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A Public Health Success Story


The Covid mass vaccination program in the US began on December 14, 2020, when a nurse at a hospital in Queens, NY, received a shot on live television.

But more than two months later, a large health clinic is based in North Birmingham, Ala. – which focuses on lower-income Black and Latino residents – has yet to receive a single dose of the vaccine. The clinic, Alabama Regional Health Services, was unable to administer the injection because it did not receive any injections from the state supply.

The reasons are a matter of dispute. Alabama officials insist that other Birmingham clinics pre-registered, depleting the initial supply. However, some officials in North Birmingham believe the state’s white, Republican leadership is ignoring non-white Democratic neighborhoods.

Chris Mosley, the clinic’s outreach supervisor, told me, “The long and short part of it, tell me,” is that Black neighborhoods don’t have vaccines and white areas don’t. yes. “

Birmingham may be an extreme case, but it is also part of a stereotype. Around the United States, many Black and Latino communities have limited early access to a Covid vaccine. Lack of access – combined with greater hesitancy about vaccines among some people of color – contributed to the racial gap in vaccination and, by extension, Large racial gap in mortality in Covid.

In today’s newsletter, I want to tell you the story of what happened in Birmingham, as a way of looking back at the larger issue of Covid and race.

In late February 2021, Mosley was able to use his political connections to warn the Biden administration about his clinic lacks a vaccine. His plea for help came as White House aides, then in their first weeks in office, were looking for ways to close the racial gap in vaccinations. “The natural social history of many diseases is that they tend to be unequal, unless you deliberately fight it,” said Dr Cameron Webb, a pandemic adviser to the Biden administration.

The Trump administration seems uninterested in combating those inequalities, leaving it up to the states. President Biden makes closing the gap a top priority. Ron Klain, White House Chief of Staff, told me: “We have built our Covid response with fairness at its heart.

The administration has shipped some doses of the vaccine from the state stockpile directly to public health clinics. It created an interagency working group to spread successful ideas. It located federal clinics in Black and Latino neighborhoods. It also helps local organizations set up church clinics, barbershops and beauty salons. “In more affluent communities,” Webb said, “people have a choice about where they feel confident getting vaccinated.”

As Mosley said, “People will call me and say, ‘I heard you got the vaccine there. Can we get some? “

In the spring of 2021, several months after the mass vaccination program, white Americans were more likely to have been vaccinated than black or Latino Americans. By the end of 2021, the Hispanics will be higher than the whites, and the blacks will be almost as high as the whites, According to CDC As a result, the racial gap in mortality has also disappeared.

That disappearance is arguably one of Biden’s greatest achievements — one that would not have happened, obviously, without the passionate advocacy and hard work of many public health officials. In a country with deep racial inequalities, where the original Covid was another tragic example, this virus no longer disproportionately harms black and Hispanic Americans.

However, this achievement continues to receive relatively little attention. Why so?

My first time writing about the reversal of the racial gap in June and that newsletter uncomfortable some healthcare professionals. Surname believe I made the mistake of focusing on overall mortality rather than age-adjusted rates. And there is a fair debate about when to emphasize each one.

Mortality is generally the main way to much organization (including The Times, on Vivid Dashboard, and CDC, in its annual mortality reports) describe the number of illnesses. This rate provides a census of people who are about to die. If the death rate of one group is higher than that of the other, it means that the victims of that disease came from the first of the two disproportionate groups.

But age-adjusted rates also have advantages. It effectively compares the number of diseases with its expected number of diseases based on the age profiles of different groups. For that reason, the CDC mortality report also includes age-adjusted tables — just behind the overall tables — for each cause of death. Because white Americans are on average larger than black or Latino Americans, and because most diseases affect older people more than young adults, age-adjusted rates tend to show greater racial gap.

If this statistical detail gives you a headache, I have some good news: It doesn’t affect the main conclusion about Covid and race. By both aggregate and age-adjusted measures, Covid mortality rates for black and Latino Americans are higher than rates for whites in the early stages of the pandemic, and they are still higher than calculated. Accumulated. Recently, however, the patterns have changed and the proportions of Blacks and Latinos are no longer higher.

The overall The percentage of blacks and Latinos was generally lower than the percentage of whites for more than one year:

The Adjust for age This gap lasted longer, before narrowing earlier this year and finally being overturned. Since April, the age-adjusted rate for Latinos has been about 15 percent lower than the rate for whites. The age-adjusted Black percentage was roughly the same as the white percentage — with the Black percentage being about 1 percent lower — during the same period. (Asia rates have been the lowest in a long time.)

One reason is that the remaining unvaccinated Americans are Disproportionate Republicansand Republicans are disproportionately white.

Katelyn Jetelina, an epidemiologist who writes a popular newsletter tells me: “The inequality has largely dissipated in recent weeks and months, even after adjusting for age. “This is absolutely a public health success story: Targeted, local access and stakeholder engagement and investment can overcome decades of health inequalities.” .

However, if you hear a lot of public discussion about Covid, you may still be unaware of the changing racial gap. You may not know about a public health success story, with potential lessons for alleviating the country’s other stark racial inequalities – in income, House, education, Criminal Justice, medical system and many other realms.

There are even lessons for future Covid policy. Without continued effort, racial gaps could open up in rates of boost or access to Paxlovid, a drug that relieves Covid symptoms.

There seem to be many reasons why the Covid story has been largely ignored. In our polarized country, many conservatives are reluctant to call attention to any of Biden’s accomplishments. Meanwhile, many libertarians feel uncomfortable calling attention to any decline in racial or economic inequality, because they worry it will reduce problems. that subject. Some libertarians have also hesitate to talk about positive news of Covid, believe that the country is still too wrong about the virus.

But can admit the full picture. For all the suffering that Covid has brought, it has also become a case study that reminds us that racial injustice can sometimes be remedied.

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