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Although Minnesota has not released any data breaking down the race and ethnicity of those getting the COVID-19 vaccine, state leaders acknowledge that the vaccine is not reaching people of color proportionately to how hard the virus has hit them.
That’s a problem because Black and Latino communities are suffering higher rates of infection, hospitalization and death from COVID-19 than the population as a whole. Advocates contend that any vaccine rollout should put these factors at the forefront of vaccination efforts.
“It’s a very, very important point and a very fair critique,” Minnesota Department of Health Commissioner Jan Malcolm said last week during a news conference.
So just how bad is it? Earlier this month, two members of a state panel of experts organized to give guidelines to ensure people of color aren’t left behind accused the Department of Health of ignoring their recommendations and doing its business in the dark.
“There has been no transparency with the advisory group or the public [as] to how decisions are being made on the methods of vaccine allocation,” Nathan Chomilo, a pediatrician with Park Nicollet and medical director for the state’s Medicaid program*, and Nneka Sederstrom, chief health equity officer for Hennepin Healthcare, wrote in a letter to Malcolm. “Right now speed is winning and equity is losing.”
In particular, Chomilo and Sederstrom criticized the state’s decision in January to start opening up vaccine distribution beyond the 1A category, which included health care workers and long-term care residents, to anyone aged 65 and older. They also questioned the state’s emphasis that clinics not hold onto doses for too long.
“Neither a first-come, first-served allocation nor a random lottery are ethical or equitable methods of allocating a scarce resource,” the letter reads. “Prioritizing speed pressures the system towards the status, structurally, systemically, and inherently racist, quo.”
MDH did not respond to the specific criticisms from Chomilo and Sederstrom. “The advice and expertise of the leaders is extremely valuable in shaping our evolving vaccination strategy and its implementation,” a spokesperson for the Department wrote in an email. “We value the crucial role of the Advisory Group, and look forward to continuing the dialogue as we move toward ending this pandemic,”
But the agency has stated that it’s working to obtain and disclose vaccination data by race and ethnicity, and is prioritizing equity in its rollout.
Malcolm’s public comments on the matter came after Chomilo and Sederstrom sent their letter, and also after Minnesota Doctors for Health Equity wrote a similar letter signed by 350 people. Sederstrom said comments represent a step in the right direction. “I know they’re coming up with efforts to try to bring equity back in the picture, so it’s on their radar again,” she told Sahan Journal.
Below, we take a look at where the state stands on vaccine equity—albeit with a limited picture—as well as what state leaders say their plans are to fix the problem.
So what’s the problem again?
As of Thursday afternoon, the Department of Health reported that more than 710,000 Minnesotans, or almost 13 percent of the state’s population, had received at least one dose of a COVID-19 vaccine. But Malcolm said last week that the state’s own data confirms vaccines aren’t being distributed proportionately to the populations affected most by the virus.
How bad are the discrepancies in Minnesota?
We don’t know. That’s because the state hasn’t publicly disclosed any of the data showing this, despite Malcolm contending during the same press conference last week that “transparency is such a key value for the governor, lieutenant governor, and all of us.”
Why won’t the state disclose vaccine data on race and ethnicity?
Health Department officials say the data they have so far is incomplete, and that there is no indication when they might provide any numbers. During a different meeting with reporters last week, Malcolm said the department was still “in the process of cleaning and validating” its data. “This is not something we’ve shared historically, so it will take a while,” added department Infectious Disease Director Kris Ehresmann.
Why is the data incomplete?
There are a few reasons for this. One is that for anyone getting the vaccine, disclosing their race and ethnicity is voluntary. “Not everybody wants to share that data, and there’s a reason for that,” Malcolm said, citing the historic distrust between communities of color and the medical industry. State officials also say their legal grounds to release the data are muddy. Previously, they understood existing law to limit disclosing it, Ehresmann said, But that changed recently. “A more recent review says we can collect and share that information,” Ehresmann said.
Is vaccine equity a problem outside of Minnesota?
Across the nation, people of color are being vaccinated at lower rates than whites. The Kaiser Family Foundation, for example, finds the Black population in 30 states are getting vaccinated at rates lower than their share of COVID-19 infections. The same data found whites getting vaccinated at greater rates than their share of infections in 31 states.
What’s to blame?
While Chomilo and Sederstrom say Minnesota sacrificed equity for speed, state leaders also say the problem is national and systemic. Last week, Governor Tim Walz said in a news conference that vaccine inequity comes up frequently in his recent discussions with other state governors and with the Biden administration. “It is happening,” Walz said last week. “It is happening in every state across the nation, and it is unacceptable.”
What did the advisory panel recommend?
The panel did not make specific proposals as much as offer a framework for the state’s vaccine distribution plan. The Health Department typically drafts recommendations for how it will distribute vaccines, submits them to the advisory panel, which provides feedback. In January, as the state was preparing to open vaccines beyond the 1A category, the advisory panel recommended that the Health Department prioritize subcategories of the state’s population based on indicators like the Area of Deprivation Index, which identifies neighborhoods at socioeconomic disadvantages. Doing so, Sederstrom said, would help ensure Black, Latino, and immigrant populations get vaccinated at more equitable rates.
Why are some doctors and advocates upset?
The state did not follow the advisory panel’s January recommendations, according to Chomilo and Sederstrom. “Instead the state just kind of opened it up for 65 and up in generic terms, which opened up the floodgates,” Sederstrom said.
“Healthcare systems and vaccination sites should be pressured and rewarded for prioritizing and delivering equity instead of rewarded for just getting shots into the arms that are easiest to reach,” Sederstrom and Chomilo said in their letter.
Chomilo added that the advisory panel has not met since January 11, and hasn’t heard directly from the Health Department since January 19.
What does the state say?
The health department spokesperson emphasized that the state and nation are in a race against time to vaccinate as many people as possible, and added that the state is trying to do so equitably.
“We have learned a lot in the first intense weeks of vaccine distribution in Minnesota,” the spokesperson wrote in an email to Sahan Journal, “and we are and will continually refine our approach to ensure we can vaccinate all Minnesotans and embed equity within the structure of the distribution process.” State officials also point to the state’s efforts to target thousands of weekly doses to Minnesota’s 17 federally qualified health centers, which serve around 200,000 low-income Minnesotans, the majority of whom are people of color.
What’s next?
The state will disclose vaccine data by race and ethnicity “in the next few weeks,” Ehresmann said on February 11. State leaders also maintain that the Minnesota COVID-19 Vaccine Connecter, which launched Thursday, will keep anyone who registers updated on when they are eligible to get vaccinated and therefore will go a long way to ensure equity. Malcolm said last week that her department would soon be setting up performance goals for health care clinics and pharmacies to collect race and ethnicity data, disclose it, and “show us your plans for specific outreach into some of these communities.”
*Correction: This story has been changed to note that Dr. Nathan Chomilo is also Minnesota’s medical director for Medicaid.
