A Shot at Racist Healthcare
In the last year we have seen poor and minority communities killed disproportionately by Coronavirus, and we have seen white communities post a disproportionate number of BLM lawn signs. These issues have an obvious intersection, and with the Covid vaccine, we can act there today! But are we doing it? Do we know how?
I’m a family doctor for ten thousand people of color in poor neighborhoods east of Denver, Colorado. That’s all I’ve done for the last decade, including almost a year of Coronavirus tests, treatments, deaths, and now shots.
When the vaccine arrived a month ago, my clinic was approved to carry it. Doses were limited, so smaller clinics would get less than the big hospitals, elderly folks would get it first, and us clinics were mandated to take vaccine appointment calls from everyone.
That all made sense to me at first. Then I filtered it through my world of underserved medicine, and thought:
- Why don’t we prioritize small clinics? Trust in vaccines is a real issue, even from people who know nothing about Tuskegee. The minorities I work with are more likely to trust my clinic than the big hospital, the county fairgrounds, or the pop up clinic staffed by white folks working for a nonprofit that knew how to grantwrite. What’s the purpose of Family Medicine if not trust building? But I am seeing no effort to prioritize small clinics, and the opposite seems true — my clinic had my vaccine orders cancelled and we were kicked off the system for trying to order! So I whined to the state, and something amazing happened: my email landed on the desk of one state employee who somehow knew of my clinic’s work. She diverted some doses from larger hospitals to me. That’s great! But why are we not systematically favoring small clinics in dosing allocations? Some clinics like mine don’t even need the extra space, staff, or other logistics, we just need doses! Give us what little we want, and let the hospitals have what’s left, which is still the majority.
- Obviously elderly need prioritization, but so do colored people. A 45 year-old poor black person may fare worse with Covid, or be more of a vector, than your 85 year-old rich white grandmother who can isolate. Didn’t you write a BIPOC mission statement last summer about how you want to prioritize people of color? Are you bold enough to say Category 1B includes anyone over age 65 AND anyone who receives Medicaid or Food Stamps? Or Category 1B is anyone living in blocks defined as low income? The goal should not be equal or even equitable distribution of vaccine, it should be affirmative action distribution. This isn’t reparations for something generations ago — there are poor colored people dying of Covid faster than rich white people right now. I work with poor colored communities — I know the grocery owners, the pastors, and the adult daycare staff who will promote the vaccines, in a dozen languages. I just need the vaccines! Even if we are talking about big entities, please prioritize the FQHCs (Community Health Centers) over the suburban hospitals — that is another way to prioritize poor and colored. As of the date I wrote this, my local fqhc (Stride) says all their locations have had no vaccines for 2 weeks — meanwhile I know a 1,000 person event was done at a sports stadium yesterday, drive-through. That means the vaccine is not making its way into the poor neighborhoods. Want to maximize QALYs saved? Coordinate a 1,000 person event with me in the hood.
- The State listed my clinic in a vaccine provider directory and mandated all such clinics make appointments for any caller. That may sound optimal to you, but it sounded classist and racist to me. We took the calls, made the appointments, and, predictably, my brown and black waiting room was overtaken by rich white people. Why? Because my poor brown and black people don’t have the wherewithal to make appointments, like rich white people do. My patients may not have a phone, may not speak any language that you have a translator for, or may not have means to get to an appointment on time. This is why I run a walk-in clinic with no appointments. Listing my clinic and making me take appointments directly shifted doses away from poor old colored people to rich old white people. So I told my staff we are only seeing four call-in (aka richer, whiter) appointments per day for vaccines. Sound racist and classist? That is exactly what most other providers do for Medicaid, in reverse. You try finding my Medicaid patients a knee doctor in the metro area. No, really, call me if you find one. Those orthopedists (and urologists) say no to Medicaid, which disproportionately means saying no to colored people. At best they say “one Medicaid patient a month,” but they will happily see you today if you have Blue Cross.
Added 3/13/21: The State told me that I can target certain populations but can not exclude anyone, and that their vaccine strategy for the underserved is “pop up” clinics (one day events). This is strange to me, because it seems that targeting advertising to population A is a secret way of excluding population B. It is like the State wants providers of underserved medicine, like me, to be in the closet, not telling others that we really are discriminating against privilege. Don’t tell the rest of the litter that you are feeding the runt, and don’t make that milk predictable lest the others steal it. Such secrecy and inconsistency is a sad strategy for the less fortunate. I popped up here 10 years ago to serve poor people and no one else, and have been open every day, including now to give them corona shots anytime they want.
I appreciate everyone that has made this vaccine possible, but if you want to take a shot at racism in healthcare: please prioritize doses to clinics that are small and/or deal with poor minorities, and let them decide how they are going to distribute it.