Oof. Data is starting to roll in on Covid-19 vaccine inequities this fall. And it’s not pretty. Access. Cost. Outreach. Education. All of these changed once the federal emergency ended in May. Vaccines are no longer purchased or distributed by the government, and funding ran out to support vaccine campaigns. This means the U.S., once again, faces the pre-pandemic privatized and fragmented healthcare and public health systems. And one could argue an even worse system, given the loss of trust.
As others have noted, I have not (yet) gotten this year's booster because I caught COVID and was told to wait 90 days before getting vaccinated; sadly, I tested positive on the day I was scheduled to get my booster, so instead of getting vaccinated, I got Paxlovid. I *will* get my booster around New Year's - and I have to wonder how many other people are in my situation and have not gotten boosted yet because of a recent infection, and how that impacts other vaccinations.
As my COVID began to clear up, I contacted my insurance company's advice line to ask when I could get my flu vaccine; it took 3 different people and 5 days to get a call back from my doctor's office, telling me I could get the vaccine any time I hadn't had a fever for 24 hours and felt well. I then began what would become a several month-long quest to get the RSV vaccine - I am under 60 by a couple of years, but immune compromised due to prior cancer treatment, and wanted all the protection I could get. This, also, took several phone contacts and several repetitions of why I wanted it - and why they couldn't approve it, because the CDC guidelines say "60+", with no mention of immune issues - but eventually, I ̶c̶o̶m̶p̶l̶a̶i̶n̶e̶d̶ advocated enough that it was kicked to the immunology department which approved it.
If I, as a reasonably well-education, middle class white woman with insurance that prioritizes prevention, have this much trouble getting vaccinations, I can only imagine what difficulties others, who don't have insurance, who may lack transportation, whose jobs may not give them the flexibility to go to clinics when the clinics are open, etc., may have getting them.
This is not inept government, but political capture by and for profit making corporations. This is an excellent demonstration that the market distribution of health services is inappropriate as Welsh family doc Julian Tudor Hart wrote in the LANCET in 1971.
Isn't it up to our government to balance the health of its citizens against corporate profit taking? Supplementing the cost of vaccines for those in need would be a win-win for both groups involved.
Yes that is a practical suggestion. However (1) it would be a band aid and subsidize pharma XS profits with my tax dollars and (2) the logistics and cost of identifying and validating those who qualify for subsidy (a model of federal vax policy now in place) is daunting, expensive and dysfunctional.
I really appreciate your meta-level approach to address the fundamental flaws in the system. It's ultimately what is needed, but it too is daunting and dysfunctional. Based on the data Katelyn presented, I would be OK with a band-aid to get us through the holidays.
Yes, I'm well aware. I'm old enough to remember when the right wing tried to stop the creation of Medicare because it was "socialized medicine" and therefore somehow Communist. I'm also old enough to remember when health insurance was a non-profit industry by law. That was before we came the Gaslit States of America.
I was remembering that part wrong. I was thinking about Blue Cross/Blue Shield in the early days. That's what I get for relying on my memory instead of looking things up.
It seems to me that a big part of why the UK is doing so much better in terms of the booster in older people is that the more vulnerable groups (older, immunocompromised etc.) are the only groups authorized to get the booster. Because the UK took a more targeted approach and better explained the underlying rationale, its citizens have more confidence in the public health edicts. Our country has really failed miserably in that regard.
I would like to offer that many this year did not get their vaccine because they came too late. I for one got COVID for the first time 2 weeks before I was scheduled to get my vaccine.
It doesn’t help that my parents’ primary care physician told them that the variants change so fast that the vaccine probably won’t do much good! What? They are in their upper 80s! Living in a retirement community. So frustrating. I pushed and so they are now finally getting it.
when you can't mandate/coerce people into taking these shots anymore, it turns out that the vast majority don't want them. Especially after "experts" lied about their efficacy and dramatically overstated the risk posed by the virus itself.
This post seeks to explain why vaccine disparities exist, and when it comes to race, the conclusion is “barriers” and “privatization” are to blame, not “hesitancy.”
While it’s likely this is partially true, there are many more factors at play. If they are not acknowledged, the unintended implication is the flawed view that Blacks and Latinx are incapable of making decisions that are in their own best interest.
Or to quote today’s top reader comment: “Americans remain stupid.” 🙄
I understand it’s not possible to address all these factors and nuances in a short post, but if Public Health has the wrong or incomplete set of theories as to why certain groups aren’t getting vaccinated, efforts to close the gap probably won’t work.
In effect he said that vaccines don't work and that the pandemic risk was grossly exaggerated. Nobody said there was no such thing as vaccine hesitancy. He is a troll. Don't encourage him or, by saying something in a better worded fashion, mislead those who think he's real. Also your own words "partially true" are subtly different but amount to claiming that other factors are much more important.
BTW It is absolutely unacceptable that there is not as much detailed data on vax uptake (as well as COVID incidence and morbidity) for every county and state in the USA>
Maybe this isn’t a privatization problem but rather a problem of demand.
Is it possible that part of the reason for the racial disparity in booster uptake is because there was a large wave of infections in late summer shortly before the boosters came out, and Blacks and Latinx were infected at higher rates (front line jobs, denser living situations) - meaning they have higher natural immunity going in to winter, which makes them reason they don’t need a booster because they are already protected?
In terms of who is currently being hospitalized and dying, do we see the same racial disparities play out? Hospitalization and death are the true measure of unequal outcomes.
There was a TON of covid going around in late summer. For 2024 maybe the boosters should come out sooner?
“There was a TON of covid going around in late summer. For 2024 maybe the boosters should come out sooner?”
Our family caught COVID at the start of this school year while waiting on booster rollout.
It still seems normal for families of schoolchildren around here to catch one “cold” after another once school starts. While it’s not individually dangerous to get vaccinated while mildly ill, it is more unpleasant, and, for others’ protection, we’re discouraged from showing up at a vax hub if we seem contagious (which we seem pretty much all the time right now).
Granted, most families seem unlikely to be as symptomatic for as long as an atopic family like ours, and our fall was disrupted in other ways. Even so, we’re not that special. If my family’s caught in a cycle where suspected contagious illness keeps preceding and delaying vaccination opportunities, other families probably are, too.
Virtu Impossible to see current info on deaths because of what the CDC has done on reporting them. Also even stopped reporting lagged info in the general history of reported deaths based on death certificates. They do “model” flu deaths though despite the imprecise nature of that reporting. They just don’t want us to see that Covid is still a big deal. They just want to push vaccination. They probably think that showing bad numbers on Covid will be used by nut cases to claim it proves vaccines “don’t work.” They are still honoring their time worn practice of “telling them what they can understand and need to know.” Usual condescension.
I feel like there's a lot that can be done technocratically, with minimal or no legislation, that could be done to move the needle to something substantially similar to single payer.
Why have Native Americans again been rounded out of existence. For your consideration with the RSV immunization for children. WA State got 14,000 doses. Two tribes (out of 29) received 80 doses. No other source is available. The second round saw another 1,000 doses come to WA after they were aware of the disparity. They then made an 5% set aside for tribes. That would be another 50 doses. Now they are committing to more doses going to tribal communities but the outbreak is already started. There will be another 7,600 doses coming in lots every 2-3 weeks. Native children has double the infant mortality rate of whites. In WA that mortality rate now surpases black childen, nationally black children have the highest infant mortality. RSV hospitalization (PEDIATRIC Aug 2023) showed rates between 1.7 and over 7 times more common for Native children. In WA at the peak of the outbreak last year there were 25% more Native children seen in the Emergency Rooms in the state. If you would be interesting in sharing more information about Native health disparities... Frank James MD Health Officer for Nooksack and Lummi Nations and clinician at Swinomish Tribe. frankjamesmd@Gmail.com
Health insurance cannot be considered a discretionary expense. Insofar as you're dissatisfied with the status quo in the US, yeah, I get it, but for now - we have the system we have. You can contact your elected reps:
In the meantime, you're gonna need health insurance. Rumors of the ACA's death are greatly exaggerated (even a Republican trifecta in 2017 couldn't kill it) and financial assistance for those with limited income is available in the form of premium tax credits. Having health insurance also connects people with reliable primary care providers, who can be soldiers in the fight against misinformation. And we can all get back in our respective lanes.
You may be right about new barriers driving down vaccination rates in communities of color -- but that's not obvious to me from the data you share. It seems to me there's an assumption that attitudes toward vaccine uptake remain stable over time, but if so that's a dubious assumption. It's also unclear to me what constitutes a new barrier. In my community, at least, the public health department and pharmacy chains such as Walgreens and CVS are offering vaccines free of charge (at least to the insured). Is that untrue elsewhere? Please understand, I'm not scoffing at the idea of new barriers, just looking for clearer evidence and an explanation.
Definitely untrue in Maryland where I live, at least for the first month after the doses started to ship when trying to get it might've been more on the forefront of people's minds. For this latest shot there are no public clinics here like there were before. You have to go to a pharmacy or a doctor's office. And many doctor's offices did not order doses at all, or ordered them quite late, and also were telling patients they had to check with their insurance themselves to know whether they'd be covered or not, or self-pay then file for their own reimbursement. The first few weeks at the pharmacies people were having their appointments canceled because doses arrived late, or ran out. And CVS is no longer 'in-network' for vaccination for Cigna, and I couldn't get a straight answer how much I might be expected to pay out of pocket, plus I had to contact Cigna support to get the list of which pharmacies local to me were in-network because that list wasn't easy to find searching their website.
Hubby and I got our updated covid boosters a couple of weeks ago. He got Moderna, which we had both gotten before. But the mRNA vaccines give me an awful fever, so I tried Novavax this time. I'm glad I did. Assuming that its effectiveness holds up, it's a good option for me.
I know that access, cost and disparities are an issue for getting the updated Covid booster, but I'm curious how many people have had the vaccine in the past and are simply choosing not to do it this fall? I personally have spoken with multiple people who have decided to opt out this fall and it's not because of cost or being unable to take time off of work. They simply don't want it. I believe that this is because most have had Covid and it was mild, so they are no longer afraid of it. I wonder if this is a nationwide issue or if it's just in my area?
I think this is a very true reality. My peers were among the first to get vaccinated, and most of them are not getting this current shot. Some upon the recommendation of their physicians and some because they don’t see a need. Some of them have had Covid several times as well.
This is not at all surprising to me. I was able to get the initial booster quite easily at our county health department - no internet needed to make an appointment, no lengthy form like at the chain pharmacies, no health insurance needed, and they would even deal with people who didn't have an ID. Location centrally located and on several bus lines.
I have attempted to get the current booster, and have not had success yet, and I am college educated and have insurance, but finding a place with the vaccine and an appointment when I am available has been difficult. There is not an easy search function like there was previously. This column has given me the push to try again, but I can see how an hourly worker wouldn't bother.
If you live near a Rite Aid, they have Novavax and accept walk ins. Costco might also accept walk ins (and has Novavax) - you can call their pharmacy and speak to a live person who has time to answer your questions and be helpful.
As I have posted before, there is definitely a discrepancy between what the general media are reporting re: COVID vaccine uptake generally and the facts on the ground in local communities like mine.
Vaccine uptake is so high where I live that we have to make appointments with CVS, Rite-Aid, or Safeway weeks out because there are shortages.
It annoys me that we have to suffer locally while idiots in areas where the vaccines are rejected have inventory we could make use of.
If you don't want to get the COVID booster, fine... get sick and die or suffer the worst symptoms of long covid for all I care. If you have kids and reject the vaccine, I hope you burn in Hell after the consequences come home to roost. Die - the world won't miss you.
As others have noted, I have not (yet) gotten this year's booster because I caught COVID and was told to wait 90 days before getting vaccinated; sadly, I tested positive on the day I was scheduled to get my booster, so instead of getting vaccinated, I got Paxlovid. I *will* get my booster around New Year's - and I have to wonder how many other people are in my situation and have not gotten boosted yet because of a recent infection, and how that impacts other vaccinations.
As my COVID began to clear up, I contacted my insurance company's advice line to ask when I could get my flu vaccine; it took 3 different people and 5 days to get a call back from my doctor's office, telling me I could get the vaccine any time I hadn't had a fever for 24 hours and felt well. I then began what would become a several month-long quest to get the RSV vaccine - I am under 60 by a couple of years, but immune compromised due to prior cancer treatment, and wanted all the protection I could get. This, also, took several phone contacts and several repetitions of why I wanted it - and why they couldn't approve it, because the CDC guidelines say "60+", with no mention of immune issues - but eventually, I ̶c̶o̶m̶p̶l̶a̶i̶n̶e̶d̶ advocated enough that it was kicked to the immunology department which approved it.
If I, as a reasonably well-education, middle class white woman with insurance that prioritizes prevention, have this much trouble getting vaccinations, I can only imagine what difficulties others, who don't have insurance, who may lack transportation, whose jobs may not give them the flexibility to go to clinics when the clinics are open, etc., may have getting them.
That sucks. I didn't get Covid until three weeks after my booster. Seems unfair that I should get a "double boost" heading into winter.
Which booster did you get?
Moderna, but I disclaim any liability for any prescriptive conclusions you might draw from that.
I also had spike antibody levels over 25,000 u/mL from a month before getting Covid
Understood. I’m just glad you didn’t say Novavax because that’s the one I got and I’m hoping it’s protecting me. Glad you’re feeling better.
Americans remain stupid.
I'd like to add to that: "And our government remains inept"
This is not inept government, but political capture by and for profit making corporations. This is an excellent demonstration that the market distribution of health services is inappropriate as Welsh family doc Julian Tudor Hart wrote in the LANCET in 1971.
Isn't it up to our government to balance the health of its citizens against corporate profit taking? Supplementing the cost of vaccines for those in need would be a win-win for both groups involved.
Yes that is a practical suggestion. However (1) it would be a band aid and subsidize pharma XS profits with my tax dollars and (2) the logistics and cost of identifying and validating those who qualify for subsidy (a model of federal vax policy now in place) is daunting, expensive and dysfunctional.
I really appreciate your meta-level approach to address the fundamental flaws in the system. It's ultimately what is needed, but it too is daunting and dysfunctional. Based on the data Katelyn presented, I would be OK with a band-aid to get us through the holidays.
None of this will happen with a "Republican" Party that has fully embraced quackery and crackpottery. Surely this is obvious by now.
Not inept. Paralyzed by the fact that the House is controlled by lunatics.
But remember, the problem of exploitation for profit was around for a long time before the incredible lunatics took center stage in the House.
Yes, I'm well aware. I'm old enough to remember when the right wing tried to stop the creation of Medicare because it was "socialized medicine" and therefore somehow Communist. I'm also old enough to remember when health insurance was a non-profit industry by law. That was before we came the Gaslit States of America.
I remember when the left wing actually held big pharma accountable. Now, they shill for them.
I remember the last time you posted a bald-faced lie here. So I guess my short-term memory is still OK.
Cute response
When was it non profit by law? Certain it must have been before my time. What law?
I was remembering that part wrong. I was thinking about Blue Cross/Blue Shield in the early days. That's what I get for relying on my memory instead of looking things up.
It seems to me that a big part of why the UK is doing so much better in terms of the booster in older people is that the more vulnerable groups (older, immunocompromised etc.) are the only groups authorized to get the booster. Because the UK took a more targeted approach and better explained the underlying rationale, its citizens have more confidence in the public health edicts. Our country has really failed miserably in that regard.
I agree. I think the boosters for all message has really bombed.
unfortunately everyone really does need boosters.
I would like to offer that many this year did not get their vaccine because they came too late. I for one got COVID for the first time 2 weeks before I was scheduled to get my vaccine.
It doesn’t help that my parents’ primary care physician told them that the variants change so fast that the vaccine probably won’t do much good! What? They are in their upper 80s! Living in a retirement community. So frustrating. I pushed and so they are now finally getting it.
my family member was told not to bother. My jaw was on the floor. I told them to fight for it!
when you can't mandate/coerce people into taking these shots anymore, it turns out that the vast majority don't want them. Especially after "experts" lied about their efficacy and dramatically overstated the risk posed by the virus itself.
Fair question: has anyone studied which racial and age groups were hardest hit by the vaccine mandates?
My guess is it wasn’t the 30-something White or Asian techie who could work from home, instacart groceries and door-dash dinner.
Not a “fair question” - comes from a troll who has consistently ignored facts.
This post seeks to explain why vaccine disparities exist, and when it comes to race, the conclusion is “barriers” and “privatization” are to blame, not “hesitancy.”
While it’s likely this is partially true, there are many more factors at play. If they are not acknowledged, the unintended implication is the flawed view that Blacks and Latinx are incapable of making decisions that are in their own best interest.
Or to quote today’s top reader comment: “Americans remain stupid.” 🙄
I understand it’s not possible to address all these factors and nuances in a short post, but if Public Health has the wrong or incomplete set of theories as to why certain groups aren’t getting vaccinated, efforts to close the gap probably won’t work.
In effect he said that vaccines don't work and that the pandemic risk was grossly exaggerated. Nobody said there was no such thing as vaccine hesitancy. He is a troll. Don't encourage him or, by saying something in a better worded fashion, mislead those who think he's real. Also your own words "partially true" are subtly different but amount to claiming that other factors are much more important.
Buddy, you got your way, mandates are gone, you won, learn to take "yes" for an answer and find another hobby
Over a million Americans would disagree with your troll response about the risk the virus posed
BTW It is absolutely unacceptable that there is not as much detailed data on vax uptake (as well as COVID incidence and morbidity) for every county and state in the USA>
Maybe this isn’t a privatization problem but rather a problem of demand.
Is it possible that part of the reason for the racial disparity in booster uptake is because there was a large wave of infections in late summer shortly before the boosters came out, and Blacks and Latinx were infected at higher rates (front line jobs, denser living situations) - meaning they have higher natural immunity going in to winter, which makes them reason they don’t need a booster because they are already protected?
In terms of who is currently being hospitalized and dying, do we see the same racial disparities play out? Hospitalization and death are the true measure of unequal outcomes.
There was a TON of covid going around in late summer. For 2024 maybe the boosters should come out sooner?
“There was a TON of covid going around in late summer. For 2024 maybe the boosters should come out sooner?”
Our family caught COVID at the start of this school year while waiting on booster rollout.
It still seems normal for families of schoolchildren around here to catch one “cold” after another once school starts. While it’s not individually dangerous to get vaccinated while mildly ill, it is more unpleasant, and, for others’ protection, we’re discouraged from showing up at a vax hub if we seem contagious (which we seem pretty much all the time right now).
Granted, most families seem unlikely to be as symptomatic for as long as an atopic family like ours, and our fall was disrupted in other ways. Even so, we’re not that special. If my family’s caught in a cycle where suspected contagious illness keeps preceding and delaying vaccination opportunities, other families probably are, too.
Virtu Impossible to see current info on deaths because of what the CDC has done on reporting them. Also even stopped reporting lagged info in the general history of reported deaths based on death certificates. They do “model” flu deaths though despite the imprecise nature of that reporting. They just don’t want us to see that Covid is still a big deal. They just want to push vaccination. They probably think that showing bad numbers on Covid will be used by nut cases to claim it proves vaccines “don’t work.” They are still honoring their time worn practice of “telling them what they can understand and need to know.” Usual condescension.
Oh course, a UHC system would go a long way towards fixing this mess. But we can't have that because Communist Marxist Woke Fascism. Or something.
I feel like there's a lot that can be done technocratically, with minimal or no legislation, that could be done to move the needle to something substantially similar to single payer.
Why have Native Americans again been rounded out of existence. For your consideration with the RSV immunization for children. WA State got 14,000 doses. Two tribes (out of 29) received 80 doses. No other source is available. The second round saw another 1,000 doses come to WA after they were aware of the disparity. They then made an 5% set aside for tribes. That would be another 50 doses. Now they are committing to more doses going to tribal communities but the outbreak is already started. There will be another 7,600 doses coming in lots every 2-3 weeks. Native children has double the infant mortality rate of whites. In WA that mortality rate now surpases black childen, nationally black children have the highest infant mortality. RSV hospitalization (PEDIATRIC Aug 2023) showed rates between 1.7 and over 7 times more common for Native children. In WA at the peak of the outbreak last year there were 25% more Native children seen in the Emergency Rooms in the state. If you would be interesting in sharing more information about Native health disparities... Frank James MD Health Officer for Nooksack and Lummi Nations and clinician at Swinomish Tribe. frankjamesmd@Gmail.com
Please, everyone in the US: this is not the year to miss open enrollment! More info here:
healthcare.gov
Health insurance cannot be considered a discretionary expense. Insofar as you're dissatisfied with the status quo in the US, yeah, I get it, but for now - we have the system we have. You can contact your elected reps:
https://www.usa.gov/elected-officials
In the meantime, you're gonna need health insurance. Rumors of the ACA's death are greatly exaggerated (even a Republican trifecta in 2017 couldn't kill it) and financial assistance for those with limited income is available in the form of premium tax credits. Having health insurance also connects people with reliable primary care providers, who can be soldiers in the fight against misinformation. And we can all get back in our respective lanes.
You may be right about new barriers driving down vaccination rates in communities of color -- but that's not obvious to me from the data you share. It seems to me there's an assumption that attitudes toward vaccine uptake remain stable over time, but if so that's a dubious assumption. It's also unclear to me what constitutes a new barrier. In my community, at least, the public health department and pharmacy chains such as Walgreens and CVS are offering vaccines free of charge (at least to the insured). Is that untrue elsewhere? Please understand, I'm not scoffing at the idea of new barriers, just looking for clearer evidence and an explanation.
Definitely untrue in Maryland where I live, at least for the first month after the doses started to ship when trying to get it might've been more on the forefront of people's minds. For this latest shot there are no public clinics here like there were before. You have to go to a pharmacy or a doctor's office. And many doctor's offices did not order doses at all, or ordered them quite late, and also were telling patients they had to check with their insurance themselves to know whether they'd be covered or not, or self-pay then file for their own reimbursement. The first few weeks at the pharmacies people were having their appointments canceled because doses arrived late, or ran out. And CVS is no longer 'in-network' for vaccination for Cigna, and I couldn't get a straight answer how much I might be expected to pay out of pocket, plus I had to contact Cigna support to get the list of which pharmacies local to me were in-network because that list wasn't easy to find searching their website.
Hubby and I got our updated covid boosters a couple of weeks ago. He got Moderna, which we had both gotten before. But the mRNA vaccines give me an awful fever, so I tried Novavax this time. I'm glad I did. Assuming that its effectiveness holds up, it's a good option for me.
I know that access, cost and disparities are an issue for getting the updated Covid booster, but I'm curious how many people have had the vaccine in the past and are simply choosing not to do it this fall? I personally have spoken with multiple people who have decided to opt out this fall and it's not because of cost or being unable to take time off of work. They simply don't want it. I believe that this is because most have had Covid and it was mild, so they are no longer afraid of it. I wonder if this is a nationwide issue or if it's just in my area?
I think this is a very true reality. My peers were among the first to get vaccinated, and most of them are not getting this current shot. Some upon the recommendation of their physicians and some because they don’t see a need. Some of them have had Covid several times as well.
This is not at all surprising to me. I was able to get the initial booster quite easily at our county health department - no internet needed to make an appointment, no lengthy form like at the chain pharmacies, no health insurance needed, and they would even deal with people who didn't have an ID. Location centrally located and on several bus lines.
I have attempted to get the current booster, and have not had success yet, and I am college educated and have insurance, but finding a place with the vaccine and an appointment when I am available has been difficult. There is not an easy search function like there was previously. This column has given me the push to try again, but I can see how an hourly worker wouldn't bother.
If you live near a Rite Aid, they have Novavax and accept walk ins. Costco might also accept walk ins (and has Novavax) - you can call their pharmacy and speak to a live person who has time to answer your questions and be helpful.
Thank you! The Rite Aid near me closed, but I think there is another nearby.
As I have posted before, there is definitely a discrepancy between what the general media are reporting re: COVID vaccine uptake generally and the facts on the ground in local communities like mine.
Vaccine uptake is so high where I live that we have to make appointments with CVS, Rite-Aid, or Safeway weeks out because there are shortages.
It annoys me that we have to suffer locally while idiots in areas where the vaccines are rejected have inventory we could make use of.
If you don't want to get the COVID booster, fine... get sick and die or suffer the worst symptoms of long covid for all I care. If you have kids and reject the vaccine, I hope you burn in Hell after the consequences come home to roost. Die - the world won't miss you.