WASHINGTON — Minority groups hit hardest by COVID-19 were not included in the recent guidance for booster shots, but the White House says the eligibility list is broad enough that anyone in those communities at heightened risk for infection can easily get another vaccine dose.
The guidance on booster shots that the Centers for Disease Control and Prevention released last week was written in a way that any adult seeking a third dose of the Pfizer-BioNTech COVID-19 vaccine can get it.
“People are going to be able to provide self-attestation to the pharmacy or wherever they choose to get vaccinated,” Marcella Nunez-Smith, chair of the White House COVID-19 Equity Task Force, said. “It is therefore up to that individual and their decision making if they want to, in consultation with a provider, to think and weigh their potential risk and exposure.”
“I think being able to have broad eligibility and broad access for people is going to ensure equity,” Nunez-Smith said in an interview with McClatchy.
The CDC said last week that individuals who are age 65 and older, work in certain occupational settings or have serious health conditions can get a booster. It’s updated guidance made no mention of race or ethnicity.
The federal government came under scrutiny early in the inoculation process for not prioritizing vaccinations for racial and ethnic groups that were contracting the coronavirus at alarming rates. Medical professionals are debating whether vaccinated individuals in those communities should be directed to receive booster shots now.
Doctors who argue that the CDC should prioritize race in the same way as age in its booster shot recommendations say vaccinated minorities younger than 65 are disproportionately at risk for coronavirus exposure because they are more likely to live in crowded dwellings, work in frontline occupations, use public transportation, be in a lower-income bracket and have limited access to quality health care.
“Race is being implicated, even in the occupational setting, so why not just be very direct and have race be one of the eligibility criteria, because of the impacts of racism,” said Dr. Chris Pernell, a public health physician and a fellow of the American College of Preventive Medicine.
Nunez-Smith said communities of color have been disproportionately affected by COVID-19 because of those underlying social realities, however the data on race and COVID-19 does not show that specific minority groups have a predisposition to contracting the coronavirus.
“This is not a biological phenomenon, in the way that age, for example, is,” Nunez-Smith said.
“And so the Biden administration, the FDA and the CDC, to me very much followed the data out there in terms of equity, and where we need to be by saying, we’re going make sure there’s eligibility and access for people with chronic conditions, and for people whose work or living situation are going to put them at high risk,” she said.
Other Black doctors who spoke to McClatchy agreed and said the CDC’s current eligibility list covers people in minority communities who are most at risk if they develop a breakthrough coronavirus case.
One pointed out that in introducing the new guidance, CDC Director Rochelle Walensky said access and equity were part of her decision to expand the list of people who could get a booster shot to include occupational settings such as schools and grocery stores.
“I don’t think that’s enough. It’s never enough to have a passive action plan against racism,” Pernell said. “It’s great that access is increasing, vaccination rates are increasing, I applaud many of those efforts by the White House, but we have to be more direct around how destructive and how pervasive racism is as a system of structuring opportunity that then drives health and life outcomes.”
DOCTORS PUSH FOR MORE DATA
Breakthrough cases of COVID-19 in vaccinated individuals are not known to be occurring at higher rates in a specific race or ethnicity group, doctors who have reviewed the available information say. However, they say they want to learn more about the studies the CDC based its recommendations on.
“I have not been able to find a difference in vaccine effectiveness, broken down by race,” said Taison Bell, director of the ICU at UVA hospital. “But I am unhappy and frustrated with a lack of data.”
Bell said the advisory committee to the CDC did not spend enough time on race and ethnicity during the presentation in which it explained its booster shot recommendations last week.
“That should be on the forefront of our minds when we’re trying to discuss this data, and it should have taken up real estate on the slide presentation so that it’s all out there and we can kind of see this data and look at it apples to apples,” he said.
Other Black doctors said they would also like to see more data on the race and ethnicity of vaccinated individuals who have tested positive for the coronavirus and receive greater clarity from the CDC on why it advised booster shots for workers in some occupations but not others.
Dr. Oni Blackstock, a primary care and HIV physician who founded the health equity consulting group Health Justice, said that confusion around who should get boosters “further engenders mistrust” in communities that were wary of the vaccines in the first place.
“We’ve done so much to get folks their initial doses, and so I would just want to make sure that we just have more data to support some of these recommendations,” she said.
Doctors are concerned about the number of people in minority communities who have not received an initial coronavirus vaccination shot. Those individuals often have unequal access to health care and are more likely to have underlying health conditions.
More than 20 percent of adults in the United States have not received their first dose of a coronavirus vaccine, despite widespread availability and free access.
“That’s the most important sort of group to be sure that we’re connecting with, reaching out to, those who are unvaccinated,” Nunez-Smith said.
Only recently, after targeted investments and a lengthy campaign, was the Biden administration able to bring vaccination levels in minority communities in line with other populations.
“There hasn’t been, I think, sufficient opportunity for many individuals to get their questions answered,” Dr. Ray Bignall, a pediatric nephrologist at Nationwide Children’s Hospital, said. “There’s been a lot of mixed messaging that they’ve heard both from government officials and from fellow community members that just made it very challenging for folks to feel confident about the advice that they’ve received.”
“Certainly that’s frustrating for people like me who are part of the public health workforce, and have been speaking with one voice, about the value and importance of vaccines,” Bignall said, “but it is a struggle that we have to be committed to addressing, day by day.”
Bell said he worries after seeing the CDC advisory committee’s presentation that telling unvaccinated individuals they should get a third shot, regardless of their potential for exposure, would only serve to further harden their resistance to being inoculated.
He referenced a survey the advisory committee presented, in which a third of unvaccinated individuals said booster shots would make them less likely to get vaccinated.
“The booster conversation is important to have, but it should not be our priority, when it comes so what is the most important thing for the health of communities of color right now,” Bell said. “It still continues to be the most important priority to make sure that we’re getting folks first and second doses rather than third doses right now. And we don’t want to take our eyes off the ball right there.”
