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A diverse suburb’s biggest pandemic challenge: Distributing the vaccine equitably

A health-care worker prepares a syringe with the Moderna coronavirus vaccine. (Mike Segar/Reuters)

Ten months after a liberal, diverse suburb saw its first cases of the coronavirus, it faces what might be its most daunting task yet: distributing a protective vaccine to all 1 million residents.

Lawmakers and health officials in Montgomery County, Md., which two years ago passed a sweeping racial equity bill, have emphasized the need to distribute the coronavirus vaccine according to “equity principles.”

That means ensuring that the suburb’s Black, Latino and immigrant communities, which have been disproportionately impacted by the virus, get their fair share of doses, even if it’s harder to reach them.

Health Officer Travis Gayles says he is committed “to a framework that allows fair, equitable access” to vaccinations, not one that advantages the wealthy or well connected. But with limited supplies of the vaccine doses, intense demand in more affluent areas and decades of systemic inequalities that have marginalized certain communities, this commitment is going to be tested.

“It’s going to be hard. This is not going to be the perfect situation for equity,” Montgomery’s head of emergency management, Earl Stoddard, warned lawmakers on Tuesday, after loud outcries on social media and in phone calls from many constituents unable to get vaccine appointments. “We’re going to be struggling with this constantly.”

The county is prioritizing residents of certain hard-hit Zip codes for vaccine appointments, corralling its census outreach team to spread information about the vaccination program and soliciting feedback to identify the specific sources of skepticism in various demographic groups.

But community health providers, advocates and experts say there’s much more logistically that needs to be done.

“This is the biggest challenge that I’ve faced in my lifetime,” said Raymond Crowel, head of the Montgomery County Health and Human Services Department. “Am I daunted by it? No. But am I aware of how much of a challenge it’s going to be? Yes.”

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According to state data, White residents in Maryland are being vaccinated at twice the rate of Black or Latino residents. As of Sunday, about 16 percent of the 498,242 vaccinations with known race information have gone to Black residents even though they constitute 30 percent of the population. White residents, in contrast, have received 68 percent of the vaccinations for which race is reported, while constituting 58 percent of the population.

Maryland recently distributed county breakdowns of this demographic data to local governments, but the state health department declined to provide that information to The Washington Post. Montgomery officials said they are still analyzing the data and expect to see racial disparities. Of the nearly 100,000 residents who have preregistered for vaccine appointments in the majority-minority county as of Tuesday, nearly three-quarters are White, Crowel said. About 65 percent of the suburb’s elderly are White, according to county data.

The County Council’s vice president, Gabe Albornoz (D-At Large), said he’s “greatly alarmed” by the vaccination numbers.

“There’s confusion and disorientation over the registration process. And frankly, people with more time on their hands, with strong command of the English language, are better able to navigate it,” he said. “It puts certain communities at a disadvantage.”

Gayles has tried to stick stringently to the county’s vaccination plan, using the county’s limited doses to inoculate health-care workers and first responders, many of whom are Black, Latino and Asian, before moving on to senior citizens.

In mid-January, after the state expanded eligibility to include other essential workers and those above 75, several Montgomery residents who fit into that category obtained access to leaked registration links and signed up for appointments at county clinics. When they were turned away at those sites and told they were not yet eligible according to county rules, many were frustrated. Some, according to clinic volunteers, were “irate.”

“We are working hard to make sure that we have a system that is fair for everybody to access,” Gayles said at the time. “A system that is not based on who you know.”

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Montgomery County Executive Marc Elrich (D) said in an interview Friday that he has personally gotten angry calls from friends who are senior citizens asking why they were turned away at county clinics. “I get that it’s frustrating to get an appointment and not be able to actualize the appointment,” he said. “But if we honored everybody at this point, we’d be doing much more harm to the community.”

Sandra Quinn, a University of Maryland professor and the senior associate director of the Maryland Center for Health Equity, said she empathizes with what Montgomery is trying to do.

“There’s a reason these priority groups are what they are. They speak to risk of exposure and risk of severe disease,” Quinn said.

The overwhelming attention on vaccine distribution has caused some people to “get ahead of ourselves,” she added, leading to “a sort of premature moving from priority group to priority group.”

Montgomery last week started scheduling appointments for those above 75, offering slots first to those who live in Zip codes with high coronavirus case rates, including densely populated areas of Silver Spring and White Oak. Crowel said the strategy, which mirrors D.C.’s approach to bridge initial disparities in vaccinations, will help the county lower overall infection rates.

“As a practical matter, attacking the virus at the places where it has the greatest chokehold is how we’re going to stop it,” he said.

At 66, Crowel, who is Black, is technically eligible for the vaccine according to state regulations and could sign up for a slot at hospitals or pharmacies, which — unlike county vaccination clinics — follow state rules. But he doesn’t plan to until supplies significantly increase.

“I have staff members who are on the front lines and who need to be ahead of me,” he said. “I’m not going to jump that line.”

During a briefing Tuesday, council member Craig Rice (D-District 2) proposed reserving certain doses of the vaccine for people of color or low-income residents, who may be less able to navigate the online registration system. Rice, who is Black, said he spent hours last week trying to help his elderly mother register for a vaccine appointment at Giant, to no avail.

Stoddard, the head of emergency management, said that at least right now, a reservation system isn’t viable because of the dire lack of supply. “If we hold doses back, the state sees we’re not giving out all our doses and gives us less each week,” he said. Gov. Larry Hogan (R) last month cut the allotment to hospital systems that had failed to distribute more than 75 percent of their doses.

Instead, officials say, they are working now to shore up trust in the vaccine and ensure marginalized communities are able to access appointments. In addition to focus groups and the census team outreach, officials are moving staff to the county’s 311 call center to answer vaccine questions and discussing with partners, such as churches and community clinics, how to convert coronavirus testing sites into vaccination sites.

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Gayles and Crowel said they were surprised by the lower-than-expected uptake of the vaccine among health-care workers and nursing home employees, and Gayles said officials need to do a better job of understanding the myriad sources of this hesitancy: “We can’t just write it off as ‘mistrust.’ ”

While the Tuskegee syphilis experiment sowed fear of the medical establishment among members of the Black community, Gayles said there are also more recent issues, such as the persistently high rates of infant mortality among Black babies, that contribute to vaccine hesitancy.

“Look at the overall health system,” he added. “We continue to see health disparities across the board — let’s talk about that.”

Jayne Park, director of nonprofit advocacy group Impact Silver Spring, said the group serves approximately 500 low-income Latino and African immigrant clients. As of Friday, none who are eligible had received the vaccine.

Yesenia Regalado, a supervisor with the group, said clients have numerous questions about the vaccine itself but also about how to sign up. These range from whether they’ll need to show proof of insurance (no) and whether preregistering means they have an appointment (no — they still need to receive an invitation to schedule one), to what the differences are between the county and state websites.

“It’s going to be very hard for the government, I’ll say that,” said Maria Gomez, chief executive of Mary’s Center, a network of community clinics that primarily serves Latino residents in D.C. and Maryland.

The limited vaccine supply has complicated how doses are being disseminated, Gomez said, and the complexities of the process have a disproportionate impact on people already struggling to avoid eviction or apply for jobs.

“Once we get people to decide that they’re going to get it, we need to figure out how to do that fast,” Gomez said. “Because that window is going to close quickly. Not because they don’t want the doses, just because they’re busy.”

In a wealthy Md. suburb, overall health gains obscure growing racial inequities

Few states are accurately tracking coronavirus vaccinations by race. Some aren’t at all.

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