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Seeking equity in vaccine distribution in the Roanoke region

Seeking equity in vaccine distribution in the Roanoke region

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A month ago this weekend, vaccinators at the Berglund Center shot 4,600 doses of COVID-19 vaccine into the arms of mostly white Roanokers.

The joy of vaccinating so many, so quickly and so seamlessly was tempered by the frustrations of those who felt shut out, and most especially by those who have carried the heaviest burden of the disease.

“We need to do better,” Dr. Cynthia Morrow, director of the Roanoke City and Alleghany Health Districts, said when asked about inequities in the days following the valley's first mass vaccination clinics of older residents.

African Americans and Latinos are more likely to become infected by the coronavirus and to be hospitalized with serious illnesses. Yet both groups were nearly absent from the mass clinics.

“I think it was a surprise to us to some degree,” said Shirley Holland, vice president for community development for Carilion Clinic. “It really got us thinking about how do we communicate to the community and what are some of the barriers they face and how do we address this. What else could we do to make this more equitable to change the composition of the clinics? And we are seeing that. We know we have increased the number of nonwhites four-fold since we started this.”

Carilion has partnered with the health districts to give out shots, and both have partnered with Roanoke city officials to find ways to bring more Black and Latino residents into the clinics.

All agreed they could do more to overcome the technology, transportation and other physical barriers, as well as to build trust in communities that have reasons to view the government suspiciously.

“We have got to get needles in arms. We’ve got to get this done. Everyone in the city is willing, and no one is backing up,” said Roanoke Mayor Sherman Lea. “We have to do big numbers. The will is there, the commitment is there, we just need to figure out how to do it.”

This past week, they began by bringing the shots to the neighborhoods in a move Lea calls “equity in action.”

'Hope for a better day'

Ever since Virginia’s vaccination campaign opened up to people 65 and older, there has been a huge demand for the shots, and too few doses to go around.

The local health districts have been receiving 3,150 shots a week that have to be split between older residents and essential workers. The easiest, most efficient way to give them out is through large clinics. But until last week when Virginia launched a call center, 1-877-VAX-IN-VA, the best chance of getting an appointment relied on being able to get preregistered online and to jump the moment an email invitation landed in your inbox.

It left out couples like Ray and Lorraine Lipscomb, who don’t have email. She thought they had registered a couple of months ago for shots but hadn’t heard a thing, until last week.

“One of my church members called me and said she had heard about somebody in the library making appointments, and I called the library,” she said. “They called us yesterday and asked if we could come today or Friday. We hit the lottery.”

The Lipscombs got their first doses Wednesday at High Street Baptist Church in the city’s northwest area, where 100 shots were being given that day to people who lived nearby and were invited by neighborhood leaders to take part in the clinic.

A second small clinic was held Friday at Breckenridge Middle School on Williamson Road.

“We are doing this as a pilot to see if it works. Does registration work over the phone? The clinics are very similar to what the health district did with the Rescue Mission,” City Manager Bob Cowell said in announcing the clinics. “At the end of the week, we will have 200 people vaccinated who otherwise wouldn’t be vaccinated.”

About 31% of Roanoke’s population is Black. For COVID cases in which race is known, Black residents accounted for 32% of the city’s cases and 38% of its hospitalizations.

About 6.7% of the city’s population is Hispanic. They have accounted for about 14% of cases in which ethnicity is identified, and 18% of the hospitalizations.

Cowell had organized a couple of task forces to reach out to the Black and Hispanic communities to find out what the city could do to help connect people with vaccines.

The Rev. Serenus Churn offered his church.

“They said, we’ll see how we can get things in the loop, that they had to ensure they had the logistics right. Last week, at the end of the day Wednesday, I got a call and they said there’s the opportunity to have a mobile clinic,” Churn said. “I was happy because I was told they’d look at it down the line, and down the line happened quickly.”

He was especially pleased to see so many people come to the church’s community center, which is called the Anchor of Hope.

“That’s what the vaccine is. It’s hope. It’s hope for a better day,” Churn said. “Any way we can help the community, and our people of race, our state, our city, we are here for them. The church is here for the people.”

Three of those people were Heywood Statum, chief of the church’s trustees; his wife, Portia; and their 98-year-old sister-in-law, Beatrice Johnson.

Statum said they hadn’t preregistered for the vaccine because he wasn’t sure until he talked with Johnson’s doctor whether it would be wise for her to get it.

“He said she would benefit from it because if she did catch COVID, it wouldn’t be as rough on her as it would be if she didn’t get the shot,” he said.

Fighting falsehoods

Statum said that while demand for the vaccine is high right now, he thinks it could fall off unless people get better information.

“I think the minority community has reservations about taking the shots because of the Tuskegee experiment. That was a situation where the federal government gave black men syphilis, and that went on for 40 years,” he said. “So the distrust in the minority community, the Black community, is very high when it comes to federal government programs, particularly vaccinations.”

Misinformation has even become widespread about the ethically unjustified “Tuskegee Study of Untreated Syphilis in the Negro Male” that went on for 40 years until halted following a 1972 Associated Press story. Public health researchers had enrolled 600 Black men, including 399 who had syphilis, and then told them they were being treated for “bad blood.” They were never treated for syphilis.

It has left distrust among Black people when the government is offering medical treatments.

Churn said that’s one of the reasons he was so glad that the city and the health department were using the church.

“Having this in the community helps greatly. People need to know it is not an experiment. That’s the thing we need to put out,” Churn said.

Morrow has addressed some of the vaccine myths during her weekly news briefings and has questioned the motives of the purveyors of falsehoods.

“We know the vaccine is safe. We know it is effective. We know COVID-19 kills. When you have a safe, effective vaccine against a disease that kills, any attempt to undermine trust in the vaccine is a direct threat to the public’s health,” she said. “Any attempt to capitalize on the mistrust that is rightful in so many of our communities of color is tragic. What we cannot let happen, what we absolutely must fight against, is allowing understandable mistrust to perpetuate inequity. We have to everything we can to recognize and acknowledge the mistrust and move forward to gain trust so that every one of our community members is able to make the best decision that they can on vaccines.”

At Wednesday’s clinic, Muhammad Rasheed, who got his first shot that day, said he’s heard all the myths.

“One of my younger brothers gave a reason why I should get it. He said he heard half a million people dying from the COVID, but he hasn’t heard nothing about people dying from the vaccine. You do the math,” he said.

“Yeah, at my job, this girl yesterday said, ‘Oh, I’m going to wait,'” added Carmen Khokhar, who’s 67 and drives a city bus. “I said, why wait? We have to control this thing right now.”

“They talk about government conspiracy. They're going to put a chip in you. They already know everything about me. I’m almost 67 years old,” Rasheed said with a grin. “They already have a locator on you. This cellphone is like a part of you here.”

To help his community gain trust, Lea turned his shot into a public relations opportunity.

“One of the reasons I did it was so they will see their leaders take the shot,” he said. “People really do have issues. I talked to a young man in city hall the other day. He’s one of the maintenance men, and he said, no, he’s not doing it. He’s just heard so much about it. I said, ‘You take the shot not only for yourself but for your family.’”

'The disparity is so blatant'

Part of the strategy of taking the shots to the neighborhoods is to help persuade others to be ready when their turn comes. The other goal is to cross the barriers that prevent those whose turn it is from taking a spot in line.  

Technology has been a challenge, as has transportation.

“There is a tiered system,” said Roanoke NAACP President Brenda Hale. “It is proven and well documented that minorities, African Americans, we are the ones suffering the most. We are the ones most likely to die. So you have to reach out to individuals in this age bracket. You have to understand that they are not the best when it comes to today’s modern technology.”

Hale thinks the city and health department are not working fast enough to reach out to people who don’t have the computer skills required to preregister and then pounce on email invitations to get an appointment.

“It’s not fair to everybody,” she said. “You are saying, here is a fence in front of you. If you are 6 feet tall, you can see over. If you are 5 feet and someone gives you a box to stand on, you can see over it. If you have no box to stand on, would you be able to see over that fence and get what you need? The disparity is so blatant.”

Hale suggested the city put information in utility bills with phone numbers for people to call.

“I’m hoping the city manager will do that. He has not gotten back to me. I’m hoping he is still working on that,” she said.

Cowell said that the city is working on ways to reach people who lack computers, and that library staffers were tapped to handle calls for people who were invited by community leaders to attend the neighborhood clinics.

He said they also recognize that transportation is a hurdle, and that family members who could drive people to vaccination clinics might have jobs that they can’t leave. That was one of the reasons for bringing small clinics to people rather than figuring out how to bring people to large clinics while still maintaining social distance.

Working toward equity

While African Americans and Latinos carry a larger share of burden from the disease, they were also largely ignored in early vaccination efforts.

The state’s vaccination system initially didn’t require vaccinators to gather information on race or ethnicity. For the 1.5 million doses given as of Friday, Virginia lacks such data for one-third of the shots. For the million doses it can assign to a race or ethnicity, nearly 700,000 have gone into white arms, about 117,000 to Black Virginians and 54,560 to Latinos.

Dr. Danny Avula, Virginia’s coordinator of vaccines, said Friday that as the state receives more vaccine it is looking at how to allocate more doses to places with underserved populations, and especially to communities with large elderly African American populations.

But, he said, they want to make sure the extra doses actually go to the targeted populations and will be looking to see what types of partnerships and resources are already in place.

Nathaniel Bishop, who was recently tapped to lead Carilion’s new Office of Diversity, Equity and Inclusion, said Carilion has always tried to build relationships within the communities that it serves, but COVID has lent more urgency.

“The enormity of the issue has allowed for relationships that have already existed to be built upon and expanded. That’s one of the good things about having these good relationships as a foundation to build upon, which has allowed persons to expand into larger roles to help address this health issue of getting vaccine into the arms our friends and neighbors,” he said.

Holland said at that first clinic, “it became pretty evident just from being there that we could strengthen the diversity of those clinics. And we started thinking about how we could do that.”

Carilion asked community influencers to pull together lists of people they knew wanted to be vaccinated, so that they could call and invite them to the large clinics.

“So far, we have made 650 outgoing calls, and continue to collect those lists and make those calls,” she said. More than 400 people have agreed to schedule appointments.

She said they will continue to do that, and to work with the city, health department and others to move closer to having vaccination clinics that look more like the community.

Morrow said the health department is grateful for having involved community partners, but there is still much work to do.

"It’s critical that we take time and engage people in a really meaningful way. Under no circumstances would I say we have achieved equity,” Morrow said. “It is going to be a long process, a very intentional process and a process that requires a lot of partners to ensure we are reaching the population and making sure folks trust us to get registered and to get vaccinated.”

 

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