Who gets a seat on the lifeboat?
People should not be an afterthought in a vaccine rollout
Imagine you are 62, you live in a semi-rural area. You have a car, but it is 15 years old and unreliable and doesn’t have working air conditioning or heat. Your rent is $600.00 but, you are unemployed and only get $700.00 a month to live. You barely can afford your electric bill, so having a smartphone or internet access in your home is out of the question. It is 2021, and there is a vaccine available that can save you from a deadly virus during a global pandemic — but you have no idea where to get one or any way to get there. Living in poverty without access to technology or proper healthcare is a situation familiar to many people living in the United States of America. These are people that are continually forgotten.
The worldwide response to the 2020 pandemic is a modern miracle. Spurred on with a massive investment in research dollars (US Congress, 2020), in less than 12 months, scientists and clinicians have taken partially completed research on a similar virus and accelerated the creation, trial, and production of a highly effective vaccine. In the U.S.A, we had an unfortunate mixture of short-sightedness by the Trump Administration and a lack of centralized health record-keeping. The initial pandemic response lacked leadership by the Federal government and instead relied on an inconsistent State-by-State response. States and local municipalities were responsible for public health directives and the rollout plan for who gets vaccines. This approach has been inconsistent at best and utterly inequitable at worst.
The problem
The Covid-19 Vaccination program began in December 2020 and was meant to be targeted to older people (over 64) who are most at risk for mortality due to the virus. In the earlier days, assisted living spaces were targeted for vaccinations. However, people living in assisted living only account for 4.5 percent of adults 65 and over. (Wellman, 2010) The remainder remains living in the community and often alone. (Wellman, 2010) In a 2010 study, the USA had 39.5 million people over 65, including 5.6 million people over 85. And this number is only expected to grow. By 2050, it is projected that North America will have 21.4 percent of its total population 65 and older. (Roberts et al., 2018) And while access to computers by older people has drastically increased, roughly half of people over 65 who live alone in the community do not have internet access. (Roberts et al., 2018)
Other populations at high risk for covid-19 are agricultural workers and service industry workers who are also less likely to have internet access or internet-connected smartphones. And this shows in the numbers of who is getting vaccines.
Racial/Ethnic Makeup of California, Census Data, 2016
Covid19.ca.gov Dashboard
In data taken on March 23, 2021, Black and Latino populations trail behind Whites in being vaccinated. This is in a state where Hispanics make up 39% of the overall population compared to whites at 36%.
Things to consider:
Design the whole experience; marketing and communications should not be an afterthought.
The US Congress appropriated 8.3 Billion dollars in March 2020 (US Congress, 2020) to develop and rollout of vaccination for Covid-19. The majority of those funds went, understandably, to research efforts; however, less than 1% was allocated towards communications and planning for the vaccine rollout. For any effective public health effort, making the public aware and creating a clear, understandable, and actionable response makes the difference between success and failure. Planning the communications to the public, ensuring they understand what will happen, where it will happen, and how to engage is critical.
Equity is not optional
This point is best made in the following passage in the County-Level COVID-19 Vaccination Coverage and Social Vulnerability Report “COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administration to those who have been most affected by COVID-19 disease) is an important goal.” (Hughes & Wang, 2021)
“Practices in states with high equity included 1) prioritizing persons in racial/ethnic minority groups during the early stages of the vaccine program implementation, 2) actively monitoring and addressing barriers to vaccination in vulnerable communities, 3) directing vaccines to vulnerable communities, 4) offering free transportation to vaccination sites, and 5) collaborating with community partners, tribal health organizations, and the Indian Health Service.” (Hughes & Wang, 2021)
Imagine if we had mobile vaccination trucks that would go to areas like mobile homes, parks, and rural towns where older individuals reside. Imagine if more dollars have been spent on getting the word out through billboards, door tags, phone calls, and outreach to organizations that vulnerable populations trust, like Churches and community groups that have lists of older people and other vulnerable populations.
Think tech-enabled, not tech-centric
Using high-tech solutions to enable the vaccine rollout to happen is great for the behind-the-scenes logistics. But they should not be the go-to solution for the user-facing experience. We have the data to know where vulnerable populations are. We have the ability to deploy the necessary resources. And with that information, creating micro-targeted communications that are tailored for that community should be possible.
The Covid-19 pandemic is hopefully a once in Century event. While we may move on as a society and the memory of the day to day complications of its presence will be lost to history, it is important to learn from the experience and make changes and improvements to ensure that when things like this happen, again we do not make the same mistakes.
Bibliography
ABC. . ABC. ABC TV Vaccine Watch. https://view.ceros.com/abc/california-covid-19-vaccine-tracker/p/1
Covid19.ca.gov. Covid19.ca.gov. https://covid19.ca.gov/vaccines/#California-vaccines-dashboard
Hughes, M., & Wang, A. (2021, 17 March). County-Level COVID-19 Vaccination Coverage and Social Vulnerability — United States December 14, 2020–March 1, 2021. MMWR and Morbidity and Mortality Weekly Report. http://dx.doi.org/10.15585/mmwr.mm7012e1
Roberts, A. W., Ogunwole, S. U., Blakeslee, L., & Megan A Rabe. (2018, October). The Population 65 Years and Older in the United States: 2016 American Community Survey Reports. Census.gov. https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf
US Congress. (2020, March 04). H.R.6074 — Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. Congress.gov. https://www.congress.gov/bill/116th-congress/house-bill/6074/text
Wellman, N. (2010). Institute of Medicine (US) Food Forum. Providing Healthy and Safe Foods As We Age. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK51841/
