A Better Model for Vaccinating The People Who Need It

 We are a little over a month into the national vaccination effort, and the evidence is mounting that we are just not getting vaccines into the arms of those from communities of color.  Yes, there is a built-in hesitation to vaccines among people of color-- but that is only a minor factor.  People of color are less likely to have health insurance, less likely to have computers or internet access, less likely to have cars, less able to afford time away from their jobs to stand in long lines.   It turns out that a very capable doctor in South Los Angeles seems to have figured out a way to address the problem, and thanks to the Los Angeles Times, states nationwide are (hopefully) listening and adopting his strategies.

Last week, there were dozens of young, mostly white people in yoga pants (many with MacBooks on their laps) in line at Kedren Community Health Center, hoping to get leftover doses of the Moderna vaccine.  Next to them, a long line of anxious older people, most of them Latino or Black and from the surrounding neighborhoods, snaked down an adjacent sidewalk. Too many to count were leaning on rickety walkers and canes.

“This is the group of seniors — the walk-ups, plus the appointments. They kind of have to just wait somewhere while we figure out capacity. And this--,” Dr. Jerry P. Abraham explained, pausing to look at the vaccine chasers, “is the random line that people camped out in from like 8 p.m. the previous night.”

What Dr. Abraham is describing is a “Hunger Games”-like situation — caused by a shortage of vaccines and exacerbated by Los Angeles County’s messy system for distributing doses — that galls Abraham, an epidemiologist who has spent much of his career advocating for equity in healthcare.

It’s no surprise then that politicians and public health officials are now talking about fixing the raft of racial inequities that have cropped up as a result. Los Angeles isn’t alone either. Several recent surveys have unearthed a pattern of disparities among vaccine recipients in multiple states, which is particularly disturbing given that those most likely to get COVID-19 are also least likely to get inoculated.

Abraham and his team at Kedren Health aren’t waiting for top-down fixes from politicians. In a matter of weeks, they have pioneered a number of workarounds to ensure that the people in South L.A. who need the vaccine most — healthcare workers and those over age 65 — can get it.

You may have heard about those clunky online portals for making appointments--forget about it. Kedren Health is determined to help residents from South L.A., who often don’t have internet access, a computer or even a smartphone. Volunteers with paper forms are on hand to collect people’s information when they arrive and enter it into the county’s online database later. Many seniors have reported that technology is their biggest hurdle to getting vaccinated.

What about the need to have a vehicle, essential for getting vaccinated at drive-through sites such as the Forum and Dodger Stadium?  Forget about that, too. Kedren Health is one of only a handful of county-affiliated vaccination sites where people can arrive on foot instead of in a car.

Unfortunately, for those who do arrive by car, parking is chaotic — but that’s in no small part because of the affluent people from outside of South L.A. who camp out on the sidewalk all day. Their vehicles, which on Wednesday included Porsches and BMWs and Audis, take up far too many street parking spots for far too many hours.

And the lines?  They're long. But volunteers regularly check it to make sure that people who are seniors and frontline healthcare workers don’t get stuck behind those who aren’t eligible for the vaccine. There are also portable toilets on site.

What about not having a driver’s license or not speaking English?  Interpreters for almost every language spoken in South L.A. are on site. And immigration status doesn’t matter. Homeless people are also welcome.

“They deserve a vaccine just as much as everybody else,” Abraham said. “If they come here, they will leave with the vaccine in the arm. It creates a lot of headaches and challenges for us to report that information to the county and to the state and the federal government, but we will find a way.”  So far, more than 9,000 people, many of them Black and Latino healthcare workers, have received a first vaccine dose at Kedren Health.

Abraham doesn’t entirely buy the data released this week by the county Department of Public Health, showing a sharply lower rate of vaccinations for doctors and nurses who live in South L.A, as compared to other regions. And he certainly doesn’t buy that the data are solely a reflection of vaccine hesitancy.  “It’s about access,” he said. “People didn’t know where to go.”

Eventually, Abraham says he wants to create a fleet of mobile units, so volunteers can take doses of the vaccine door to door or to homeless encampments. He and a group of other Black doctors and healthcare workers have started exploring grant funding to do it.

That way when there are doses left at the end of the day, Kedren Health can take them to elderly residents for whom standing outside in line is too dangerous. Or volunteers can set up a vaccination event at a church or community center to inoculate essential workers.

In some ways, Abraham’s motivation comes back to the under-65 crowd of vaccine chasers whom he sees on the sidewalk every day.  Sure, vaccinating those folks is better than throwing unused doses in the trash-- every vaccination is a step toward herd immunity. But with the yawning need among Black and Latino people in South L.A., well-off white people aren’t who he wants to vaccinate.  “To come here and feel this sense of entitlement, or because you don’t need to work or because you have those luxuries and you can sit here,” Abraham said, “those people I’m not proud of vaccinating.”