NC works to make COVID-19 vaccine distribution equitable

When Dr. Rasheeda Monroe volunteered to work at WakeMed’s COVID-19 vaccine site in mid-January, she quickly realized that almost everyone who was driving up to get a shot was white.

So Monroe, a pediatrician whose practice is in Southeast Raleigh, volunteered to work with a team of Black and Hispanic doctors to ensure that the vaccine reached diverse groups in Wake County.

“Black and brown communities have suffered tremendously during COVID, have disparate outcomes as far as hospitalizations and deaths,” Monroe said. “My goal, and the goal of the team I am working with, is to do whatever we can to decrease that disparate impact.”

That meant working with churches and community groups to recruit people who may not otherwise be able to access the vaccine, using trusted messengers to quell fears about the shot and reaching out directly to those who may not be able to figure out an often-complex online registration process. Saturday, the group brought 1,800 shots to 16 churches and a community center in Southeast Raleigh in an attempt to overcome transportation and other equity concerns.

Like many states, North Carolina has struggled with equity in its rollout of the COVID-19 vaccine. White people are overrepesented among those who have taken the shot so far, making up 80.3% of those who have received a first dose of vaccine as of Feb. 4 while representing only 70.5% of the state’s population.

Black people have received 12.6% of first doses despite making up 23.1% of North Carolina’s population. Hispanic people are also underrepresented among those receiving the shot, with 2.3% of those who have received first doses identifying as Hispanic even though the group makes up 9.8% of the state’s population.

“We do not see that we are vaccinating our African-American, our Hispanic community, our Native American community at the same rate we are vaccinating our white community, and that means we have work to do,” Dr. Mandy Cohen, the secretary of the N.C. Department of Health and Human Services said during a fireside chat with Rev. William Barber II on Tuesday.

Trusted messengers

Pastor Joe Stevenson of Macedonia New Life Church on Rock Quarry Road said his congregation had significant interest in the vaccine. It only took six or seven hours for the church to fill all 100 vaccination slots for Saturday’s event.

Church leaders are trusted, Stevenson said, because they are familiar and consistent voices advocating for an area that has often been overlooked.

“There are the trust factors there, the historical concerns,” Stevenson said. “But by placing it in the community, in the care of trusted community partners such as churches and other community partners, it eases the tensions and the concerns of the community.”

On Saturday, Macedonia New Life’s choir hall was turned into a vaccination room, with a technician filling syringes on the stage and shots being administered on the floor. Sunday school classrooms to the side of the room served as observation spaces, where people waited once they had received the shot to ensure they didn’t have reactions.

Gladys Cash waited in one of those rooms with her niece Brenda Grissom, who had secured the appointment. Cash had tried unsuccessfully to get an appointment with the health departments in Person County, where she lives, as well as Durham and Granville counties.

For Cash, there was a sense of relief not only that she had been vaccinated against the virus, but also that she no longer had to seek out a shot.

“Sometimes you’re on the phone for three hours waiting on them to answer or get a call. I don’t have to worry about that now,” Cash said.

Dr. Viviana Martinez-Bianchi, a Duke University professor of family medicine and community health, agrees that it is important for people to be able to get the vaccine in places they trust. Martinez-Bianchi also said it is important that people be able to register on-site and that all messaging be culturally and linguistically appropriate.

When her mother tried to register to get the shot in Wake County, Martinez-Bianchi said, she waited for 35 minutes to talk to someone. Then, she needed to wait 20 more minutes before an interpreter was available.

In another instance, Martinez-Bianchi had a patient who received a call from a vaccine provider asking him if he could be at the vaccination site within two hours because some shots had become unexpectedly available. The problem was, he doesn’t have a car and there was no way the bus would get him there within two hours.

“We have created systems that really create barriers,” Martinez-Bianchi said, adding that those who know the system or helped develop it are those who have had more access to the vaccine.

Vaccine equity

Lechelle Wardell, a Wake County community outreach engagement manager for COVID-19 response, was also part of the Southeast Raleigh effort. It is part of how Wake County is trying to increase equitable access to the COVID-19 vaccine, which Wardell explains by talking about mugs on a shelf.

Wardell is about five feet tall. If she and a person who is six feet tall are trying to get to the same shelf, they have equal access: The mug is in the same place.

But, Wardell said, “It’s going to be easier for him to reach them because he’s six feet. For me, you’ve got to build in some extra steps to make it equitable so that I don’t have to fight as hard to get it.”

With the COVID-19 vaccine, someone who is familiar with computers will have an advantage, able to work through the sign-up process. Someone who has access to a working vehicle will have another advantage, able to jump in and go if a shot becomes available at the last minute or even drive to another county to receive the vaccine. And someone who has a child with a job that lets them stay at home will have yet another advantage, with the child able to set the phone down and work while they wait for a vaccine provider to pick up.

“Equal access does not result in equity when there’s historical barriers to overcome,” said the volunteer Dr. Monroe.

Wake County Public Health’s vaccine wait list prioritizes people, in part, based on their ZIP code. Those who live in ZIP codes with higher rates of COVID-19 infection over the last two weeks are bumped to the top of their priority group.

Ryan Jury, mass vaccination branch director for Wake County, said, “What we do know is that those historically marginalized populations and our more racially and ethnically diverse populations are traditionally in the ZIP codes that have the highest rates of infection. So by focusing on vaccinating the areas that have the highest rates of infection, we are then also targeting (people in marginalized groups), as well.”

In Wake County, that means a focus on nine ZIP codes in Southeast Raleigh and the southern to southeastern corner of the county, including Knightdale and Wendell. Saturday, there was a vaccine event at St. Matthew AME Church, a congregation in the 27604 ZIP code that spans from East Raleigh to Northwest Knightdale.

Still, Wake County leaders admit that they have more work to do. Of the 86,704 first doses of vaccine administered in the county through the end of the day Thursday, white people had received 76.5%, Black people 11.6% and Hispanic people 3.2%. According to U.S. Census estimates, 65.4% of Wake County residents are white, 20.4% are Black and 10.1% are Hispanic.

Black and Hispanic people are also underrepresented in Durham and Orange counties’ vaccinations so far. Durham County’s population is 36.5% Black and 13.5% Hispanic, but only 20.6% of the county’s residents who have taken the vaccine are Black and 3.9% are Hispanic.

In Orange County, the population is 75.4% white, but 81.72% of those who have received a vaccine are.

Vaccinating at New Bethel

Curtis Richardson decided to get the COVID-19 vaccine as soon as it was authorized.

Saturday, Richardson visited New Bethel Christian Church for his first dose. Tracy Bell, the church’s pastor, said Saturday’s event was the fullest the sanctuary has been in months, with an eight-person vaccination team working at the front of the room and a handful of people filling out paperwork before their vaccine or chatting while they waited for their observation period to end.

After taking his shot, Richardson pulled his blue Apex Consolidated High School Alumni sweatshirt over his head. Richardson, who still lives in Apex, attended the segregated high school on the site of what is now Apex Elementary.

Asked why he wanted the shot, Richardson, who is 65, said, “I’m old. I’d like to keep living. So yeah, I think it’s viable reason to some in. i don’t take the flu shot. I hate shots, but I thought this was a good reason to come in.

“To save a life: Mine.”

Richardson said he attended a funeral on Friday for someone who had survived a bout with COVID-19 only to die because it had weakened his heart. Then he came home and learned that his sister-in-law’s uncle had died from COVID-19 shortly after being taken to the hospital.

“Common sense got to kick in somewhere,” Richardson said.

Like others, Richardson described the frustration of trying to get on a vaccine wait list. Richardson said he’d tried the Wake County vaccine line on the first and second days it was open to the general public. When several phone calls were unsuccessful, he stopped trying.

“I just don’t have time to be on the phone all the time. I’m trying to run a business,” said Richardson, who runs his own plumbing company. “I eventually felt like I would get to it.”

Annette Haley received one of New Bethel’s last two doses on Saturday.

Initially, Haley described feeling some hesitancy about the COVID-19 vaccine. But after paying attention to media and doing her own research online, Haley alleviated her own concerns, namely the fear that she could contract COVID-19 by taking the vaccine. Neither of the vaccines now available — one from Moderna, the other from Pfizer — contain the virus. They work by telling your body how to create antibodies that fight against it.

“It’s better to be safe than sorry,” Haley said. “If I take the flu shot, I can take this shot.”

Battling hesitancy

There has been much public concern about vaccine hesitancy among Black and Hispanic people, in part due to historic factors. But when vaccines do become available, the demand is overwhelming, as proven by churches like Stevenson’s rapidly filling up their slots.

During Tuesday night’s town hall, Barber said, “We have to be careful of constantly suggesting mistrust from Tuskegee because that lets people off the hook. It tends to suggest that people are still stuck in that, and that’s actually not the case. A lot of the disparities come from people who do not have the access in their communities.”

Among Hispanic people, Martinez-Bianchi said, there is not traditionally a fear of vaccines. Some of her patients crossed the border carrying no other identification but their vaccine cards, Martinez-Bianchi said.

But in the United States, many of her patients are worried. They heard stories about immigrant women being sterilized in Georgia last year, stories that carry weight and cause suspicion about the government’s intentions.

“There are new fears that come into place when you are in a position of vulnerability,” Martinez-Bianchi said.

To overcome those concerns, Martinez-Bianchi said, health officials should think of ways to build trust in themselves and in the vaccine rather than trying to explain why Black and Hispanic people shouldn’t be hesitant.

That’s what worked for Dr. Nerissa Price, a Wake County psychiatrist who led the vaccination team Saturday at New Bethel. Price, a native of the 27610 ZIP code, said her own family was hesitant about the vaccine until she took it and told them she had little more than a sore arm.

“It started to get people feeling more comfortable,” Price said. “So that’s what we need in medicine: We need people who come from the same places and speak the same languages and to really help people feel more safe and comfortable with their choices.”