Lady Business: Vaccines, racial equity, and Pennsylvania’s rocky rollout
Hello, and welcome to Lady Business, a newsletter about women, the business world, and all the ways they overlap. You can sign up for Lady Business and read previous issues here. This is the 126th issue, published April 11, 2021.
Penn Problems
I have a somewhat personal feature in the new issue of Fortune, or at least another entry in my unofficial Pennsylvania chronicles. This one is about my home state’s extremely rocky vaccine rollout, the various entities trying to fix it, and how the Keystone State’s struggles to equitably and efficiently distribute its COVID-19 vaccines reflect similar problems across the nation:
Pennsylvania’s rollout problems have mirrored those of many other large, racially and socioeconomically diverse states as they navigate a massively complex process. The national effort has required unprecedented coordination among a mismatched team of players, including a federal government that squandered months in an acrimonious presidential transition; cash-strapped state and local governments; and a patchwork of big health care providers, small clinics, and Fortune 500 pharmacy and grocery chains sorting through changing—and often conflicting—distribution and eligibility rules.
Still, Pennsylvania’s campaign has stood out for its problems, some of which are self-inflicted. … “The fact that there’s not a centralized process across the state means that you’re really depending on each individual organization doing their own thing and hoping that it works,” says Tracey Conti, a member of the Pittsburgh-based Black Equity Coalition and program director of family medicine at the UPMC McKeesport health care system. “It creates a lot of unknowns—and a lot of frustration.”
The first seeds of this story began with my personal frustration and impatience about how difficult it was, back in January and February, to find vaccine appointments for my eligible parents. So I started paying attention to the data, which at one point in late January showed that Pennsylvania was ranked 49th out of all states, beating only Alabama, in distributing its available vaccine supply. I also started paying attention to local news stories about all the problems with the state’s vaccine rollout, including the Philly Fighting COVID meltdown that made national headlines.
That startup-implosion story highlighted many of the racial-equity issues that governments and vaccine providers across the nation still aren’t doing a good job of addressing. The CDC demographic data on who’s been vaccinated so far is incomplete but illuminating: Black and Latinx people account for more than 13% and 18% of the U.S. population, respectively, but only 8% and 11% of those who have been vaccinated.
This can’t be blamed entirely or even largely on vaccine hesitancy, which is decreasing among Black Americans. It’s more a question of access—and the massive health care disparities that have become so obvious over the course of the pandemic. As I found in my reporting on Pennsylvania:
In Philadelphia, whose population is 44% Black, the inequities are just as stark. Rite Aid, the pharmacy chain based in Harrisburg, Pa., is one of the city’s dominant distributors, with an online registration system that’s theoretically equally open to all residents. In late March city government data showed that 83% of Rite Aid’s vaccine recipients were white, and that the pharmacy had inoculated nearly 11 white people for every Black person who received a shot. One problem: More than half of Rite Aid shots went to suburban residents who drove into the city—which is permissible under state guidelines.
A Rite Aid spokesperson says the company has increased the share of vaccine doses going to Black Pennsylvanians within the past month, and is “working tirelessly to overcome the many disparities” that cause vaccine inequity. Some factors are indeed outside its control, like the suburbanite invasion—which also illuminates some of the reasons why authorities nationwide are flunking vaccine equity. Black and brown people are more likely to be lower-income and less likely to have access to health care providers who can steer them into the vaccination pipeline. They’re also more likely to work in “essential,” non-remote jobs. All those factors create barriers to getting vaccine appointments through systems that privilege people with Internet access, the ability to work from home, and the free time to refresh scheduling websites multiple times a day.
To overcome these disparities, “it’s not enough to say, ‘I put a link out on a county website,’ where it was in essence buried,” says Ala Stanford, the pediatric surgeon who founded Philadelphia’s Black Doctors COVID-19 Consortium. Since January, her nonprofit has vaccinated more than 30,000 Philadelphians; more than 80% of the recipients are people of color. The organization runs walk-up clinics that administer shots only to residents of specific zip codes (usually those hardest-hit by COVID). “Everyone acknowledges the health disparities. And everybody talks about it—but no one makes an active plan,” Stanford says.
The state government is trying to do so. “I absolutely agree that we need to make inroads on equity,” Pennsylvania acting Health Secretary Alison Beam told me, adding that the state is working to increase its share of vaccines going to providers who can reach underserved populations.
So Pennsylvania is hardly alone in facing these issues. And its vaccine-distribution numbers, and rankings, have improved significantly since I started reporting this story. But its experience, as one of the country’s most populous states and the one with the fifth-highest death toll from COVID, illuminates the equity problems that are continuing to plague the vaccine rollout nationally—and that can’t be fixed, anywhere, without a lot more people making many more active plans.
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