Careless Decision Making Creates Race-Ethnic Disparities in Distribution of COVID-19 Vaccine

 

The recent story in The Dallas Morning News was clear and disturbing: 

”COVID vaccines at Fair Park aren’t going to Black, Latino residents as officials hoped” [1] 

The story chronicles the missteps in public communications efforts to schedule large-scale vaccinations to historically disenfranchised neighborhoods, which are mostly Black and Latino and below Interstate 30 – groups that have experienced a higher number of illnesses, hospitalizations and mortalities during the pandemic.  Instead, however, the thousands of residents that showed up for the vaccinations at Fair Park were mostly white North Texans from higher-income neighborhoods following mixed messages to the public – many showing up in their Mercedes, Infiniti and BMW automobiles. 

Dallas City Mayor Eric Johnson blamed County Judge Clay Jenkins for the confusion generated by the announcement to register online with the county to receive a vaccine appointment at the South Dallas Mega Center – an announcement that was apparently not coordinated with the Mayor’s office. Word of mouth spread rapidly that an appointment was not needed for residents 75 and older – which left thousands of others on a waiting list and encouraged many out-of-town residents to show up for a vaccine.  County officials pointed out that a significant number of residents who showed up were able to access an unsecured web link that allowed them to book an appointment, regardless of age or status.  Other residents who showed up also pointed to emails received from the county encouraging them to sign up for an appointment.

Interestingly, Dallas County was not prepared to release a demographic profile of those that received vaccinations, a report that would have been very useful in evaluating the extent of the exclusion of more deserving Black and Hispanic residents in the targeted community.  As an apparent after-thought to expand access to the intended Black and Hispanic residents,  Jenkins and his staff began reaching out to leaders in those communities, including elected officials, faith leaders and other organizations that work in communities where the coronavirus was most prevalent.

The vaccine distribution fiasco in Dallas County is not an isolated one as many communities throughout the U.S. are struggling to coordinate the vaccinations using a confusing set of federal guidelines that are implemented inconsistently thoughout the nation.  In a previous blogpost, I had warned about potential problems that could complicate the distribution of the vaccines once they became available.  For example:

·        The Center for Disease Control decided to exclude Blacks and Hispanics from the category of “high-risk” groups, thus reducing their priority level for intervention strategies. Why?  Because the CDC concluded that the high virus rates are not due to genetics, and they want to avoid stigmatizing these groups as “COVID carriers.” [2]

·        Race-ethnic information is missing for many of the cases, hospitalizations and mortalities recorded for COVID-19, which obscures the accurate reporting of this information for Black and Hispanic communities – a consequence of lax mandates for recording race-ethnic information. The absence of this information obscures the true picture of community spread of the virus. [3]

·        Access to testing sites in states like Texas is problematic since these sites are more commonly located in white communities than the more vulnerable Black and Hispanic communities. [4]

It is also disturbing to learn that states like Florida have relaxed the requirements for vaccine eligibility by allowing anyone over the age of 65 years to obtain a vaccine, which has encouraged many tourists and out-of-town residents to drain the vaccine supplies at the expense of more deserving local residents.

In the case of Dallas County and the City of Dallas, it was unfortunate that better coordination was not in place to implement such an important vaccine intervention program at the Fair Park Mega Center.  However, even if the communications had been better coordinated, there is still one important tactical decision that could have produced a different outcome.

In my opinion, it was a major mistake to rely primarily on a web-based strategy to encourage Black and Latino residents in the targeted communities to register for the Mega Center vaccination. From their recent experience to encourage response rates to the Census 2020, both Dallas County and City of Dallas officials were aware that Black and Latino residents, especially immigrants, were excluded in large numbers from completing the Census questionnaire which also primarily relied on the Internet.  Our past research in multicultural communities confirms that Blacks and Hispanics are more likely to respond by telephone, mail and personal contacts when completing surveys and Census questionnaires but least likely to respond by using the Internet. Lastly, a Census population pyramid easily illustrates that a much larger proportion of whites are concentrated in ages 65 and older than Hispanics or Blacks – which would provide whites a distinct advantage when using eligibility criteria based on age alone.

For damage control, Jenkins reportedly began outreach to community elected officials, faith leaders and other organizations in the targeted zip codes – an approach that should have been followed initially. Whether by intent or just careless decision-making, Mr. Johnson was correct in stating that the county was “promoting a system that gave preferential treatment” – that is, to white, higher-income residents who were not the intended target audience of the Mega Center.

With COVID-19 vaccinations, there is less room for error in the fair distribution of a life-saving solution.  Let’s hope that public officials agree to improve the coordination of public vaccination campaigns by improving their communication strategies in culturally diverse communities.

 

Reference Notes


[1]Garcia, N. and Bailey, E. (2021, January 14). COVID vaccines at Fair Park aren’t going to Black, Latino residents as hoped.  The Dallas Morning News.  Accessed at: https://www.dallasnews.com/news/public-health/2021/01/14/dallas-mayor-eric-johnson-blasts-county-after-walkups-allowed-at-covid-19-vaccine-mega-site/

[2] Rincon, E.T. (2020, July 30) CDC blunders in excluding communities of color among high risk groups for COVID-19. https://www.rinconassoc.com/cdc-blunders-in-excluding-communities-of-color-among-high-risk-groups-for-covid-19

[3] Rincon, E.T. (2020, April 16). Missing race-ethnicity data complicates COVID-19 mortality counts, but the solution is simple. Accessed at: https://www.rinconassoc.com/missing-race-ethnicity-data-complicates-covid-19-mortality-counts-but-the-solution-is-simple

[4]Fanning, R. (2020, May 29). Across Texas, black and Hispanic neighborhoods have fewer coronavirus testing sites. Texas Standard. Accessed at: https://www.texasstandard.org/stories/across-texas-black-and-hispanic-neighborhoods-have-fewer-coronavirus-testing-sites/

Texas Hispanic Construction Worker Mortalities Are Alarming: Is Anyone Listening?

The news was alarming: Hispanic construction workers represent over half (56%) of the state’s COVID-19 deaths although Hispanics currently represent 40 percent of the state’s population.  The story, reported today by The Dallas Morning News,[1]discussed the results of a research study published in the Journal of the American Medical Association (JAMA) by a team of researchers at The University of Texas at Austin. The study pointed to the increased risk faced by Hispanic construction workers and living arrangements that preclude social distancing.

The story is also concerning for the issues that were not addressed. For example, the story did not include any comments from the one organization in North Texas that would have relevant insights to contribute to our understanding of this elevated health threat to Hispanic construction workers:  The Regional Hispanic Contractors Association.  

Previous COVID-19 news reports have focused considerable attention on essential workers in healthcare, the food industry and other occupations. However, the risks faced by construction workers have received relatively little attention, especially Hispanic workers who comprise 30 percent of all construction workers. Under the current administration, OSHA (Occupational Safety and Health Administration) has relaxed their inspections of occupations to verify compliance with COVID-19 safety measures which has undoubtedly contributed to the increased risk faced by Hispanic workers who often do not wear face masks.

Of course, we have known for several months that Hispanics and Blacks have been experiencing higher levels of COVID-19 illnesses and mortalities.  As I discussed in an earlier report,[2]  these COVID-19 mortality rates are likely much higher for Blacks and Hispanics since state and federal health data are often missing information on the race or ethnicity of COVID-19 mortalities. There is a simple procedure available that can estimate the race-ethnicity of a person based on their name and zip code with 80 to 90 percent accuracy – a tool that could be used to fill in the missing data and obtain a better estimate of COVID-19 mortalities.  

Communication of these alarming health risks to the right audiences is also problematic. For example, it is not likely that the Hispanic construction workers and families that need to know about their elevated risk of death related to COVID-19 will read the report in JAMA or The Dallas Morning News.  During the pandemic period, audiences are more likely to obtain news information from television and online sources if they have Internet access. And Hispanic construction workers are more likely to use Spanish-language sources of information.  Consequently, it is imperative that Spanish-language television stations like Univision and Telemundo assume an increased responsibility to ensure that COVID-19 health alerts are regularly communicated to their audiences.  Moreover, organizations like the Regional Hispanic Construction Association are perhaps the best vehicle to deliver and reinforce the health alerts to their membership.

While the issue of increased COVID-19 exposure and deaths of Hispanic construction workers is urgent, one wonders if the study findings will be sufficient to wake up the various stakeholders to take decisive action. As the story points out, Dallas-Fort Worth is second among the country’s largest building markets in September this year with an estimated 155,000 workers in the building sector.  But as one of the study authors, professor Lauren Meyers pointed out, the study findings do not necessarily mean that construction work needs to stop. “It means that we need to go to great lengths to ensure the health and safety of workers when they do go to work.” 

In the meantime, let’s ensure that Hispanic construction workers and their families are informed about the elevated risks that they face from COVID-19 and, more importantly, that they are provided practical solutions to mitigate the risks.  Following are a few suggestions for achieving these objectives: 

  • Being the second highest building market in the nation, it seems reasonable to ask investors and builders to create a fund that is dedicated to keeping the Hispanic contractors and workforce safe and able to meet basic expenses. 

  • Create a fund to offset the costs of funeral expenses for the many Hispanic families who have lost a family member working in the construction industry.
  • Pressure OSHA to conduct more frequent checks of construction work sites to ensure that workers are following COVID-19 safety guidelines and have a sufficient supply of PPE supplies.
  • Provide funding for temporary shelter, such as trailers or hotel rooms, to provide family members the opportunity to quarantine themselves when necessary from exposed construction workers. 
  • Ensure that all construction workers are tested for the COVID-19 virus before starting their work shift.
  • Provide continuing funding to organizations such as the Regional Hispanic Contractors Association so that they are able to conduct the needed training to Hispanic contractors regarding COVID-19 safety measures and risks.
  • Lastly, ensure that all COVID-19 related communications are delivered in both English and Spanish languages.  Native-born Hispanics primarily view English-language media while foreign-born Hispanics primarily view Spanish-language media – a fact that we have confirmed from our 45 years of evaluating the media habits of Hispanics throughout the U.S.

End Notes



[1] Difurio, D. (2020, October 31).  Construction workers hit hard by virus. Dallas Morning News. Accessed at https://edition.pagesuite.com/infinity/article_popover_share.aspx?guid=6e7208df-d7f4-44e9-af63-fef33cd734fb

[2]  Rincón, E.T. (2020, April 16).  Missing race-ethnicity data complicates Covid-19 mortality counts, But the solution is simple.  https://www.rinconassoc.com/missing-race-ethnicity-data-complicates-covid-19-mortality-counts-but-the-solution-is-simple