As Vermont works to expand who can get vaccinated for COVID-19, state officials say they are committed to ensuring those disproportionately affected by the virus, including those who are Black, Indigenous and people of color, have equitable access to the vaccine. But what does equitable mean, and is the state's plan achieving it?
So far, Vermont has inoculated more than 85,000 people, mostly those deemed essential workers and those who are 75 and older. State officials have said the state's vaccination plan comes down to saving lives. And to do that, it has prioritized the oldest Vermonters first.
"By vaccinating those who are most susceptible to severe illness and death, we hope to reduce our hospitalization rate and the number of deaths we're experiencing, more quickly," said Gov. Phil Scott at a Jan. 25 press conference. "This will allow us to begin turning the spigot once again, and relaxing all those restrictions we placed on everyone."
State officials have also insisted they are working to address racial inequities as part of Vermont's COVID-19 vaccine rollout program. But Mark Hughes, the executive director of the Vermont Racial Justice Alliance, says there's still work to do.
VPR’s Henry Epp spoke with Mark Hughes. Their interview is below and has been edited and condensed for clarity.
Henry Epp: You sent a letter to Gov. Phil Scott and Health Commissioner Dr. Mark Levine, among others, earlier this month, and you criticized the state's vaccination plan and asked the state to revisit it with an eye and commitment to racial equity. How, in your view, does the current plan not achieve racial equity?
Editor's note: You can read Mark Hughes' full letter at the bottom of this post.
Mark Hughes: We sent a letter out and we'd love to get some response, by the way, just in case Dr. Levine or the governor or anyone else has an opportunity: We'd love to hear back from you.
As far as the current priority, I think where we're missing it really has to do with folks who are living in multigenerational dwellings, and folks who have folks who are leaving the house every day for employment. And obviously, you know, [in] Black and Brown communities, that's going to be more prevalent. So, yeah, there's some gaps there, and we've been asking them to look into it, and I think that... I think we can do better.
How specifically do you think the state could be better reaching Black and Brown communities to get vaccines more equitably?
I think there's two things that we've gotta be talking about. First of all, an information campaign across the state that speaks to the efficacy and the safety of the drug itself, so folks who trusted folks in communities across the state will have the ability to, first of all, learn for themselves, but be able to pass along credible information.
I don't know that there's been a good campaign that has reached out to folks with the stamp and seal of what is supposed to be the trusted arm of the government, called the Health Department, that says, "Look, here's the efficacy data, here's the safety data." You know, "Here's our letterhead. We can assure you; pass this along." So that might be a good start for them, because that would allow folks like me to be able to disseminate that information if we have the capability to do so.
And then the second piece is obviously, how do we go about, you know, getting into these communities? And for folks who do decide that they want to do it, and building the trust in these communities in the department to do so.
When you have, I think, a situation where, first of all, they're not getting the information — and we can never, never forget the backdrop of the historical distrust that Black folks have had in the health care system, and how we've been consistently underserved in health services. So, there needs to be some significant work done there.
We probably just need to hit the reset betton on the establish trust thing.
It really does seem that nearly every press conference recently, the state is asked about its plan for vaccinating BIPOC Vermonters. And they consistently say, you know, like "We recognize this is an important group, we know there are inequities." So where are you seeing the breakdown?
What we're dealing with here is, we're dealing with something that has nothing to do with COVID, OK. So, all of these inequities that we're seeing here in [the] health services system, they predate COVID.
This is the way the system was built. It was never built to serve Black people well. Neither were any of these other systems. In terms of the disconnect, in terms of why it is that we can't seem to get from here to there — that's a question that we're going to have to ask the administration, because up until now, to me personally, it doesn't seem as that we've gotten there.
It's somewhat of a no brainer … if you know that there are trusted voices in communities that you're looking to get this word out across the state, then equip them with what they need. After that point, enable some type of apparatus that is really based upon what is currently existing. The infrastructure exists, it just has to be a political will to leverage it, and it shouldn't take me to tell the administration on how to go about doing that.
Note: A request for comment to the administration was not immediately returned. This post will be updated if one is provided.
Mark Hughes' letter to the Scott administration:
Dear Mr Governor and Commissioner Levine
I’m writing about Vermont’s vaccination policy, which, according to vtdigger.org , Commissioner Mark Levine has described as “simple and fair.” As you know, phase one of the rollout was for front-line workers and long-term care facility residents, and phase two, is people 75 years and older.
Due to structural racism, this so-called “simple and fair” policy, will have a disparate, negative impact on Vermonters who are black, indigenous and people, of color.
The first phase, which prioritized long-term care facility residents, effectively excluded Vermonters who are black, indigenous or people of color because the overwhelming majority of long-term care facility residents nationally (78 percent) and in Vermont are white. Vermonters who are black, indigenous or people of color tend not to house their elders in long-term care facility for cultural reasons.
However, the risk to Vermont elders living in multi-generational households is no less than that of Vermonter elders living in long-term care facilities. In fact, as you know, Vermonters who are black, indigenous and people of color are at a higher risk of contracting the coronavirus from a household contact. Thirty-six percent of non-white Vermonters had household contact with a confirmed case of COVID-19, as compared to only 20 percent of white Vermonters.
Thus, even though non-white Vermonters living in multi-generational households have the same or greater risk of exposure and/or dying from COVID-19, they were structurally excluded from the first phase of the vaccination roll-out in Vermont by limiting it to those who have the resources or the cultural norm of moving their elders into long-term care facilities.
The second phase of the vaccination rollout is also problematic in terms of racial equity. A vaccination program that prioritizes people age 75 years and over structurally excludes Vermonters who are black because nationally, the average life expectancy of black people is just 75 years of age, due in large part to the effects of systematic racism.
In addition, COVID-19 cases among non-white Vermonters tend to be younger than for white Vermonters. The average age of persons testing positive for COVID-19 is 33 among non-white Vermonters, whereas the average age is 46 among white Vermonters.
As you know, non-white Vermonters have been disproportionately affected by COVID-19. Nearly one in every five COVID-19 cases in Vermont are among non-white Vermonters even though non-white Vermonters make up approximately six percent of Vermont’s population. The incidence rate is as high as 225.7 for black Vermonters versus 26.2 for white Vermonters.
The most troubling statistic is the preexisting conditions rates among COVID-19 cases. Based on the 2018 Vermont Department of Health’s Behavioral Risk Factor Surveillance System report, there are no statistically significant differences in the rates of pre-existing conditions, such as diabetes, lung disease and cardiovascular disease among white and non-white Vermonters. However, there are disparities in the rates of pre-existing conditions among Vermonters testing positive for COVID-19. The pre-existing conditions rate among COVID-19 cases is 19.4 percent for non-white Vermonters and 12.1 percent for white Vermonters. This suggests that non-white Vermonters are at higher risk of exposure to COVID-19 due to their type of employment and living arrangements. Thus, a vaccination program that priorities long-term care facilities and age 75 years and older, effectively excludes non-white Vermonters who are at disproportionate risk for contracting the virus and for more serious outcomes, such as hospitalization.
While it may be simple to use residence at a long-term facility and age at criteria for access to the vaccine, it is not fair or equitable to all Vermonters because of systemic racism.
We implore you to re-visit this vaccination plan with an eye and commitment to racial equity.
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