Dr. Joneigh Khaldun has been knee-deep in coronavirus data for nearly a year. As the state’s chief medical officer and the chief deputy director for health for the Michigan Department of Health and Human Services (DHHS), she has weighed racial disparities, partnering with Lt. Gov. Garlin Gilchrist last spring to remove barriers related to race as the virus hammered the Detroit metro area.
“Good public health meets people where they are at,” Khaldun said last week.
Ingham County Health Officer Linda Vail agrees with that assessment and has been driving to make sure racial equity remains a priority as the county transitioned from testing to vaccination.
That is not what is happening nationally, however.
Black people make up 13.4% of the U.S. population, yet they accounted for only 5.4% of the vaccines administered during the first month, according to the U.S. Centers for Disease Control White people are 59.7% of the population and received about 60% of those first-round shots, according to the U.S. Centers for Disease Control and Prevention.
Localized data hasn’t yet been made readily available.
“When you look at the prioritization that had to happen first, it’s not surprising that when you look at a lot of communities right now that they are behind in basically vaccinating their people of color versus the white population because that is where they were guided,” Vail explained.
To move forward equitably and make sure that racial equity is front and center with vaccine distribution, Vail said the county works alongside an ethicist who specializes in the field. That ethicist is Jeffrey Byrnes, a professor of philosophy at Grand Valley State University.
“Those first tiers were really quite proscriptive. There wasn’t a lot of room for interpretation,” Byrnes said. “That requires us to think about who we reach out to and how we reach out to them. There’s sort of two categories: First is who is most likely to suffer from it. The second is who is most likely to encounter it. We have to take both into account.”
Since the beginning of the pandemic, COVID-19 has disproportionately impacted people of color — particularly Black people — nationally, statewide and in Greater Lansing. Vail said that’s because those communities are impacted by more issues that make them more vulnerable.
Such vulnerabilities can range from where people live and environmental impacts like coal-burning emissions to poverty, pre-existing conditions, food deserts and education disparities.
“All those together make for a more vulnerable population,” Vail added.
And that vulnerability, Khaldun said, is part of how the state is determining how many vaccine doses to distribute in Michigan’s 83 counties. The state uses the CDC’s Social Vulnerability Index (SVI). The tool establishes the social and environmental factors that create higher risks in any given community. The SVI is a scale of 0 to 1. Ingham County’s 2016 index, the most recent publicly available number, was .5715. That means Ingham has a moderate to high vulnerability.
Khaldun said those counties with higher SVIs receive more vaccines. In addition, each county is allotted a certain number for particularly vulnerable communities such as the elderly, people of color and people with underlying health conditions — like heart disease, diabetes and HIV.
Some GOP lawmakers have argued the metric shouldn’t be used. State Sen. Lana Theis (R-Brighton) sent Gov. Gretchen Whitmer a letter last week arguing it’s unfair to her mostly Livingston County constituents.
“It is my duty, and the duty of all elected officials, to ensure that Michigan addresses health care disparities in a way that doesn’t create further disparity. Instead of prioritizing COVID-19 vaccine distribution based on medical need, the state’s current method prioritizes bureaucratic social determinates to the detriment of tens of thousands of residents in my district,” Theis wrote.
Despite the drive for racial equity to vaccinate people of color, however, there is no way to monitor how well the state is reaching communities of color. Officials are building a data collection system to capture racial demographic data on those vaccinated, but it isn’t ready.
Vail said Ingham County has been collecting racial demographic data on vaccine applications. But because the state’s vaccine tracking database system does not collect that data, county officials do not have a clear picture of how racially diverse the distribution of vaccines has been.
Still, that’s not preventing the county from taking actions that they know will result in a deeper reach to more vulnerable populations, such as people of color. Vail said popup clinics can be used to specifically target those communities — like in Lansing ZIP code 48911, which is 28% African-American.
That south Lansing ZIP code also has the second-highest number of cases, after East Lansing’s 48823, which has been experiencing a Michigan State University student-driven outbreaks since August. ZIP code 48911 also became an early concern after outbreaks hit immigrants living in high-density rental communities — specifically those working at Herbruck’s Egg Farm and the Meijer warehouse in Eaton County. Targeted testing and interventions have since driven those case numbers down.
Byrnes said using ZIP codes acts as a starting place, but it isn’t necessarily fool-proof science.
“You have to use that ZIP code specific data to look deeper,” he said. “That means not just looking at the number of cases, but who has the cases. You make a decision about who is more likely to be harmed if they get it. That is not likely to be students.”
Byrnes said county vaccine distribution also has to compensate for the over-representation of white community members early on — as well as those who have jumped the queue, like the 200 city of Lansing employees who received early access to the vaccine last month.
Vail noted that communication errors revolving around Sparrow Hospital in Lansing allowing that misplaced city clinic to occur were a “mistake” that has since been discussed and resolved.
Byrnes also noted that the American health care model has led to a self-empowerment system that drives people to search out the best care. But they haven’t faced a situation where the care — in this case the vaccine — is in limited supply. That clearly creates new challenges, he said.
“It’s hard to wait in a line, but that’s what we have to do,” Byrnes added.
A version of this story originally ran in the Lansing City Pulse. Read the story here.