As the state moves to reopen, Oregonians are starting to see a light at the end of the pandemic tunnel filled with summer barbecues and breezy, bustling happy hours—at least, for vaccinated, and mostly white, Oregonians.
The Oregon Health Authority (OHA) predicts that 70 percent of adult Oregonians will have at least one shot of the COVID-19 vaccine by June 21, at which time almost all statewide mask, social distancing, and building capacity limit requirements will be lifted. But that critical mass of people triggering the theoretical end of the pandemic is expected to be made up of mostly white people, due to lower vaccination rates amongst Oregonians of color.
As of June 10, about 36 percent of Black and Indigenous Oregonians and 35 percent of Latinx Oregonians have received at least one dose of the vaccine, as compared to 48 percent of white Oregonians. The vaccine equity gap has been closing slowly as state health officials have partnered with community-based organizations to distribute the vaccine; the Oregon Health Authority (OHA) reported a 5 percent increase in vaccination rates among Latinx, Black, Indigenous, and Pacific Islander Oregonians last week while white Oregonians saw a 2.5 percent increase in vaccinations. But that incremental change isn’t enough to placate stakeholders in Oregon’s communities of color who fear they will be left behind as Oregon relaxes its safety precautions later this month.
Multnomah County health officials and community-based organizations are working together to mobilize the second phase of vaccine distribution in an attempt to stop that from happening.
Why Vaccine Inequities Exist
Since COVID vaccines became available in early 2021, the state has followed a phased rollout based on risk level. That rollout plan—which prioritized frontline workers, the elderly, and immunocompromised people—was determined by state health officials, as well as the Vaccine Advisory Committee, a diverse group of 27 community stakeholders tasked with advising OHA on an equitable rollout of the vaccine.
Nannette Carter-Jafri, a member of SEIU Local 503 Indigenous People’s Caucus who was on the Vaccine Advisory Committee, said the committee “advocated loudly” for their communities, but they were also limited by the urgency of the vaccine rollout, the scope of what they could advise on, and the ever-changing information about vaccines during the time they were meeting in early 2021.
“Week by week, sometimes day by day, information was coming out that impacted what all of the states were trying to do to implement the COVID vaccine,” Carter-Jafri said.
The advisory committee initially wanted to prioritize people of color to receive the first wave of vaccines because they disproportionately represented COVID cases early in the pandemic. But, after three weeks of meetings, the committee members were told they could not legally use race as a category for who gets the vaccine. Additionally, committee members had no say in the logistics of vaccine distribution, meaning they could not advise OHA to staff vaccination sites with healthcare workers who reflected the ethnic and racial communities they were serving, according to Carter-Jafri.
The age-based phases of the vaccine rollout that prioritized older Oregonians also contributed to inequities according to Serena Cruz, the executive director of Virginia Garcia Memorial Health Center, a health center founded to serve the Latinx community.
“The age restrictions were inherently aspects of structural racism because they weren't accounting for the differences in dominant age among the different population groups,” Cruz said.
The median age of the Latinx population in the US is 29 years old, significantly younger than the white median age of 43. Black and Asian Americans are also younger on average, at 35 and 37 years old respectively.
“I think we would have seen fewer COVID cases [in the Latinx community] had we been able to provide the vaccine to younger populations, sooner,” Cruz said.
"The age restrictions were inherently aspects of structural racism because they weren't accounting for the differences in dominant age among the different population groups."
Vaccine supply was also directed mostly to state-controlled mass vaccination sites, like the Oregon Convention Center and the drive-thru clinic at the Portland International Airport. According to Cruz and Carter-Jafri, those large, fixed sites are less accessible to communities of color due to a lack of language accessibility, their inconvenient locations to many communities of color who don’t live in the central Portland area, the presence of uniformed National Guard members who ask for a patient’s ID and insurance card as part of the check-in process, and a general mistrust of the government public health departments who operate the sites.
“There are, unfortunately, way too many examples of the practice of public health perpetrating harm on BIPOC communities so I mean [mistrust] is to be expected,” Multnomah County Public Health Director Jessica Guernsey said.
One prominent example of US public health perpetrating harm on communities of color is the Tuskegee Syphilis Study, a government medical experiment that intentionally allowed hundreds of Black men with syphilis to remain untreated in order to study the effects of the disease. The US also participated in the forced sterilization of one-third of Puerto Rico’s female population in the mid-to-late 1900s.
That’s why, according to Guernsey, the county health department is expanding its partnerships with trusted community-based organizations to address the vaccine equity gap with urgency, as well as changing its larger approach to public health to repair community trust in the long run.
Addressing the Vaccine Equity Gap
In mid-May, Governor Kate Brown announced a new framework for COVID safety restrictions allowing counties to move to “Lower Risk”—a less restrictive status that increases capacity limits in public venues—if 65 percent of adults were partially vaccinated and if that county submitted an equity plan detailing how it planned to address the equity gap in the vaccine distribution. Multnomah County submitted an equity plan to OHA on May 21 detailing how the county will continue to collaborate with 83 state- and county-funded community-based organizations to distribute vaccines and vaccine information, and continue to center a racial equity plan that the county developed in response to the pandemic last year.
The county will also be applying for a $4 million health literacy grant from the Centers for Disease Control and Prevention (CDC) to help fund vaccine equity efforts which will vary based on what feedback the county receives from communities in need. That may mean developing mobile vaccination sites that travel to areas of the county that have low vaccination rates, or hosting vaccine information sessions with community organizations. The county will take cues from community organizations to determine what resources will best serve each community’s vaccination efforts.
According to Guernsey, the equity plan is a formal extension of what the county has been doing since the beginning of the pandemic, except the county department has more agency now that Oregon officials are moving away from a state-controlled crisis response to a county-specific response.
“We’re really trying to assess and build upon what we call our ‘hub and spoke model,’ which is really understanding where there are going to be additional strategies that are needed that maybe aren't fixed sites,” Guernsey said.
For example, the Virginia Garcia health center was authorized by the federal government to distribute the vaccine through its health center and smaller vaccination clinics in early 2021. The center’s physical building in Hillsboro is the ‘hub’ where patients can go get a vaccine, while the pop-up clinics hosted in collaboration with large employers and other organizations act as ‘spokes.’ While Virginia Garcia mostly serves people in Yamhill and Washington counties, the center also serves Multnomah County residents, now that vaccine supplies aren’t as limited.
By mid-May, Virginia Garcia had distributed over 37,000 vaccines, 75 percent of which were given to people of color. Notably, 64 percent of the vaccines were given to Latinx people, while Latinx people only make up 55 percent of the clients that the medical center typically serves.
Cruz, Virginia Garcia’s executive director, attributed the center's success to its existing relationship with the Latinx community.
“I think one of the first differences is having a trusted relationship with community members,” Cruz said. “We didn't just start trying to reach out to the Latinx community, we were founded to respond to the Latinx community.”
That's reflected in the clinic’s basic structure. Cruz said that Virgina Garcia’s medical staff are members of the ethnic communities they serve and that the center provides medical care and health information in over 60 languages. Additionally, vaccine clinics hosted by Virginia Garcia are designed for people who may be uncomfortable in traditional health care settings. The sites are small, which allow people to move through quickly, deemphasize the need for ID and insurance, and, unlike the mass vaccination centers, don’t have a law enforcement presence that can often act as a deterrent to communities of color and undocumented people.
Creating a comfortable, community-oriented space at vaccine clinics has also been successful for the Oregon Pacific Islander Coalition, a group of organizations that advocates and coordinates services for the local Pacific Islander community and partners with the Multnomah County Health Department.
The coalition has hosted five series of vaccination clinics in Washington, Marion, and Multnomah counties for the Pacific Islander community. These clinics are about more than just creating an abundance of opportunities to get vaccinated, according to Manumalo Ala’ilima, the executive director of the United Territories of Pacific Islander Alliance (UTOPIA) Portland chapter, a coalition member.
“It’s about the experience, especially for culturally specific communities,” Ala’ilima said. If getting communities of color vaccinated were simply about access, Ala’ilima said, then people would have already walked to Walgreens or another pharmacy offering walk-up vaccinations and received their shot.
UTOPIA focuses on building a pleasant experience by having members of Oregon’s Pacific Islander community welcome people to the clinic, as well as promoting the event and vaccine information in native languages.
After seeing a dearth in communications materials for Pacific Islander communities, UTOPIA created an online toolkit, which translates the latest vaccine information and resources into native languages. According to Ala’ilima, facilitating vaccine education in someone's native language is critical to empowering them to make an informed health decision.
“Just the ability to see your language reflected in information that's timely during this pandemic signals that ‘Hey, we care about you so much,’” Ala’ilima said. “We're doing the steps to be inclusive to make sure that nobody gets left behind, especially during this pandemic.”
Beyond creating welcoming clinic environments, both UTOPIA and Virginia Garcia collaborate with other culturally-specific organizations that may serve members of the community that don’t know of UTOPIA or Virginia Garcia’s resources. This kind of coordination allows for a greater awareness of the vaccine clinics within the targeted community, according to Cruz.
Tailoring the experience to each person has also been beneficial for Highland Haven, the public health branch of the Highland Christian Church which serves a majority Black congregation.
Highland Haven was authorized by the federal government to start distributing vaccines in February 2021. After seeing the initial wave of people who were already interested in getting the vaccine, Highland Haven began actively engaging with vaccine hesitant people.
The first step was leading by example, so Highland Christian Church’s Pastor Shon Neyland documented his experience receiving the vaccine and spoke to the importance of getting vaccinated in a video shared on the church’s social media pages. Teresa Johnson, Highland Haven’s health director, then focused on scheduling a consistent vaccine clinic at the church on the second and fourth Tuesday of every month. Johnson said that creating a consistent schedule helped capture vaccine hesitant people, because Johnson can immediately book their appointment when they make the decision to get the vaccine, instead of putting them on a waiting list where they have more time to change their mind. The Highland Haven clinics can bring in a range of 150 to 400 people weekly.
Now, Johnson’s main task is responding to individual people’s concerns about the vaccine. While it may be time consuming, Johnson believes it is one of the most impactful ways to reach wary community members.
“For me it's not so much about how many people we reach, but that we're reaching people,” Johnson said.
For example, Johnson was talking with a friend and found out they were skeptical of the vaccine. Johnson spent time answering all of their questions, describing how the vaccine worked, its effectiveness, and her personal experience receiving the shot. A couple days later Johnson got a call from that same friend, asking to schedule not only an appointment at the Highland Haven clinic for herself, but for her entire office as well. The Highland Haven team also regularly posts social media videos to answer questions about the vaccine and dispel misinformation.
Highland Haven will continue to operate its vaccine clinic for at least another six months, and Johnson plans on reaching out to more community-based groups to organize collaborative clinics in the coming month.
Long Term Changes
For Guernsey of the county health department, the pandemic and vaccine rollout has laid bare the historic and present inequities in the public health system.
“I think it just reinforces why we need to be on a path for really deconstructing a lot of how we do public health and medicine, because it doesn't work for a lot of people and, for the people it doesn't work for, they’re suffering the most egregious health disparities,” Guernsey said.
The county health department has identified two major changes that need to happen in public health: decolonizing public health practices and expanding the infrastructure of public health to include more community-based organizations.
Decolonizing public health means moving away from the Western view of medicine that emphasizes empirical data over peoples’ lived experience.
“In the past I think we've treated data as the expert to tell us what’s going on, but communities know what's going on,” Guernsey said. “They’re the experts.”
"I think it just reinforces why we need to be on a path for really deconstructing a lot of how we do public health and medicine, because it doesn't work for a lot of people and, for the people it doesn't work for, they’re suffering the most egregious health disparities."
In practice, that means the county will continue to develop relationships with community stakeholders and seek their advice on developing new health metrics. Guernsey also notes that those community-based organizations need to be funded just like any other branch of public health.
“If we've learned nothing else from this pandemic—there’s lots of lessons but—clearly community based agencies are part of a public health system and they should be funded with parity,” Guernsey said. There are community-based organizations that have had to grow unexpectedly to meet community demands during the pandemic as well. Guernsey notes that those organizations need to continue to be supported as part of the public health landscape or else the infrastructure will fall away and the next time an emergency health situation hits, the county will be back in the same place it started.
Ala’ilima of UTOPIA echoes Guernsey’s point. At the start of the pandemic, all of the Oregon Pacific Islander Alliance members were volunteers who were organizing community resources and events in their free time. Ala’ilima, who only transitioned to full-time work with UTOPIA in May 2021, stressed that the Pacific Islander community still does not have the infrastructure to respond to an emergency, whether it be a pandemic or a natural disaster.
“We're decades behind most of the community of color organizations, so for us it's playing catch up for sustainability,” Ala’ilima said.
A Race Against Reopening
Cruz from Virginia Garcia believes that the state is entering a new phase of vaccine efforts full of community-tailored pop-up clinics and one-on-one communication, but says those efforts alone won’t boost vaccination rates to parity across racial and ethic groups.
Cruz is hoping to find a middle ground between the mass vaccination sites that can be approachable for communities of color, and the smaller vaccination clinics that are reaching 150 to 500 people per event. This middle ground might look like FEMA-assisted vaccine sites that are still a larger scale operation, but maintain cultural relevance to the community the site is situated in.
“I think making sure that those are sited in communities with low vaccination rates is important and ensuring that they're staffed by trusted community members,” Cruz said.
Highland Haven’s Johnson is worried that Oregonians’ collective excitement of reopening and putting the pandemic behind us will leave unvaccinated communities behind and lead to more COVID cases within the Black community.
“There's still a whole ethnicity of people that haven't got to the 70 percent—where will that put us come December when we're in cold and flu season?” Johnson said.
While the OHA is reporting that the ethnic and racial vaccination gap is closing, Johnson is still seeing the virus spread in the Black community. Highland Haven offers support for people who have tested positive for COVID and need to quarantine. After a steady decrease in support requests, the hotline received five calls in a single week, coinciding with a spike in COVID hospitalizations within the African American community that OHA reported on May 21.
“I thought COVID was putting a big spotlight on the disparities that are happening within our communities, but now that the big push is to get back open, we’re doing the same thing and the same people—the poor, less fortunate, my community, my ethnicity—are going to be left behind once again,” Johnson said.