COVID-19 Health Equity

Both Pfizer and Moderna required that the studies include volunteers who are high risk, have an underlying condition (like diabetes or obesity) or belong to specific racial and ethnic groups.

In Phase 3 clinical trials, large groups of trial participants tested the safety and effectiveness of the vaccines. Those groups included diverse volunteers:

• For Pfizer, out of more than 37,700 participants, 9 percent were Black or African American, 28 percent were Latino and 21 percent had at least one underlying health condition.
• For Moderna, out of the 30,000 participants, 20 percent were Latino, 10 percent were Black/African American and 25 percent were 65 or older.
• For Johnson & Johnson, there were 43,783 trial participants worldwide. Of those, 44 percent of the participants were in the United States. Of U.S. participants, 15% were Latinx/Hispanic, 13% were Black/African American, 6% were Asian, and 1% were Native American. Forty-one percent of participants in the Johnson & Johnson trials had comorbidities associated with an increased risk for progression to severe COVID-19.

While COVID-19 impacts different groups disproportionately, the trials found  no difference in how effective the vaccines are across different demographics.

No, there is no experimentation. This is a valid concern, and it is important to recognize why there is mistrust and hesitancy. Black and African American communities have suffered a long history of ethical violations and injustices. These injustices still affect health outcomes in some medical settings to this day.

The COVID-19 vaccines were studied across diverse and high-risk populations, all of whom bravely volunteered to participate, and the safety and effectiveness have been proven.

Health equity means that everyone has a fair and just opportunity to be as healthy as they can be. It means empowering community voices to guide and drive decision-making and to help us better understand and address barriers.

Health disparities are differences in health outcomes that are closely linked with social, economic and environmental disadvantage. Health disparities are often driven by the social conditions in which individuals live, learn, work and play.

The five key topic areas of social determinants of health listed below contribute to racial and ethnic minority groups being disproportionately affected by COVID-19. Discrimination, which includes racism and associated chronic stress, influences each of these key topic areas.

• Neighborhood and Physical Environment
  People from racial and ethnic minority groups are disproportionately affected by difficulties finding affordable and quality housing. This may limit their housing options to neighborhoods and residences with mostly other racial and ethnic minority groups, crowded conditions, and that lack access to reliable transportation. These conditions may make illnesses, diseases, and injuries more common and more severe, when experienced. In addition, access to nutritious affordable foods may be limited, and they may experience more environmental pollution within their neighborhoods. In some cultures, it is common for family members of many generations to live in one household, which could lead to exposure for older adults who are at increased risk for severe illness from COVID-19.
• Health and Healthcare
  People from racial and ethnic minority groups are disproportionately affected by lack of access to quality health care, health insurance, and/or linguistically and culturally responsive health care. Inequities in treatment may result in distrust of government and healthcare systems. Such barriers increase risks for poor health and health outcomes by limiting health promotion, disease and injury prevention, and condition management activities.
• Occupation and Job Conditions
  People from racial and ethnic minority groups are disproportionately represented in essential work settings such as healthcare facilities; farms; factories; food production and processing; grocery stores; and public transportation. People who work in these settings have more chances to be exposed to COVID-19 because these types of jobs require frequent or close contact with the public or other workers, involve activities that cannot be done from home, and may lack benefits such as paid sick days.
• Income and Wealth
  People from some racial and ethnic minority groups have lower incomes, experience barriers to wealth accumulation, and carry greater debt. Such challenges may make managing expenses, paying medical bills, and accessing affordable quality housing, nutritious food, and reliable childcare difficult.
• Education
  People from racial and ethnic minority groups are disproportionately affected by inequities in access to high-quality education which can lead to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. In addition to educational barriers, limited access to quality job training or programs tailored to the language needs of some racial and ethnic minority groups may limit future job options and lead to lower paying or less stable jobs.

These factors may increase risk of COVID-19 exposure, illness, hospitalization, long-term health and social consequences, and death. To stop the spread of COVID-19, we need to ensure resources are equitably available for everyone to maintain physical and behavioral health. Resources include easy access to information, goods and services, affordable testing, and medical and behavioral health care that are all tailored to meet the needs of people from diverse communities.

Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policy makers, and others all have a part in helping to promote fair access to health. 

We need programs and practices that fit the communities where people live, learn, work, play and worship.

• Here's "What we Can Do" from CDC: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/what-we-can-do.html
• Strategies CDC: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/cdc-strategy.html
• Resources AMA: https://www.ama-assn.org/delivering-care/health-equity/covid-19-health-equity-resources
• Webinars and resources APHA: https://www.apha.org/topics-and-issues/communicable-disease/coronavirus/equity

The Colorado Vaccine Equity Taskforce exists to ensure that all groups – regardless of race, ethnicity, ability and other factors – have all the facts to make informed decisions about the safety of vaccines for their families, and to hold leaders accountable for ensuring access to these vaccines for all. Taskforce members represent a diverse collection of Coloradans working to ensure all communities have all the facts to keep their families healthy.

• Setting aside 10 percent of vaccines for distribution through CDPHE and the Governor's Office Equity Task Force.
• Reducing health inequities in Colorado by providing vaccine to the most vulnerable communities and vaccinating 70 percent of eligible citizens in these communities.
• Opening a community-based clinic in 50 percent of the top 50 Census tracts for high-density of low-income and minority communities. 
• Strengthening community partnerships in the fight against COVID-19.
• Increasing public trust in the COVID-19 vaccine and the agencies that provide it.

President Joe Biden has ordered the federal government to pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality. Affirmatively advancing equity, civil rights, racial justice and equal opportunity is the responsibility of the whole of our Government. Because advancing equity requires a systematic approach to embedding fairness in decision-making processes, executive departments and agencies must recognize and work to redress inequities in their policies and programs that serve as barriers to equal opportunity.  

The Federal Government’s goal in advancing equity is to provide everyone with the opportunity to reach their full potential. Consistent with these aims, each agency must assess whether, and to what extent, its programs and policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups. Such assessments will better equip agencies to develop policies and programs that deliver resources and benefits equitably to all.  

Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government

U.S. Department of Health and Human Services Office of Minority Health