America Needs More Than Vaccines to Cure the Pandemic, Pt. II

By: Prema Rahman, MPAC Human Security Program Manager

Via CBS58 / CNN

Ahead of the March 14 deadline for President Biden to sign the new COVID relief package into action, MPAC is releasing a 3-part analysis of the expected legislation through a human security framework. This piece is the second in the series. Read the first part here.

Congress is poised to pass President Biden’s American Rescue Plan, the next COVID-19 relief package, by early March. With a COVID-19 death toll of half a million Americans, a clearly inadequate healthcare system, and an insecure economic environment, now more than ever, we need to prioritize the pressing needs of the American people. As we noted in our piece “America Needs More Than Vaccines to Cure the Pandemic”, the human security framework serves as a litmus test to determine if the provisions of the latest package address the pressing needs and insecurities of the American people. To quickly recap, we have identified three major pandemic-induced issues that are obstructing human security for Americans:

1. discrepancies between and inequities in state vaccine distribution,
2. the struggle to meet the needs of communities most vulnerable to COVID-19, and
3. the plight of small businesses in the face of lockdowns and widespread economic insecurity.

Last week, we delved into the first of the three issues identified: discrepancies between and inequities in state vaccine distribution. To mitigate the gaps and inconsistencies in our distribution, we advocated for a balance between a centralized and decentralized approach to the process, whereby the national government would streamline state eligibility criteria and vaccine administration and state governments would strategize how to best meet the needs of at-risk populations. Even if we smooth out our vaccine distribution process, we cannot achieve herd immunity until we address medical racism and vaccine hesitancy. Medical racism refers to our nation’s history of marginalizing and exploiting people of color through racism in our medical system. Unfortunately, those implicit biases and exclusionary practices continue to exist in our healthcare infrastructure to this day. In this second installment of our 3-part analysis, we will focus on the struggle to meet the needs of communities most vulnerable to COVID-19.

Issue 2: Meeting the Needs of Vulnerable Communities

We as a nation have been struggling to meet the needs of communities most affected by the pandemic. There are two key angles on this particular issue. One is the disproportionate impact of the virus on Black and Brown communities, with the former suffering more than any other demographic. In fact, between January and June 2020, the life expectancy of Black men dropped by three years due to COVID-19, while America’s average life expectancy declined by a year. The other is vaccine hesitancy and mistrust of the American medical system. Both angles are inherently tied in with the history of medical racism in America.

By now, it is common knowledge that Black Americans are disproportionately affected by COVID. According to one study, “in more-poverty counties, those with substantially non-White populations had an infection rate nearly 8 times that of counties with substantially White populations (RR, 7.8; 95% CI, 5.1–12.0) and a death rate more than 9 times greater (RR, 9.3; 95% CI, 4.7–18.4).” Another report notes higher incidences of comorbidities and greater air pollution in counties with higher percentage Black residents and disproportionately higher rates of COVID-19 deaths in Black rural and small metro counties. Yet, states continue to lag in vaccinating predominantly Black neighborhoods. In California, based on information volunteered by recipients of first doses, 32.7% of the vaccines went to White Californians, while a mere 2.9% went to Black Californians. When compared to the state’s race demographics, these statistics do not raise any alarms, but if we take the disproportionate infection and death rates amongst the Black population, this hardly paints a fair picture. Lagging data collection on vaccine recipients adds to this disparity and hinders the federal government’s efforts to diminish racial inequities in vaccine distribution.

Accessibility is another barrier to vaccinations in cities and counties with significant non-White populations. Black and Brown communities are less likely to have internet access and therefore fall behind in the race to secure vaccine appointments. In other cases, like in Suffolk County, Massachusetts, vaccination sites were closer to predominantly white neighborhoods than they were to Black or Latinx neighborhoods. These disadvantages are symptomatic of a greater problem in America: medical racism.

Be it in the form of excluding Black physicians from the American Medical Association (AMA) or infamous, non-consensual medical experiments like the Tuskegee Study, medical racism is embedded into American history and continues to this day. Despite comprising 13% of the American population, Black physicians make up only 4% of the physicians workforce. There are also ample studies that have looked into implicit bias among medical professionals against Black patients and undeniable evidence of healthcare disparities between Black and White communities. As such, it comes as no surprise that members of the Black American population are mistrustful of the novel COVID-19 vaccines. Vaccine hesitancy is a pressing public health issue, and it is imperative we work to assuage these fears and build trust with communities that have historically been victims of racist medical experiments. Otherwise, we will risk the lives of many more Black Americans and endanger our chances at achieving herd immunity through mass vaccinations.

President Biden has made equity the primary theme across his executive actions and policy initiatives, including the American Rescue Plan. On his first day in office, he issued the Executive Order on Ensuring an Equitable Pandemic Response and Recovery, establishing a COVID-19 Health Equity Task Force to submit recommendations for improvement on state and local policies. From the Executive side, this is by far the one of the most comprehensive EOs on addressing the inequities of our COVID-19 response. Biden directs “a Government-wide effort to address health equity” through this EO. The American Rescue Plan also seeks to redress racial inequities in vaccine distribution and “intergenerational inequities that have worsened in the wake of COVID-19”. Medical and systemic racism, however, need to be tackled through direct policy rather than through parts and pieces of legislation that seeks to resolve another issue. Vaccine hesitancy, too, needs a more targeted federal program that includes community-level vaccine awareness campaigns which involve trusted Black medical professionals and community leaders. Earlier this week, in his testimony before the Senate Committee on Health, Education, Labor and Pensions, HHS Secretary nominee Xavier Becerra emphasized the need to “restore faith in our public health institutions” by “putting science and facts first”. Proactivity in building trust in our health infrastructure will be essential in meeting the needs of Black and other minority communities. Biden’s “whole-of-government” racial equity initiative is a start, but his administration and Congress should launch a comprehensive medical equity task force that goes beyond COVID-19 to uncover the depths of medical racism in national, state, and local settings and determine where more funds are needed to increase access to basic and critical healthcare needs.

The coronavirus pandemic has now claimed the lives of half a million Americans. While vaccines have given us cause for hope in the era of COVID-19, we must still overcome several more hurdles on the path to strengthening human security for all Americans. Apart from eradicating discrepancies in vaccine distribution and comprehensively resolving medical and healthcare racism, we need to also save America’s small businesses from drowning in the economic downturn brought about by the pandemic. Next week, in the final installment in our 3-part analysis, we will dive into the plight of small businesses in the face of lockdowns and widespread economic insecurity.