It has now been over a year since the first cases of COVID-19 were detected in California, and, while the vaccine rollout has brought hope that the pandemic will eventually be behind us, distribution problems threaten that progress. At this point, we know who is at greatest risk of contracting or dying from the virus in our state: essential workers, Latino, Black, and Native Hawaiian/Pacific Islander populations, immigrants, and low-income communities. However, the State has not sufficiently prioritized these groups in its vaccination efforts. In order to end the pandemic, California must ensure that the vaccine is accessible for those who are most vulnerable to the virus and its devastating effects.
Disproportionate Risk and Harm for Essential Workers, BIPOC
The COVID-19 pandemic has exacerbated existing structural and systemic inequities in our health care system. It is clear from the data that essential workers, low-income individuals, and Black, Indigineous, and People of Color (BIPOC) are contracting and dying from coronavirus at higher rates. In California, Latino people account for 55 percent of COVID-19 cases and 46 percent of deaths, despite only making up 39 percent of the state population. In addition to experiencing historical and structural barriers to health care, BIPOC are at increased risk from COVID-19 as they make up a disproportionate number of essential workers. Almost 25 percent of Native Hawaiians and Pacific Islanders serve in essential roles, yet they make up less than 1 percent of the U.S. population.
In particular, high rates of death resulting from the virus have been documented among essential workers in the fields of food and agriculture, transportation, facilities, and manufacturing. Low-income workers are also more likely to live in larger households, meaning they are unable to socially distance to prevent spread of the disease. The actions of state and local leaders matter, and unfortunately the data demonstrates that California’s reopening efforts to spur economic activity come at the expense of communities of color. As the goal of vaccine distribution is to stop the spread of COVID-19 and prevent death, the effort cannot be successful if those most likely to contract and die from the virus are not being vaccinated.
Lack of Resources to Support the Populations Most at Risk
While California has prioritized other vulnerable populations such as older adults and health care workers for initial vaccinations, the State has not adequately prioritized policies which will enable BIPOC, essential workers, and low-income communities to access the vaccine. Advocates for low-income and BIPOC Calfornians report confusion about who is eligible for the vaccine, where to find vaccine information, and where eligible individuals can actually access the vaccine, particularly amid shortages across the state.
Additionally, Californians must sign up for the vaccine online, through a complicated website, which requires both a stable internet connection as well as substantial free time. Language access is another concern, and a lack of resources for limited English proficient (LEP) individuals has resulted in missed appointments and misunderstandings about the vaccine’s two-dose protocol. Further, long-term concerns about systemic problems in the health care system are affecting the vaccination effort: after being historically subjected to bias and experimental treatment, Black Americans are justifiably hesitant about receiving the vaccine. Similarly, noncitizen immigrants are concerned that obtaining the vaccine could result in negative effects on their immigration status or result in their personal information being shared with ICE.
Other high risk populations are also not able to access the COVID-19 vaccine. Despite the fact that the virus is running rampant in jails and prisons, thus far vaccination has not focused on the facilities that have been hardest hit. Similarly, homeless Californians, who face heightened risk of COVID-19 as well as documentation and internet access barriers, have recently been deprioritized in the State’s vaccination plans. Other advocates have highlighted the need to get vaccines to people with disabilities, including individuals with intellectual and developmental disabilities, who are more likely to experience many of the risk factors associated with severe outcomes from the virus.
The State has shown more success distributing the vaccine in wealthy areas, while low-income areas with fewer resources face difficulties. Nationwide, Black and Latino Americans are being vaccinated at significantly lower rates than white people and wealthy Americans are getting more vaccinations, even in low-income neighborhoods. In Los Angeles, officials express concern about low vaccination rates among essential workers, particularly in communities with high percentages of Black and Latino residents, and even among seniors, BIPOC age 65 and order are being vaccinated at lower rates than white seniors.
California Must Commit to Vaccine Equity
In order to vaccinate those most at risk from COVID-19, California must pursue policies that will reach them where they are. Essential in reaching this goal is prioritizing health equity and committing to non-discrimination. The State must prioritize essential workers, low-income households, communities of color, and other high risk populations like those without homes and people who are incarcerated. The State should ramp up distribution in areas with the highest rates of COVID-19 and build on programs like the newly announced federal-state pilot partnership which will open vaccination sites in hard-hit, low-income communities. In addition, California must work to ensure that immigrants and LEP individuals can access the vaccine safely, both by translating resource materials and assuring the community that they will not face adverse immigration consequences.
In order to reduce barriers to vaccination, the State must simplify the registration process and should provide options for vaccine sign-ups that do not require an internet connection. Further, California should take efforts to clarify information about vaccine eligibility and improve the way this information is provided to vulnerable communities. Officials should invest in public education and outreach programs and partner with trusted community groups to ensure this information is getting to the communities that are most at risk.
In addition to being supported by the majority of Californians, health equity policies are essential to ending the COVID-19 pandemic. As vaccination efforts continue, California must prioritize equity in order to move forward.
