By: Kate Warren, Loren Anthes

More than 1.4 million Ohioans have now received at least the first dose of a COVID-19 vaccine. Vaccine distribution was sure to be challenging from the very beginning, with demand far exceeding supply, a history of underfunding in Ohio’s public health system and states being able to decide where and how to distribute vaccines independent of federal guidance. Moreover, as there has been with testing and transmission, there are racial equity concerns about vaccine access around the state.

Black adults in Cuyahoga County are much less likely than white residents or people of other races to have received a vaccine

 

 

So far, the concerns about equity have been born out – Black adults in Cuyahoga County are much less likely than white residents or people of other races to have received a vaccine. The reasons for this are layered. As our colleague Hope Lane has talked about, Black people may have justified mistrust of health care systems, due to historical and persistent racist practices in health care. There are also access concerns around the locations of vaccination sites, transportation challenges and even the fact that the phased vaccine distribution began with health care professionals, followed by the oldest Ohioans. Due to life-expectancy disparities, Black Ohioans are less likely to live past age 80, making them under-represented in that strata of the population. There are also concerns about Latino vaccine access. Only 1.2 percent of vaccines in Cuyahoga County have gone to Latino people, who account for 5.4 percent of the total population.[1]

Due to life-expectancy disparities, Black Ohioans are less likely to live past age 80, making them under-represented in that strata of the population.

A key part of the state’s strategy to address these equity concerns has been to distribute some vaccines via Federally Qualified Health Centers (FQHCs),[2] which are well-equipped to reach vulnerable populations, including Black, Latino, low-income and immigrant populations. Indeed, FQHCs are already serving low-income people and people of color given their historical and legal obligations to serve medically underserved areas. The chart below focuses on the racial and ethnic demographics of FQHC patients who are between 65 and 75 years old, who have had a visit at an FQHC in Cuyahoga County in the past year.[3]

 

 

FQHCs are also doing a better job capturing racial and ethnic data than other vaccine providers – the ODH vaccination dashboard still reports many “unknown” race and ethnicity, which makes it difficult to truly know how equitable or inequitable the vaccine distribution is. Initially the racial demographics of FQHC vaccines looked very similar to the racial demographics of vaccinations in the county overall. This could have been partially due to the fact that FQHCs had to pick up the slack from major hospital systems that were also struggling with low supply, and often referred patients to FQHCs for a vaccine. FQHCs in Cuyahoga County have a good track record of reaching Black and Latino residents with COVID-19 tests;[4] as vaccine supply increases and as FQHCs are responsible for their distribution, we would expect similar outcomes. In fact, we have already seen promising improvements; the percentage of vaccinations at Cuyahoga County FQHCs going to Black or Latino people doubled from January to February. FQHCs are now giving a higher percentage of their vaccinations to Black and Latino people than other providers in the county.

The percentage of vaccinations at Cuyahoga County FQHCs going to Black or Latino people doubled from January to February

It should be noted that FQHCs have only been responsible for a small fraction of the vaccine distribution (only about 3 percent so far in Cuyahoga County), despite the fact that they served about 8 percent of the population or more than 100,000 people in Cuyahoga County in 2019. Things are changing, however, as the Biden administration, in an explicit effort to address disparities in vaccinations and access, launched the first phase of a program to allocate vaccines directly to FQHCs. As Marcella Nunez-Smith, head of the administration’s Health Equity Task Force stated, “…direct allocation to the community health centers really is about connecting with those hard-to-reach populations across the country.” While it remains to be seen if this move will be effective, it seems to be a sound tactic to reduce disparities. While this new program is deployed, Community Solutions will continue to monitor the data and advocate for more equitable access.

 

 

 

 

[1] Ohio Department of Health COVID-19 Vaccination Dashboard, accessed 2/16/21; 2019 American Community Survey 5-Year Estimate. Note: 24.4 percent of vaccines have gone to people with “unknown” ethnicity.

[2] https://governor.ohio.gov/wps/portal/gov/governor/media/news-and-media/covid19-update-02022021

[3] Data provided by Better Health Partnership on 2/10/21; includes data from Asian Services in Action, Care Alliance, Circle Health Services, Northeast Ohio Neighborhood Health Services and Neighborhood Family Practice.

[4] In September and October, 2020, 32 percent of FQHC COVID-19 tests went to African-American patients, and 15 percent went to Latino patients, according to data provided by Better Health Partnership