Only 20 states used health equity committees in COVID-19 vaccine distribution planning

Photo: Luis Alvarez/Getty Images

During the large second wave of the COVID-19 pandemic in fall 2020, pulmonologist and critical care provider Dr. Juan Rojas reflected on how disproportionately members of minority populations were being affected by the disease. After hearing similar thoughts from colleagues in New Orleans and New York City, Rojas began to wonder how, if at all, state governments planned to ensure these disparities would be addressed when COVID-19 vaccines were rolled out to the public.

In a new study published in JAMA Network Open, Rojas and his team were surprised to find that while 43 states created a committee to develop a vaccine distribution plan, only 20 plans mentioned using a health equity committee to assist with plan development. 

Of those 20 health equity committees, only eight included minority group representatives, with remaining members including physicians, government officials, ethicists and clergy.

WHAT'S THE IMPACT?

The variability across states wasn't surprising. What was surprising was the lack of patient advocates on committees to add a voice about additional challenges that may exist for vulnerable patients. 

Additionally, the team found that states used different high-risk criteria and medical conditions to determine which group would get priority vaccine access. Some states prioritized those older than 65, while others prioritized people older than 75. Diabetes and obesity were the most common high-risk conditions in the plans studied, but sickle cell disease, which disproportionately affects African Americans, was listed as a high-risk condition in just 72% of the state plans. 

The researchers analyzed early versions of these plans, and acknowledged that most remained in "draft" status throughout their analysis, since each state's task force continued to adjust and update vaccine rollout efforts. In future studies, the team hopes to investigate how those plans translated to outcomes in vaccine distribution.

The team hopes this work can be used to help inform ongoing COVID-19 vaccination efforts, but more importantly, that it can help guide policies for potential future healthcare crises and focus on equitable distribution. 

They stress the importance of a standardized process by which states and the country can roll out vaccines while simultaneously acknowledging existing disparities that affect disadvantaged communities.

THE LARGER TREND

Addressing healthcare disparities has been a goal of the current administration almost since President Biden took office. The Fiscal Year 2022 budget the administration crafted focuses investments in areas such as pandemic preparedness and expanding affordable healthcare.

The budget announcement garnered reaction from the healthcare industry, with Dr. Bruce Siegel, president and CEO of America's Essential Hospitals, saying it takes a positive step toward health equity by targeting disparities and the social determinants of health.

A 2020 analysis of hospitalization rates from the University of Minnesota showed Black, Hispanic, Native American and Alaskan Native populations in the U.S. are significantly more likely to be hospitalized due to COVID-19 than whites. 

When compared to the populations of each state, people identified as being African American or Black were hospitalized at higher rates than those who were white in all 12 states reporting data, with Ohio (32% hospitalizations and 13% population), Minnesota (24.9% hospitalizations and 6.8% population), and Indiana (28.1% hospitalizations and 9.8% population) having the largest disparities.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com