To Close Racial Gap for Vaccines, Agencies Address Access, Trust

YOUNGSTOWN, Ohio –There is no doubt that the rollout of vaccines against COVID-19 is sharply divided along racial lines.

Locally, more than three-quarters of vaccines have gone to White people: 78.9% of the 75,694 vaccines in Mahoning County, 77.6% of the 61,795 vaccines in Trumbull County and 72.7% of the 27,927 vaccines in Columbiana County. At the state level, 80.1% of the 3.6 million vaccines administered have gone to White people as of April 4, according to the Ohio Department of Health’s coronavirus dashboard. Nationally, according to the Centers for Disease Control, White people have gotten 65.8% of vaccines.

Meanwhile, the risk of severe illness or death from COVID-19 is higher for minorities. A CDC study in December found people of color were sicker from the disease when they arrived at the hospital for treatment, while underlying health conditions put them at greater risk of developing severe cases. The agency also cited another study of selected states and cities finding Black people accounted for 34% of COVID-19 deaths despite being 12% of the total U.S. population.

There are two major factors in the slow rollout to minority communities: access and trust. 

Access to the vaccination process is hampered by a lack of reliable internet access to schedule appointments – a factor that can be coupled with long wait times to sign up or refresh web pages hoping for a new availability. Transportation to and from clinics can be difficult for those who don’t have a vehicle of their own or don’t have a schedule that allows them to get to a site.

In Mahoning County, clinics are largely found in suburban areas, with five of the 27 sitting on or near U.S. Route 224 and four along Mahoning Avenue beyond Youngstown city limits. There’s also a lack of access in the western portion of the county, as just three – two in Canfield and one in Lake Milton – are west of Interstate 76. 

In Trumbull County, vaccination sites are centered along major corridors: U.S. Route 422, Mahoning Avenue, Elm Road and Market Street; just seven of the county’s 31 sites aren’t on those routes. The northern half of the county has only two clinics, one each in Cortland and Kinsman.

And in Columbiana County, the clinics are all held in the county’s biggest towns: Salem, Columbiana, East Liverpool, Lisbon, Calcutta, Salineville and East Palestine. Of the 19 vaccination sites, most are in the northeastern quadrant of the county: seven in Salem, one each in Columbiana and East Palestine, and four in Lisbon.

Western Reserve Transit Authority, already offering free trips on its fixed routes, is also offering free trips to mass vaccination sites held by Youngstown City Health District at the Covelli Centre and Mahoning County Public Health at the former Dillard’s space in the Southern Park Mall. The sites were chosen because of their accessibility, with each sitting along WRTA routes.

The public health departments have also launched a scheduled transportation service that will pick up those seeking a vaccine and drive them to their appointment, not just the mass clinics, before dropping them off where they need to go. Pick-up times can be scheduled by calling 330 716 2684 and 330 716 2843.

“Not everyone has the time to go to the bus stop and wait on a bus and a ride. It can be a lot. It’s so much easier to have someone pick you up and drop you off,” says Erin Bishop, commissioner of Youngstown City Health District.

Adds Ryan Tekac, her counterpart at Mahoning County Public Health: “One of the biggest barriers to vaccination clinics is transportation. WRTA is offering free transportation. That’s one avenue we’re thankful for, but we’ve come up with a model where one person oversees transportation to an appointment.

“There are several church organizations and other agencies that are offering those already, but we’re working to have a single organization that will handle where people call,” he continues.

One of the keys to increasing vaccination rates for people of color is going to where they are, Bishop says. The city health district has been rotating through each side of the city with its vaccination clinics, often partnering with churches.

“I’ve been working since I’ve been here to help build those relationships with our mayor and local pastors. For the last couple of weeks, we’ve been going to the bigger churches because we need that space [for social distancing],” she says. “We went to New Bethel Baptist Church and did 347. [March 30] we were at the Spanish Evangelical Church and did 75. [March 31] they’re at Metro Assembly Church doing about 360.”

Beyond just hosting the clinics, the churches also promote the events both in their membership and in the community around them. 

“If it’s their church, there’s a sign-up sheet. We have a lot of people at the churches who either signed up or know somebody who goes to that church,” Bishop says. “At New Bethel, some people walked there. Had we not been in their neighborhood, who knows if they would have gotten a vaccine? You really have to go to where the people are.”

Although its effort is smaller, One Health Ohio has seen the same trend. So far, the federally qualified health center has given 2,200 shots, according to chief medical officer Dr. Maria Kowal. That breaks down to 1,600 first doses and 600 second doses, administered at its clinics at Youngstown Community Health Center and the Lloyd McCoy Community Health Center in Warren.

“Many of our patients don’t have access to the internet, phones or transportation. All of that makes health-care access – and especially access to the COVID vaccine – more challenging. As a federally qualified health center, our locations are embedded in those areas,” she says. “Both of those [vaccine clinics] are right in the heart of underserved areas. Many of our patients walk to the clinics. We’re getting not only our patients, but probably more than half of our vaccinations have been for community members. A lot of them actually walk in to schedule their appointments. We’re embedded in those communities and along bus routes.”

One Health Ohio is also working on getting its mobile clinic ready for use as a vaccination site, which will further allow the organization to reach traditionally underserved communities.

“I’ve seen other mobile clinics used across the nation and they’re successful in getting the word out to people who aren’t on the internet or aren’t hearing about this through the media and social media,” Kowal says. “That’s a key part of distributing vaccines to people.”

It’s also a matter of trust, she says. Without a regular health-care provider to discuss the vaccine with, there may be lingering doubts that could mean the difference between getting a shot or not.

“We’ve been serving that population for over 30 years. There’s a trust factor with our practitioners. That goes a long way when we talk to people about the benefits,” Kowal says. “It’s new and they have questions. There are people who aren’t going to just go out and get it. They want to be confident that it’s safe and effective before they decide to get the vaccine.”

Even excluding the coronavirus pandemic, distrust of the health-care system is common for people of color, and for good reason. Looking beyond historical events – such as the Tuskegee Syphilis Study and the work of J. Marion Sims, whose work to build the foundations of gynecology was performed on enslaved women without anesthesia – health-care for people of color is often worse when provided by White doctors.

In a February article published in the New England Journal of Medicine outlining the extent of medical racism in the United States, Dr. Fatima Cody Stanford and Simar Singh Bajaj reported Black women were willing to wait a month or more to see a Black doctor instead of a White doctor. Meanwhile, a study found 64% of a Black men reported lower blood pressure after barbershop-based interventions, compared to 12% of the control group, showing a link between providing care in familiar spaces and health outcomes.

“[A study published in December] demonstrated that watching a video with a Covid-prevention message delivered by a Black physician increased information-seeking behavior among Black patients as compared with watching the same message delivered by a nonracially concordant physician,” the report said. “Even with no live interaction, the messenger’s racial identity affected recipients’ approach to COVID health literacy, which has important vaccine-related implications.”

To improve that messaging locally and expand vaccine distribution through trusted organizations like churches, several local organizations – Mercy Health, Youngstown City Health District, Mahoning County Public Health and the city of Youngstown – have created the Minority Community Vaccination Action Group. The group meets weekly to discuss the rollout in minority communities and how it can be improved.

“This may be working more with African American churches or in more areas where access isn’t as great. That’s something we’ll continue to work on,” says Dr. James Kravec, chief clinic officer for Mercy Health-Youngstown and chief medical officer of the county health department. “It’s part of our overall plan with community health. Mercy has a dedicated plan that looks at things like social determinants of health and all things related to making people healthier. Receiving a COVID-19 vaccine is certainly one of those.”

In total, Mercy Health-Youngstown has administered about 55,000 vaccine shots across both the first and second doses. A key part of that, Kravec says, has been conversations between doctors and their patients.

“The physician knows their patient best,” he says. “They’re out there talking about general health, such as colonoscopies and mammographies and blood pressure, but also things like COVID vaccines and if they should receive it. Those conversations are happening every day.”

From a system-wide standpoint, the focus now is on education, he continues, especially that getting vaccinated will slow the spread of the coronavirus and that vaccines are necessary to reach the threshold for herd immunity, which is usually pegged as being between 70% and 80% of the population. 

“We need enough people vaccinated to get to that number, so it’s really about getting people vaccinated as quick as we can,” Kravec says. 

Pictured: The Mahoning County Public Health mass vaccination clinic at the Southern Park Mall.

Copyright 2021 The Business Journal, Youngstown, Ohio.