sites across the state. To date, more than 2.5 million doses have been administered statewide and more than 4.6 million doses have been shipped to local health departments and providers.

Gov. Gavin Newsom’s announcement Monday that the state would begin giving vaccination priority to people based on their age has sparked concerns from groups representing some essential workers and disabled people who may now have to wait longer.

Before Newsom’s announcement, the state intended to give priority to several new groups after California is done vaccinating people 65 and older, including residents in incarcerated and homeless settings, essential workers and individuals with underlying health conditions.

It’s now unclear when those groups would be vaccinated.

Officials said California will implement a statewide eligibility standard starting in mid-February — allowing those who work in the education and child-care, emergency services and agriculture and food sector to begin making vaccine appointments pending availability. Healthcare workers and those older than 65 would also remain a priority.

“Californians were understandably confused by mixed messages, variability of eligibility across the state, ‘When it’s my turn, who’s going next?’” Yolanda Richardson, secretary of the state’s Government Operations Agency, said during a briefing Tuesday.

A more uniform framework, she said, “will make it easier for Californians to understand who is eligible to make an appointment to get vaccinated.”

State officials insist that equity remains a key factor in how the vaccine is being rolled out.

“We don’t want to have equity and speed at odds to one another,” added Dr. Mark Ghaly, California’s health and human services secretary. “It’s an important equity principle to get those who are disproportionately impacted vaccine [doses] quickly.”

Part of that equation, he said during a briefing Tuesday, is “ensuring that we have real-time data” to assess whether those efforts are paying off, and to make adjustments if necessary.

A slide he presented offered some additional considerations — that “vaccines will be allocated to make sure low-income neighborhoods and communities of color will have access” and that “providers will be compensated in part by how well they are able to reach underserved communities.”

Mark Ghaly said “the worst thing is when people don’t know where they are in the line” and that, in adjusting its processes, the state is “listening to a lot of feedback, making what I would say are difficult decisions, but trying to make sure that they’re clear and simple to follow.”

“Using an age-based framework helps us get there,” he said.

Not everyone agrees.

A coalition of more than 60 community organizations on Tuesday urged Newsom to reconsider.

The new approach would leave hundreds of thousands of low-wage workers, inmates and homeless individuals vulnerable to the deadly virus, said Najee Ali, a South L.A. activist and part of the Community Response System of South Los Angeles coalition.

“It’s a life-or-death situation for Black and Latino essential workers,” he said.

County Supervisor Holly Mitchell said she worries the state is moving toward a vaccine distribution framework that may not “address what is really necessary to deliver a really equitable and ethical vaccine program when you look at communities that are being disproportionately hit by the virus.”

Mitchell noted that Latino residents in L.A. County are dying of COVID-19 at triple the rate of white residents, and the COVID-19 death rate among people living in the most impoverished neighborhoods of L.A. County are almost four times the rate of residents in the wealthiest areas.

“If our ultimate goal is to reduce infections, hospitalization and mortality rates, we’ve got to figure out how to target those who are truly at most risk,” Mitchell said.

Advocates for the disabled are also worried about being left out of the criteria.

“It sounds like it’s more bad news for people with disabilities,” Andy Imparato of Disability Rights California said following Mark Ghaly’s briefing. “They mentioned race and marginalized populations, but didn’t mention people with disabilities.”

Solis said some L.A. County residents have traveled far to get their vaccines. On Friday, Solis said more than 100 seniors received their first dose at L.A. County-USC Medical Center in Boyle Heights.

“I met an 82-year-old woman in line, pushing her son who uses a wheelchair … and I was so in awe of her resilience,” Solis said. One 67-year-old man took three buses from South Gate to get the shot before heading to his restaurant job in Downey.

Solis asked why he came, and he responded: “Because it’s a matter of my life, and also providing for my family.”

Times staff writer Erika D. Smith contributed to this report.

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