How California can make the vaccine distribution system more equitable

As counties throughout California have begun distributing the COVID-19 vaccine, it’s become increasingly clear that our distribution system is reinforcing — rather than reversing — COVID-19 inequities. It doesn’t have to be this way.

Vaccines ought to go to the communities that have been hit hardest by the pandemic, which, in California is predominantly low-income, Black and brown neighborhoods. But by designing a vaccine distribution system that relies on hospitals, stadiums and for-profit companies like Walgreens and CVS, we’ve locked out many residents of the neighborhoods that need the vaccine most.

These distribution sites are often on the other side of town or inaccessible to people who don’t have a car. Meanwhile, most low-income residents cannot afford to take off work during the day and wait 4-5 hours in “mega lines” to get vaccinated.

There is an alternative: investing in vaccine-distribution efforts at community-based organizations and health centers that are best positioned to reach people in the neighborhoods that have been most devastated by the virus. Nonprofit California health centers alone could vaccinate 500,000 patients a week in all the underserved urban and rural areas of the state — yet most still do not have access to the start-up funds and vaccines necessary to put that system into place.

Health equity and racial justice leaders in Los Angeles are aiming to get vaccine into people’s arms in communities hardest hit by the pandemic. South Los Angeles is an epicenter of the pandemic in L.A. County and — at the moment — one of the most serious outbreaks in the country, with some of the highest rates of COVID-19 transmission, hospitalization and death. South Los Angeles’ 1.5 million residents — over 90% of whom are Black or Latino — endure community conditions that undermine their health and face significant and longstanding gaps in access to healthcare and health insurance.

When early indications suggested that South L.A. healthcare providers were not included in the first wave of vaccine distribution, community health centers, community-based organizations, churches and labor unions mobilized. They successfully urged L.A. County decision-makers to include South L.A. community health centers in first-round distribution. One well-respected health center, St. John’s Well Child and Family Center in South L.A., became a hub for first-round vaccine distribution. In its first weeks, St. John’s staff administered first doses of the Moderna and Pfizer vaccine to over 25,000 patients, the overwhelming majority of whom are low-wage African American and Latino health workers and seniors.

Unfortunately, it took an organized campaign by grassroots organizations to make sure South L.A. community health centers were included in the vaccine distribution system. What we need instead is a statewide commitment that community-based health centers in every county are central to vaccine distribution going forward. Community-based health centers have proven time and again their ability to reach the most indigent, most in need and so-called hardest-to-reach populations. It’s in their DNA.

The vaccine distribution “win” in South Los Angeles required substantial upfront investments of time and staff from South L.A. partners. For instance, St. John’s spent $150,000 to purchase ultra-cold freezers capable of storing vaccines, hired staff to meet additional demand and shifted hours of operation so patients could come in before and after work. For other community health centers to follow suit, state and local decision-makers would need to make it easier for community partners to access critical resources by removing contractual red tape and reducing barriers, such as reimbursement-only contracts that require organizations to have substantial cash on hand, thus shutting out small and mid-sized organizations.

Investing in the capacity of community-based organizations and health centers is long overdue. This pandemic has shown us that the people and places hardest hit by COVID were the ones that were least connected to health-promoting resources beforehand and most likely to be deprived of community conditions that support healthy lives like stable housing, safe streets, access to healthy food and outdoor spaces for physical activity.

It is time to end the starvation cycle for community-based clinics and local organizations in the most impacted communities. The vaccine-distribution strategies we use now can break old patterns of disparity and injustice by placing urgently needed resources where they are needed most. State and county policymakers have an opportunity right now to deploy vaccines and resources to bolster the capacity of community-based organizations already operating in the hardest-hit Black, Latino and Indigenous communities. Doing so is a practical response to this pandemic and will leave us better prepared to meet ongoing health needs into the future.

This story was originally published February 20, 2021 at 6:00 AM with the headline "How California can make the vaccine distribution system more equitable."