Editor's note: After this story published, the state of Texas announced the launch of 28 vaccination hubs, including some located in communities of color. Gov. Greg Abbott said the state plans to open more hubs in the future.
COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.
“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn't availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I'm very nervous and anxious that this [vaccination effort] is not going to work out for us.”
According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.
In Travis County, for example, 88 sites have been designated to administer vaccines, and roughly three quarters are in majority non-Hispanic white census tracts. And in Dallas, the southern part of the city — where people of color predominate — has fewer distribution centers than the north, which tends to be more white and affluent. Out of 140 distribution sites in Dallas County only 10 are located in majority Black census tracts while 37 are in majority Hispanic census tracts.
People in underserved communities often don’t have vehicles and must rely on public transportation. During the pandemic, many urban transit agencies have reduced their service or limited the number of passengers to provide for social distancing.
“This vaccine distribution has a big transportation component,” said Jill Ramírez, CEO of the Latino Health Forum, which works to promote good health care practices among the Hispanic community in Austin.
For advocates, this feels like déjà vu. Omar Gomez, an engineer based in Austin, started volunteering to help the Hispanic community when the pandemic started. He noticed that in East Austin neighborhoods it was more difficult to find masks and hand sanitizer than in the rest of the city, and started working to get those to people in his community.
Now as he tries to get his 93-year-old grandmother vaccinated, he sees the same problem.
“Whatever happened with PPE is happening with the vaccine: disparities, inequalities. It’s not a balanced approach,” Gomez said.
For example, Gomez pointed out that while the state has given priority to nursing home residents for vaccination, many Hispanic families care for elderly relatives at home.
“Our abuelitos live with our families, not in nursing homes,” he said. “And they forget about that.”
On Wednesday, lawmakers voiced similar concerns in a letter to Gov. Greg Abbott, written by state Rep. Vikki Goodwin, D-Austin, and co-signed by 37 other Democratic House members.
“A cursory glance at my local map of vaccination locations suggests that providers are much less concentrated in areas that have a higher percentage of minority residents,” Goodwin wrote. “I ask that you take special care to distribute opportunities for vaccination widely and with an eye toward making them equally available to all Texans regardless of racial or ethnic background.”
DSHS has announced that it will be sending vaccine shipments to large vaccination hubs next week. Spokesperson Chris Van Deusen said the focus during the first weeks of the vaccine effort was on health care workers and residents of long-term care facilities, but in the upcoming phases of distribution they will diversify the type of providers for the vaccine.
“We’re also going to be in a position to allocate more vaccine to providers like local health departments and community clinics that often serve diverse populations,” he said in an email.
Dennis Andrulis, a professor at the UTHealth School of Public Health in Austin, said health officials should actively search for places like churches or community centers, which have been used as coronavirus testing sites, as vaccine distribution sites in underserved communities.
“Recognizing the historic absence of science or health care services in these areas is paramount,” Andrulis said. “You may have to establish venues in a trusted place that people know to go to.”
Ramírez said health authorities also will have to work hard to gain the trust of communities of color. Although many are eager to get the vaccine, advocates said they do hear of people hesitant to get it, either because of a general distrust of government institutions or because of misinformation. Among Hispanics, anti-immigrant rhetoric and policies have contributed to these concerns, Ramírez said.
“Latinos have been really a big target for a lot of things, a lot of discrimination. And so now we're telling people, 'But now you can trust us and now we're going to give you a vaccine'?” Ramírez said. “We will have to dispel a lot of myths. We have to let people feel comfortable that they need to take the vaccine, because that's the only hope.”
There’s a similar mistrust within the Black community, where the collective memory of the Tuskegee experiment — in which Black Alabama residents with syphilis were left untreated and instead monitored to track the fatal path of the disease — contributes to a general distrust of institutions.
“There's still a distrust,” Prince said, who added that health and governmental institutions often "are not meeting the needs of Black and brown communities."
For Andrulis, these challenges have been overlooked during the rush to get vaccines to the public as soon as possible. He praised Operation Warp Speed, the public-private partnership started by the federal government to produce vaccines as fast as possible, but said that was just the first step in vaccinating people who are the most at risk of being hospitalized or dying from the virus.
“Texas needs to come up with a cohesive strategy to promote information, in a way where communities will accept that information, so that it is through trusted sources” such as religious and community leaders, Andrulis said.
Some Texas cities have announced plans to address the uneven distribution of vaccination sites. Dallas County is preparing a “mega COVID-19 vaccination site” in Fair Park to serve the southern part of the city.
In Harris County, where Houston is located, the county has only received 6,000 vaccine doses so far, while 224,000 doses have gone directly to providers like hospitals and nursing homes. Rafael Lemaitre, spokesperson for the county, said that they are working on a “multi-language media campaign” and are partnering with community leaders to limit the barriers for people of color, including undocumented people.
In a press conference on Wednesday, Stephanie Hayden, director of Austin Public Health, said they are trying to learn from previous experiences and are looking at vaccine distribution “with an equity lens.”
But experts and advocates aren’t convinced that those efforts will be enough to bridge gaps needed to serve communities of color.
“COVID-19 and the issues around access to care and the distribution of vaccines is something that is historically embedded in inequity,” Andrulis said. “With the way that has played out in the past, is there any reason to think that the patterns of inequities and access to treatments and access to care will change? So far I think the jury is out.”
In the meantime, Omar Gomez will keep trying to find the vaccine for his grandmother, but he knows that he and his community might have to wait even longer.
“People need to be patient and keep being safe. Vaccines are coming and they will be better for us,” he said. “We need to keep believing in science and in facts.”