The reasons for this disparity have long been understood by communities that have suffered other negative outcomes because of the social determinants of health: Affordable housing is health care; access to stable work is health care; food is health care, in terms of both access and distribution. Inequitable access is rooted in systemic barriers that are in large part because of racism and the centuries-long economic, social and racial impacts of bonded slavery.
In my position as chief executive at Bread for the City, a direct-service nonprofit that provides food, clothing, medical care, and legal and social assistance to D.C. residents living on low incomes, I have seen regional and national crises come and go, but none with the sustained and deep impact of the current health crisis and resulting economic fallout. Working closely with the D.C. Department of Health, Bread for the City’s Health Center became a vaccine distribution point at the end of December. These vaccines were rolled out to state and district health departments to be distributed to residents.
About 87 percent of the 35,000 D.C. residents Bread for the City serves each year are Black. But in the first weeks of vaccine distribution, our waiting room was filled with White vaccine recipients. Of course, everyone should be vaccinated, regardless of race or economic status. However, I knew that even though we were vaccinating according to the D.C. Department of Health’s guidelines and using its open-access portal, people of color who qualified in each category were noticeably missing: health-care and front-line workers, and those over 65. But they were not in our waiting room in the early weeks.
The pandemic has laid bare a second public health crisis: the full impact of systemic racism. Though the Health Department certainly did not intend to create a vaccine portal that was more easily accessible to White and privileged residents, that was the outcome. For many Bread for the City clients, reliable access to computers and WiFi as well as digital literacy are challenges. Those who were initially assigned to our medical center for their vaccines also had the time and energy to advocate for themselves. In D.C., those people were overwhelmingly White.
Anti-racism is an active state. Passivity allows for systems to be built with privilege centered and defaulted as the mainstream.
We knew we had to actively work toward equity. Our solution was simple but effective: We opted out of the online vaccine registration portal and, staying within the specified eligibility criteria authorized by D.C., began to actively reach out to our community and our patients and bring them in to be vaccinated. Our patients are everyday heroes. They are solving issues that are often overlooked by those with means: limited transportation access or budgeting for bus fare; limited or no child care; an inability to take time off work, even for a lifesaving vaccine. Our approach is to problem-solve alongside our community. What can we do to reduce burdens so that we can get vaccines to a grandmother who is raising her grandchildren who are in virtual school or a home-care nurse without a car?
The results were immediate: When we were vaccinating residents who signed up via the D.C. portal, only 22 percent of our vaccinations were given to Black individuals. Two weeks after we opted out of the portal, that number rose to 75 percent. Similarly, at the start of our vaccination program, only 9 percent of vaccine patients were from Wards 7 or 8, where 92 percent of residents are Black. After we pivoted our approach, that number rose to 19 percent. Two weeks after we decided to actively work toward equity, 33 percent of those vaccinated at Bread for the City came from across the Anacostia River to our clinic in Shaw. Once we open an additional vaccine clinic in our new, expanded Southeast Center on Good Hope Road, we expect that percentage to climb.
Bread for the City is troubled by the overall vaccination results in D.C. As of Feb. 14, according to the city’s vaccination data, only 21 percent of residents 65 years of age and older in Ward 8 had received at least one vaccine dose, compared with 50 percent of this same population in Ward 3. Ward 8 represents the highest concentration of poverty in D.C. (about 27 percent of Ward 8 families live below the federal poverty line, and the median household income is $39,000). Ward 3, on the other hand, is the wealthiest ward, with a median household income of more than $143,000. Ward 3 also has the highest percentage of White residents, at 81 percent, and the lowest percentage of Black residents, at just 5 percent. When looking at numbers of all residents fully vaccinated by ward, Ward 3 has the highest percentage, at almost 4.5 percent, while Ward 8 has not even reached a full 1 percent.
Racial equity in vaccination distribution is possible, but it must be actively pursued. In a city where life expectancy for Black residents is more than a decade shorter than that of White residents, equity could look like applying different age criteria based on race. It could consider the higher risk factors for the Black community, brought on by systemic racism, that are leading to higher rates of coronavirus infection and death.
Diversity makes our city unique and beautiful. But equity comes through active work, and a critical racial-justice lens must be applied to every system. The D.C. Department of Health trusted Bread for the City to know who within our community was most vulnerable to the coronavirus and allowed us to actively practice an equitable approach to our vaccine distribution. We’ve shown that this approach works and should be scaled across D.C. and the region: applying a racial-justice lens to stem the spread of the pandemic and keep safe the communities that are most in need and already struggling.