We don’t have the data to show racial inequity in vaccine distribution, but we do know Louisiana

The first doses of Pfizer's COVID-19 arrived in Louisiana in December, including these that were opened at Ochsner Lafayette General. (Photo courtesy Ochsner Health)

Public health professionals in Louisiana have cautioned that spotty data collection makes it impossible to know if the COVID-19 vaccine has been equitably distributed. As of last week, the state only had racial data on 44 percent of people who’d received at least one dose of the vaccine, and it didn’t have ethnic data at all.  

It’s understandable, then, why Louisiana Public Health Institute CEO Shelina Davis would say Thursday that “the verdict is out” on the equity question.

However, until we’re shown otherwise, the rest of us are free to assume that people with social advantages are disproportionately represented among vaccine recipients because when has any good thing ever been equitably distributed across Louisiana?

Gov. John Bel Edwards set up a task force last spring when the earliest data revealed that 70 percent of the people who had died of COVID-19 in Louisiana were Black.

Since then, Davis said, the death rate “leveled out a little bit,” and Black Louisianians no longer account for the majority of the state’s COVID-19 deaths. Even so, Black people’s percentage of the COVID-19 death toll is still disproportionately high.  

And if the state doesn’t do something dramatic, the same factors that have contributed to Black people dying more often and poor people dying more often less access to health care, less access to transportation, an inability to take off from work and even less access to technology such as internet access will also be a factor in their limited access to the vaccine. 

Ochsner Health, the largest hospital system in the state, and Our Lady of the Lake, another large system, acknowledged this month that they’d only been vaccinating people who were already their patients.

Consider what that means. For an untold number of people, a lifelong lack of access to health care providers meant they were in poorer health and more likely to suffer and die from COVID-19. And these two hospital systems were comfortable denying a life-saving vaccine to people who aren’t their patients.

To the extent that such discrimination is occurring,” Joe Kanter, the interim head of the Office of Public Health, wrote in a letter to the state’s health care providers, “it must immediately cease.”

 

But there are other hurdles, still, in between people and COVID-19 vaccines.

The state has released a list of hundreds of pharmacies across Louisiana that are dispensing the COVID-19 vaccine. For a number of the pharmacies on that list, there are no phone numbers provided, only physical addresses and website addresses. According to the Louisiana Department of Health website, “Locations with no phone number listed are by online appointment only.” At the same time, Ochsner has said it will comply with the state’s requirement to vaccinate people who aren’t their patients, but they’re expecting everybody who makes an appointment to use my.ochsner.com.  

David Holcombe, a doctor who serves as the state’s regional medical director for Central Louisiana, told the Illuminator this week that about 17 percent of households in his region make less than $15,000 a year and that providers who require people to sign up online are inaccessible to many people. “They don’t have internet access,” he said. “They don’t have computers.”

Davis, who serves on the state’s Vaccine Action Collaborative, made a similar point Thursday when she said, “There could be some inequities in terms of who’s getting the vaccine now. I think that will always exist, especially for populations who are kind of underserved or marginalized, especially in rural communities. Because I feel like rural communities are the ones that are often missed.”

It has to be said that not all of the vaccine distribution disparity will be a result of inaccessibility.  Some of that disparity will likely be the result of people who are eligible to receive the shot choosing not to get it.   

A survey that Davis’ organization conducted in June 2020 found that only 59 percent of White Louisianians and only 49 percent of Black residents expressed a willingness to get a vaccine if one became available. Ochsner reported recently that fewer than half of its eligible employees had been vaccinated. At a press conference Thursday, Kanter said that only 26 percent of nursing home employees statewide had been vaccinated.

Thus, the state has two major vaccine problems on its hands: How to address the skepticism that’s making vulnerable groups decline the vaccine and how to make sure members of those vulnerable groups who want the vaccine have unfettered access to it.

It may never have been the case that a good thing is equitably distributed across Louisiana, but with a larger supply of the vaccine on its way, it’s imperative that we start now.