By: Shivan Lala
Black, Indigenous, and Latinx communities are disproportionately impacted by the COVID-19 pandemic, but there are policy solutions to ensure treatments make it to the most vulnerable populations. As researchers make headway in vaccine development, policies aimed at improving the vaccine supply chain and increasing healthcare access to vulnerable communities must be prioritized.
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While the consequences of the COVID-19 pandemic continue to unfold in unprecedented ways, the disease has been predictable in one respect: a disproportionate impact on racial and ethnic minorities in the United States. In New Mexico, 37% of COVID-19 infections (and 26% of the deaths) occurred in the state’s Native American community, although they only make up 11% of the population. Chicago’s African American community makes up 29% of the city’s population, yet accounts for 70% of the deaths, and Iowa’s 6% Latinx population makes up 20% of infections. Stark disparities are present across the US, as states such as Michigan, Washington, Wisconsin, and Louisiana report similar statistics that can be traced back to “historical and current practices of racism that cause disparities in exposure, susceptibility, and treatment”. While promising research is being completed by companies such as Moderna, CanSino and Inovio (a full overview of current vaccine candidates can be found here), developing the vaccine is not enough. To ensure the most adversely impacted communities receive these treatments in an equitable way, policy measures should focus on two areas – increasing the efficiency and efficacy of the vaccine supply chain and expanding healthcare access by minority populations.
Supply Chain Challenges Exacerbated by COVID-19
The vaccine supply chain refers to the non-research aspects of vaccine deployment, specifically the production, allocation, and distribution of a discovered vaccine. The typical challenges presented in this supply chain are only increased by the overwhelming global demand for a COVID-19 vaccine, thus requiring preventative policy intervention for an effective rollout. The main challenge relates to scaling to meet this demand. The United States is already weathering a shortage of specialized glass and stoppers (those that do not react with biological and chemical agents), whose demand will skyrocket once an effective vaccine has been developed. The standard response would involve international collaboration with the World Health Organization, but this is no longer possible given President Trump’s recent decision to terminate the United States’ relationship with the WHO. Regardless of future policy action aimed at improving the vaccine supply chain, re-establishing this relationship is paramount to reaching the global scale inevitably required to distribute a COVID vaccine.
The next step, then, is to expand federal and state efforts aimed at increasing manufacturing capability and quality. Luckily, federal programs such as Manufacturing USA and state programs such as Massachusetts’ Advanced Manufacturing Training Program and Connecticut’s Manufacturing Innovation Fund provide easily accessible blueprints for such action. Emphasizing similar policies and initiatives with a focus on vaccine-related supply manufacturing therefore represents a promising avenue to mitigate the consequences of glass and shopper shortages across the US. Policies should also focus on solving wide-ranging logistical challenges relating to storage, transportation, distribution, and maintenance. Solutions include embracing practices from UNICEF’s Cold Chain and Logistics Task Force, providing direct shipment to lower inventory management, and allocating resources to develop an IT infrastructure to prevent issues of duplication and complexity which normally hinder supply chains. Without policies that specifically address these issues, it will be impossible to adequately deliver a COVID-19 vaccine.
Disparities in Healthcare Access
The second pillar of equitable COVID-19 treatment access involves addressing structural racism in healthcare policy that affects the accessibility and quality of care in Black, Indigenous, and Latinx populations. The Hill-Burton Act, introduced in 1946, allowed for the creation of “separate but equal” healthcare facilities in the United States, laying the foundation for unequal access to quality healthcare for African Americans. The Civil Rights Act of 1964 attempted to remedy this issue, as Title VI specifically addresses quality healthcare access and nationally eliminated the “separate but equal” provision in Hill-Burton. However, the US Department of Health and Human Services does not apply Title VI of the Civil Rights Act to healthcare providers, which has important ramifications. Research has demonstrated that as African American populations in neighborhoods increase, rates of closure and relocation of hospital services also increase – directly and dramatically reducing access to healthcare. Additionally, there are many well-documented cases of interpersonal racism against African Americans in healthcare, leading to an overall poorer quality of care for African American patients when compared to White patients treated for the same illnesses. Without enforcing Title VI to include healthcare providers, the federal government permits this behavior and prevents providers from facing accountability. Therefore, long-term policy solutions should focus on expanding Title VI to include hospitals and other healthcare providers to directly mitigate disparities in quality treatment. In the short term, policies that aim to provide low-cost or free COVID treatment options in states that did not expand Medicaid must be prioritized (including legal protections such as preventing ICE enforcement in healthcare centers). By embracing these policies, the federal government can guarantee COVID-19 treatment is readily available to those who need it most – and take a step in the right direction of improving the structural issues that caused this disparity in the first place.
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