The masks are coming off — tentatively. We’re seeing what people look like for the first time in over a year. Indeed, we’ve got COVID-19 on the run, especially in Massachusetts, which was recently named the third-safest state in the country. The Commonwealth hit a significant milestone on Tuesday, which marked the first day in nearly a year with zero new confirmed COVID-19 deaths reported.
Meanwhile, the state ranks second in the nation — at 59.5 percent — for its high share of residents who have received at least one dose of the vaccine, according to the US Centers for Disease Control and Prevention. More than 3 million residents are fully vaccinated.
And yet the conquest mentality is premature and shortsighted, for it ignores the realities on the ground, especially in communities of color, where the vaccination rates are significantly lower.
In concrete terms, the community-by-community inoculation picture tells the story. Wellesley has a vaccination rate (at least one dose) of 62 percent. New Bedford and Springfield are both at 38 percent, while Lawrence’s is nearly 40 percent. Within Boston there are wide disparities: As of May 4, the rate is over 80 percent in the South End and about 42 percent in Mattapan. Statewide, as of May 11, 36 percent of the state’s Latino residents and 39 percent of Black residents have received at least one vaccine dose, compared with 57 percent of white residents.
There’s a lot of work to do, without which some communities will continue to suffer disproportionately. The primary reason for this wide gap is that people are still not being met where they are.
“The number one barrier is still access,” said Dr. Alister Martin in an interview. Martin, an emergency medicine specialist at Massachusetts General Hospital, created GOTVax along with Jon Santiago, the Boston Medical Center emergency department physician and state representative who’s running for mayor of Boston. GOTVax is a vaccination effort in Greater Boston’s communities of color that uses a “get out the vote” model, with text messaging, phone banking, and old-fashioned door-knocking. Since GOTVax launched in March, the team has vaccinated nearly 4,000 people, more than 80 percent of whom are people of color, Martin said. They’ve done it via pop-up clinics, held during after-work hours and weekends, at places like public housing projects and neighborhood churches.
“Most vaccination clinics around the state are by appointment and operate from 9 to 5,” Martin said. “But the working-class communities . . . can’t take time off work or afford an Uber. You have to figure out how to bring the vaccine to them, literally.”
Martin said a second barrier is what he calls “hassle bias,” or having to navigate the public health systems to get vaccinated. It assumes that people have access to a computer or phone, for example. “That could be the difference between following through the intention to get vaccinated,” Martin said. The third current barrier is misinformation. “I don’t know how many times I’ve had to tell people in East Boston and Chelsea that it doesn’t matter if you have [legal] papers or not, or if you don’t have health insurance.”
None of that should come as a surprise — disparities in vaccination rates across race and ethnicity in communities that have been hit the hardest by the coronavirus have been highlighted repeatedly. Nor is GOTVax the only vaccination effort targeting underserved populations. The Vaccine Equity Now! coalition has been pushing for evidence-based solutions that put equity at the forefront. And the Baker administration has its own vaccine initiative targeting residents of color.
And yet, that hasn’t been enough to clear the vaccination gaps. Vaccine equity is also an issue nationally. But if it seems like we’re seeing the light at the end of the COVID-19 tunnel, with all the metrics trending in the right direction, should inequities still matter?
“The [virus] metrics look good — for now,” Martin said. “We’ve seen this thing really surge out of nowhere.”
It’s also about long-term goals, said Dr. Monica Schoch-Spana, a medical anthropologist and senior scholar at the Johns Hopkins Center for Health Security and cochair of CommuniVax, a vaccine equity coalition working to highlight strategies to elevate vaccine uptake among Black and Latino populations.
“Vaccine uptake is not the only measure of success,” Schoch-Spana said in an interview. “Are the needs of underserved populations being addressed both immediate and long-term?” Schoch-Spana said public health authorities should judge themselves against bigger-picture metrics like “how strong their relationships are with the communities in which there are pockets of impaired access and wariness toward the vaccine.”
In other words, the bar has to be set higher. “[If you don’t consider equity] you have the re-creation of the same systems and trends that created vulnerability in the first place,” Schoch-Spana said. “If you don’t address longstanding trust relationships in addition to the social determinants of health, we’re just not going to get health equity outcomes.”
She is right. The Baker administration vaccine rollout put a premium on speed and shots in arms. It’s why the state ranks at the top. That deserves to be celebrated. But at the same time, we must define success more broadly: We can’t declare victory until the most vulnerable communities are caught up on vaccinations.