Racial Equity in COVID-19 Vaccination Policy

Dear Mr Governor and Commissioner Levine

I’m writing about Vermont’s vaccination policy, which, according to vtdigger.org,  Commissioner Mark Levine has described as “simple and fair.” As you know, phase one of the rollout was for front-line workers and long-term care facility residents, and phase two, is people 75 years and older.

Due to structural racism, this so-called “simple and fair” policy, will have a disparate, negative impact on Vermonters who are black, indigenous and people, of color.

The first phase, which prioritized long-term care facility residents, effectively excluded Vermonters who are black, indigenous or people of color because the overwhelming majority of long-term care facility residents nationally (78 percent) and in Vermont are white. Vermonters who are black, indigenous or people of color tend not to house their elders in long-term care facility for cultural reasons.

However, the risk to Vermont elders living in multi-generational households is no less than that of Vermonter elders living in long-term care facilities. In fact, as you know, Vermonters who are black, indigenous and people of color are at a higher risk of contracting the coronavirus from a household contact. Thirty-six percent of non-white Vermonters had household contact with a confirmed case of COVID-19, as compared to only 20 percent of white Vermonters.

Thus, even though non-white Vermonters living in multi-generational households have the same or greater risk of exposure and/or dying from COVID-19, they were structurally excluded from the first phase of the vaccination roll-out in Vermont by limiting it to those who have the resources or the cultural norm of moving their elders into long-term care facilities.

The second phase of the vaccination rollout is also problematic in terms of racial equity. A vaccination program that prioritizes people age 75 years and over structurally excludes Vermonters who are black because nationally, the average life expectancy of black people is just 75 years of age, due in large part to the effects of systematic racism.

In addition, COVID-19 cases among non-white Vermonters tend to be younger than for white Vermonters. The average age of persons testing positive for COVID-19 is 33 among non-white Vermonters, whereas the average age is 46 among white Vermonters.

As you know, non-white Vermonters have been disproportionately affected by COVID-19. Nearly one in every five COVID-19 cases in Vermont are among non-white Vermonters even though non-white Vermonters make up approximately six percent of Vermont’s population. The incidence rate is as high as 225.7 for black Vermonters versus 26.2 for white Vermonters.

The most troubling statistic is the preexisting conditions rates among COVID-19 cases. Based on the 2018 Vermont Department of Health’s Behavioral Risk Factor Surveillance System report, there are no statistically significant differences in the rates of pre-existing conditions, such as diabetes, lung disease and cardiovascular disease among white and non-white Vermonters. However, there are disparities in the rates of pre-existing conditions among Vermonters testing positive for COVID-19. The pre-existing conditions rate among COVID-19 cases is 19.4 percent for non-white Vermonters and 12.1 percent for white Vermonters. This suggests that non-white Vermonters are at higher risk of exposure to COVID-19 due to their type of employment and living arrangements. Thus, a vaccination program that priorities long-term care facilities and age 75 years and older, effectively excludes non-white Vermonters who are at disproportionate risk for contracting the virus and for more serious outcomes, such as hospitalization.

While it may be simple to use residence at a long-term facility and age at criteria for access to the vaccine, it is not fair or equitable to all Vermonters because of systemic racism.

We implore you to re-visit this vaccination plan with an eye and commitment to racial equity.

Respectfully,

Mark

cc’d:  UVMMC, HRC, RE Director and Legislative Health Committee Leadership