Do the Poor and Downtrodden Deserve the Covid Vaccine Before Everyone Else? Community Health Centers Advocate to Receive More Vaccine Doses

February 26, 2021 Community health clinics think the answer to solving vaccine rollout disparity is to let them administer more vaccines. At a webinar on February 24, representatives from health clinics and the President of Chares R. Drew University of Medicine and Science made the case for allocating more doses to health clinics that service poor communities. "Advancing equity is in our DNA," said Louise McCarthy, President of the Community Clinic Association of Los Angeles. Equity is "fundamentally what we do," said Anita Zamora, Deputy Director of Venice Family Clinic.

According to the LA County Department of Public Health, less seniors from communities of color are receiving the Covid-19 vaccination than white and Asian seniors. Only 24% of Black/African-American seniors and 29% of Latino seniors have been vaccinated. On the other hand, 43% of white seniors and 39% of Asian seniors have received their vaccines. Much hand-wringing has ensued.

The Venice Family Clinic, which actually comprises 14 sites in Venice, Santa Monica, Mar Vista, Inglewood, Hawthorne, and Culver City, sponsored a webinar to discuss the inequity and propose a solution.

The difference between ethnicity and socioeconomic class were very blurred during the discussion, with the assumption that most, if not all, of the lower socioeconomic class members are people of color. This assumption may be true given that all of the barriers discussed regarding getting the Covid-19 vaccine related exclusively to lack of financial resources: lack of a vehicle to get to a vaccination site, lack of technology and/or savvy to navigate the vaccination sign-up websites, and lack of the time flexibility necessary to drop everything to take the appointments with next-day or same-day notice.

During the hour-long discussion, not once did any of the panelists even hint that explicit discrimination was taking place. Rather, inequity had resulted from the imposition of transportation and technology barriers that are difficult to overcome for people who might be unsophisticated or simply lack a car.

The solution, according to both McCarthy and Zamora, is to allocate more vaccine doses to community health centers than are currently being allocated to the megasites. "A third of the vaccination sites are community health centers," McCarthy pointed out. Yet health centers like Venice Family Clinic only received 1,000 doses - when they needed almost 3,000.

"The capacity of health centers as a network is greater than the FEMA sites," added McCarthy, and they would have a greater impact on equity. These sites are already in the underserved communities, already have relationships and connections with the impoverished individuals residing there - some of them on the street - and could get vaccines into the arms of the seniors of color who so far appear to be underrepresented in the rolls of the vaccinated. "That would measure things more fairly," McCarthy said.

The argument for allocating more vaccine doses to community health centers so that they could more effectively reach people unable to navigate one part or another of the county's mass vaccination program had been making sense up to this point. But we find dubious McCarthy's assertion that, at a third of vaccination sites, community health centers could put more doses into more arms than the mega-drive-through sites at Dodger Stadium and the like. To date, the county has administered 1.67 million doses with nearly half a million having received a second dose. If Venice Family Clinic only had 2,200 seniors to vaccinate - with 14 clinics - then it is unlikely all of the community health centers combined could have come up with a number that high.

While all socioeconomic groups should be served, another part of this equation is speed and quantity. The more people who get vaccinated - regardless of race or income level - the faster the entire society can rid itself of the Covid-19 disease .

But McCarthy stated, "It's not volume but value." She made it clear that, to her mind, some people deserve the vaccine more than others. "It does not make sense a 65-year-old in Bel Air gets a shot before a 63-year-old on Skid Row," she said. She went on to exhibit scorn for "those folks who feel privileged" - including unionized workers at major grocery stores, the next group eligible for vaccinations - and how they will "step forward first" to sign up for vaccines. Apparently, people who advocate for themselves are despicable simply by reason of the fact that others don't have the wherewithal to do the same thing.

"Shame," McCarthy answered, when asked how an ordinary person could help solve the inequity problem.

We don't know how an ordinary person feeling shame could do a single constructive thing toward getting more vaccines to people unable to navigate the insanely difficult county sign-up process. A high-income white senior staying home out of shame instead of driving to get a Covid-19 vaccination will not give a poor, Black person without a car or a computer a vaccination. Nor will it go toward killing off the SARS-CoV-2 virus.

The plain fact is that the vaccine is in scarce supply. Not everyone who needs it will get it. That is what "scarce supply" means. Questions of who deserves to get ahead in line are necessarily tricky and fraught with moral and ethical problems. The broad goal of decreasing death - regardless of what class or ethnicity of person is dying - seems the best yardstick to use.