Vaccination of minority populations continues to lag

When Clifton West learned that there was a surplus of vaccines in Strafford County, he promptly went into fire-drill mode. He made calls, sent text messages, composed emails – any method he could think of to get the word out.

“It was like, oh my God, okay, we have to get people there,” he said.

West is the co-founder and executive director of the Seacoast Black Lives Matter chapter. He is intimately familiar with the data in both New Hampshire and across the country showing the disproportionate impact that COVID has had on Black communities. And he knows that white residents of New Hampshire get vaccinated at twice the rate of communities of color, according to the state’s most recent data.

West got the call to mobilize at 6 p.m.; by the next day, his flurry of communication paid off in Strafford County’s first vaccination clinic, held at Dover High School, that specifically sought out participants who were Black, indigenous or people of color. More than 50 people were vaccinated at that clinic, West said.

That was in February. Since then, West has continued working with the Strafford County Public Health Network to connect people in his community with vaccines – through two clinics that were organized to reach those who are Black, indigenous, and people of color, or when there’s a surplus of vaccine at other area clinics.

For West, the main priority has been figuring out how communities of color can access the vaccine. It makes a difference when someone who can speak your language or who looks like you is there to help you through the process, he said.

“Really that starts with trying to figure out who are these community leaders who can do this quick outreach,” he said.

Ten percent of vaccines are set aside to reach these populations, according to the state vaccination plan. Those vaccines are allocated to regions where minority populations live, based on census data. And the plan calls for culturally aware messaging to be used to reach populations that may be hesitant to get the vaccine.

But these efforts have failed to reach some communities entirely. Indigenous leaders in the state say they have been left in the dark about the vaccine allocation.

And even community leaders like West say the state has been slow to release key data about where the vaccine has been distributed and where there are still gaps. Without having a breakdown of information by town or city, West said, it’s impossible to know where to target efforts.

“Right now, we’re kind of guessing,” he said. “Trying to get this data from the state has been like pulling teeth.”

‘If I had known’

Rhonda Besaw, a speaker for the Abenaki Nation of New Hampshire, said she was unaware of any outreach to native communities or other marginalized communities in the state.

“If I had known about that, I would have told other people who I know have been waiting,” she said.

Five or six members of her tribal family under 60 years old were waiting to be eligible based on their age bracket.

“They were on the phone trying to call to get in as soon as they could to get the shot,” she said. But “they didn’t know anything about people of color being able to get the shot.”

Other indigenous community leaders have had a similar experience. They say that the state has been silent about the 10 percent “equity allocation” of the vaccine.

“I don’t know of any outreach to the BIPOC community,” said Paul Pouliot. His wife, Denise Pouliot, serves on the state Commission for Native American Affairs, but she hasn’t heard anything about outreach efforts either.

“We’re not sure what the state is doing,” he said. “We’re frustrated. They mean well, but they don’t carry through.”

The most recently released data shows that vaccine coverage of nonwhite residents of New Hampshire is only half that of the white population.

Earlier this month, the White House announced a $4 billion investment to fight COVID-19 in Indian Country. Indian Health Services will receive money from the American Rescue Plan to expand vaccinations, testing, and treatment. But since tribes in New Hampshire don’t have federal recognition, they can’t receive health care through Indian Health Services.

American Indians and Alaska Natives are 1.6 times more likely to get COVID than the non-Hispanic white population, according to a CDC report. And they are 3.5 times more likely to be hospitalized as a result of COVID.

In a press conference Thursday, Gov. Chris Sununu said the state is still focused on populations that don’t have the best access to health care, like people who are homeless and those who are homebound. He called efforts to reach these populations “phenomenal.”

So far, 236 clinics are classified under the equity allocation, said Dr. Beth Daly, the chief of the Department of Health and Human Services Infectious Disease Control. More vaccines go to the regions in the state where more of the vulnerable populations are living based on the census tracts.

But Besaw said that census data in the state is woefully inaccurate when it comes to indigenous people.

“You can take your census report and throw those out the window,” she said. In part, that’s because many Abenaki people are hesitant to self-identify for fear of discrimination.

“People want their children to fit in and not get beat up on the playground,” she said.

Plus, there’s mistrust of providing information to the government, which institutionalized and sterilized indigenous people during the eugenics movement of the 20th century.

“It hasn’t been safe historically to be an Indian person,” Besaw said. Now, “we are invisible.” She called it hiding in plain sight.

According to Daly, equity allocation clinics have been held in all of the state’s counties, vaccinating 23,000 people. That’s a little under 7 percent of the 338,000 people vaccinated in the state, still falling short of the 10 percent allocation.

Daly said she expected the gap in vaccine coverage along the lines of race and ethnicity would close as vaccination opens up for younger people.

“Our population in New Hampshire is more diverse the younger you get,” she said.

Sununu said that while there was interest in providing race and ethnicity data by age demographic, “we have not done that.”

“That’s a challenge,” he said.

But Rep. Manny Espitia, a Nashua Democrat, said the state could be doing more to get the word out about opportunities to get vaccinated. He pointed to states such as Rhode Island that are posting public messages about open vaccinations slots.

“We need to be public, and we should be out there hustling for this,” he said.

Partnering with local organizations has worked, Espitia said, but that’s done on a local level, a strategy that has worked well in some areas of the state and left holes in others.

Vaccine hesitancy?

The state’s plan around culturally aware messaging was meant to address vaccine hesitancy.

“This includes acknowledging the unethical past of scientific experimentation in the U.S. on Black, Hispanic, Indigenous, and incarcerated populations, among others, that has resulted in vaccine hesitancy, fear and distrust of public health/government systems,” the plan reads.

But Espitia said public officials shouldn’t use vaccine hesitancy as an excuse for inequities in the vaccine rollout. He said structural issues are at play: People want the vaccine, but they can’t always access it because they’re unable to take a day off of work or they don’t have transportation to get to a clinic.

“Black and Latin and Asian Americans are saying on polls, we’ll take it at the same levels that Caucasian and white Americans are,” Espitia said.

“Most people of color don’t necessarily have the means and the access. That’s why we’ve seen these disparities.”

West says he’s encountered a little bit of both. Some people he speaks with are hesitant, especially now that the Johnson & Johnson vaccine has been paused after six women developed an extremely rare case of blood clotting after getting the vaccine. For others, it’s structural barriers that are getting in the way: not having access to the internet, language barriers, or not being able to take off work.

Some indigenous leaders in the state have taken a wait-and-see approach.

Besaw, who is 66, has long been eligible for a vaccine based on age alone, but for now she prefers to stay at home. She said she appreciates that others in the community are getting vaccinated, and that makes her feel more protected, but she hasn’t decided if or when she’ll get the vaccine herself.

“I’m not quite sure. I’ve talked with some other elders and we’re waiting to see what’s going to happen with the Johnson & Johnson vaccine now,” she said. Of all the vaccines, that was the one she felt most comfortable with because the technology was more similar to that used in the flu vaccine.

Besaw said some vaccine hesitancy could be linked to the government’s past mistreatment of indigenous people in the area.

“If government says you have to have a shot, you’ll have people who say the government wasn’t so good to my grandmother. They put her in an institution. They sterilized my aunt,” said Besaw.

And Paul Pouliot expressed reservations as well. Like Besaw, he said he has chosen to stay home and self-quarantine “until everybody else has got a chance to get the shot that really needs it.”

“We’re still questioning the efficacy of the vaccine,” he said. The Pfizer vaccine has been shown to have 95 percent efficacy, Moderna is now estimated to be at 90 percent, and before it was paused, Johnson & Johnson was at 72 percent overall efficacy and 86 percent efficacy against severe cases.

“I’m not saying we’re anti-vaxxing, but there’s some concerns,” Pouliot said.

Clearly, there have been critical gaps in the state’s plan to address those concerns. In the state, there are currently 120,000 doses of the vaccine available. On Monday, the state will open vaccine appointments to everyone over the age of 16, regardless of residency.