Millions of people are pinning hopes for a return to normal on a COVID-19 vaccine as cases and deaths continue to mount in Georgia and the U.S., but public health officials have work to do to make sure communities hit hardest by the virus have access to treatment.
Two potential vaccine candidates are showing promising results in preliminary tests. On Monday, Moderna Inc. announced its two-dose trial vaccine was 94.5% effective in a clinical study.
“This is a pivotal moment in the development of our COVID-19 vaccine candidate,” said Moderna CEO Stéphane Bancel. “Since early January, we have chased this virus with the intent to protect as many people around the world as possible. All along, we have known that each day matters.”
Another vaccine series from Pfizer Inc was found similarly effective last week. Both companies are asking the Food and Drug Administration to be able to begin shipping the vaccines under an emergency use plan.
Pfizer expects to produce up to 50 million doses in 2020 and up to 1.3 billion in 2021, while Moderna has said it expects to have about 20 million doses ready to ship this year and another 500 million to 1 billion doses in 2021.
But with more than 10 million Georgians to prioritize, how will the people who need the medicine most get it quickly?
States including Georgia sent draft plans to the Centers for Disease Control and Prevention last month, but those are still works in progress and missing important details, including the cost, expected to be in the billions of dollars.
Another critical detail left out is how the plan will deliver vaccine doses to the people most susceptible to the virus, including racial and ethnic minorities, said Georgia State University public health professor Dr. Harry J. Heiman.
“It’s striking that as much as we continue to talk about vulnerable populations and prioritizing vulnerable populations, there’s no specific mention of racial and ethnic minority communities that are being disproportionately impacted and strategies particularly targeted to engaging those communities about messaging and communicating to them in a way that is culturally and linguistically appropriate,” he said.
The state’s vaccination distribution plan was released last month and last updated Nov. 6, before the recent announcements of vaccine breakthroughs, and will be continually updated, said Georgia Department of Public Health spokeswoman Nancy Nydam.
“There are still many unknowns about the vaccines and we will continue to revise the plan as additional vaccine guidance and information becomes available,” she said.
Among COVID-19 patients in Georgia with ethnicities known to public health officials, 17.7% were Hispanic or Latino, according to state data. According to U.S. Census data, 9.9% of Georgia residents are Hispanic.
Hispanic and Latino Georgians, especially immigrants and non-English speakers, have been disproportionately affected since the start of the crisis, said Gigi Pedraza, executive director of nonprofit Latino Community Fund.
“Since the beginning of the pandemic, we haven’t really necessarily seen intentional design around the most vulnerable communities, which, for us, are immigrant communities, communities with different types of status, different types of documentation and that are also English learners,” Pedraza said.
In the beginning, Georgia’s COVID-19 hotline was only available in English, as were most of the testing sites. Others were afraid getting tested would put their personal information including immigration status in government hands.
Other hurdles to connecting vulnerable communities with vaccines when they’re available include a digital divide and a lack of medical infrastructure in places with predominantly poor and minority populations.
It’s important to remove as many of these types of barriers as possible for the state’s vaccination distribution plan, not just for the people in vulnerable communities, but for the state as a whole, said Dr. Michelle Au, a physician and state Senator-elect representing a northern suburban Atlanta district.
“When vaccination levels in the community fall below a certain threshold, like below 90ish percent, we start to see holes in these walls of defense that people can get sick, and it exposes the whole community to vulnerability for catching this virus,” she said. “So the challenges in vaccine distribution are not just coming up with a vaccine and distributing it, but also getting enough people to buy into the vaccine and take it.”
The Latino Community Fund offers testing in areas with high immigrant populations and finds success by meeting people where they are, Pedraza said. That means recruiting bilingual volunteers from the area, offering no appointment, walk-up service and making it clear patients’ privacy will be respected.
“When you have undocumented folks that are unable to drive in Georgia, any effort whether it’s food distribution or testing that is only drive-through, you’re literally asking them to break the law to be able to get food or get testing,” she said. “So for us, walk-in, no appointment required, was really important, having people from the local community that speak language, and then not asking any information that’s not needed.”
The state could borrow ideas from the Latino Community Fund when it comes time to distribute the vaccine, Pedraza said.
For example, the final draft should include a plan to get critical information people need to know to them in a language they can understand, she said.
“The language access and literacy level are really important,” Pedraza said. “There needs to be some type of language that makes sure to let people know that people without insurance are welcome to receive the vaccine. A lot of the language is usually done so there is not any clarification on if you don’t have insurance and are unable to get insurance, what’s going to happen to you.”
State health department leaders should map out Georgia’s communities and send resources to areas where racial and ethnic demographics suggest heightened risk, Heiman said.
“We need to think about targeting those populations at the population level, rather than strictly thinking about risk in terms of age and chronic disease and long-term care settings,” he said. “It’s not that we don’t want to do that, we need to be doing both of those things, but it’s that population and community level risk that really doesn’t seem to be addressed hardly at all in the draft plan our state has put together.”
The final plan should also take into account peoples’ distrust of government officials and spell out methods to get buy-in, Au said.
“Already these communities have difficulty accessing health care in a way that we think is accessible, because it’s already baked into the medical system that access is more difficult,” she said. “So I would like to see specific community outreach, I’d like to see engagement of community leaders in order to get buy-in for the vaccine to be higher, because, with some good reasons, sometimes, communities of color are a little bit distrustful of the medical edifice, they maybe don’t know as much about this vaccine. There’s been a lot of politicization around vaccine development.”