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When Sahan Journal last spoke with Dr. Nathan Chomilo, the state had just released vaccination rates by race for the first time, after much anticipation.
This came in early March, two months into the state’s rollout of the COVID-19 vaccine. The results, by many measures, were dismal.
Black, Latino, and Asian people were all receiving vaccines at rates that trailed their percentage of the statewide population. Racial equity advocates like Chomilo argued that people of color should be getting vaccinated at higher rates than their population share because their communities suffered from COVID-19 disproportionately.
“Anything lower than demographic representation should trigger swift and notable changes,” Chomilo, a pediatrician for Park Nicollet and medical director for the state’s Medicaid program, told Sahan Journal at the time.
Then, just two weeks later, the Minnesota Department of Health tapped Chomilo to do just that. He’s been the state vaccine equity director ever since, leading Minnesota’s statewide strategy to get shots into the arms of more people of color.
Yet today, more than two months and a couple of million vaccine doses later, the racial gaps in Minnesota vaccination rates still persist. This, despite the fact that COVID-19 vaccines are now widely available.
As of May 8, the most recent date available for data, 57 percent of white Minnesotans received at least one dose of vaccination against COVID-19. Yet among Minnesota’s Black, Hispanic, and American Indian adults, slightly less than 40 percent have received vaccines. Asian adults, however, beat all other racial categories with the highest vaccination rate in Minnesota, nearly 61 percent. Similar trends persist across the nation.
Sahan Journal caught up with Chomilo to ask him, among other things, for a progress report on the “swift and notable” changes to vaccine distribution that he called for in early March.
Chomilo described “notable changes,” and pointed to a statewide strategy to target communities that rank high on the federal Social Vulnerability Index.
This index measures the demographics and socioeconomic status of different communities. A community with high social vulnerability may lack resources and contain higher-than-average poverty rates, for example. Neighborhoods with high social vulnerability rankings also often show low vaccination rates, Chomilo said, and often hold higher populations of color.
The state is targeting these high-ranking areas with mobile vaccination clinics and COVID-19 information drives. It’s also working to find Medicaid enrollees who aren’t yet vaccinated and provide them with resources like interpreter services and transportation to a clinic in order to encourage them to get a shot. And it’s looking into providing incentives like grocery vouchers for unvaccinated, low-income residents.
Sahan Journal spoke with Chomilo about these efforts and more. The following conversation has been edited and condensed.
With COVID-19 vaccines now easily accessible, why do gaps in vaccine distribution by race persist in Minnesota?
The gaps persist for a number of reasons. Just based on how we made our initial eligibility decisions, those decisions disproportionately favored communities with older, whiter individuals. Then opening up the vaccine to everyone 16-plus at the end of March. So we’re still playing catch up because of these decisions.
There’s also some information catch-up that we’re still playing. A lot of folks aren’t tracking this very closely. You know, every day there’s something in the news about COVID. And they’re kind of going out and about their regular day. Initially, they may have heard that shots wouldn’t open up to all folks until May.
Even though that eligibility opened up fairly early, I think there’s still a segment of the population that didn’t realize it right away. I don’t have specific data for this, but national polls show that there is a gap not only with access to the vaccine, but access to information about the vaccine.
We see this in our Black and Hispanic communities in particular. I’ve even seen that somewhat in practice when talking to parents. Even a couple weeks ago, at the end of April, some parents were surprised. They didn’t know that it was already open to everyone. I think that’s part of it.
Physical access to vaccines is less of an issue now. But that’s only been the case for about two weeks or so, when we’ve started to have more walk-ins available.
That also doesn’t get at some of the barriers around folks who are working. Some folks have concerns about missing work because they might experience a day or two of side effects from the vaccine.
We’ve had one story from one of our community sites where a guy got his first shot, had some mild side effects, and his employer got mad at him. He was having trepidation about getting his second shot because he didn’t want to miss any more time and potentially lose his job. So I think those are the type of barriers right now.
Last week, the Minneapolis Health Commissioner during a city council meeting said her numbers are showing that 71 percent of white Minneapolis adults had at least one dose compared with 28 percent of Black adults and 35 percent of Hispanic adults. That suggests a much wider gap in Minneapolis than statewide. Do your numbers square with this?
We don’t track by the city level. We are looking at zip codes. I can look at a map and tell you that there are definitely zip codes in Minneapolis where we see rates below 40 percent. We can also look at census tracts, where we see some rates even below 30 percent still.
We’re making those links to help guide our outreach, and where we decide to put mobile vaccine units or partners to do pop-up clinics.
Where are the census tracts and zip codes you cited where you’re seeing vaccination rates at 40 percent or less?
These are in census tracts all across the state. Pretty much every corner of the state besides the northeast—from Duluth on, which is actually doing well—have census tracts that are still in those lower areas.
What is the state doing to close these gaps?
Starting with mobile clinics, this week we have six buses running, which is our full fleet. Each bus can run four days a week and deliver up to 150 doses per day, using either Johnson & Johnson or Moderna shots. They’re being deployed to areas with a high Social Vulnerability Index and low vaccination rates.
We’re trying to see how we can potentially pair some incentives along with the mobile sites. We’re looking at things like food vouchers with grocers to help meet folks with multiple needs. Because that’s another thing that often comes up. Getting a vaccine isn’t the only need that folks are having at this time. So how can we pair those things?
We’re working with our community pop-up sites, which are working with a lot of our federally qualified health center partners, to identify areas to have pop-up clinics. Some just for one-time clinics and some on a more regular basis.
For example, Minnesota Community Care, an FQHC on the east side of St. Paul, has been working with the Neighborhood House in the Wellstone Center to do a pop-up clinic every Wednesday through June. And that’s also a place with a food shelf and other resources. We’re trying to match pop-up clinics with places where folks are already going to kind of get needs met, and give them an easy way to get their shot.
How are you getting the word out about these opportunities?
There’s been some questions about that. Because earlier on, when there was more demand than supply for the vaccine, there was some intentionality to not blast it out to everyone. We were really trying to have these opportunities be focused in the communities that they were intended for.
There’s still some communities that prefer to have word spread through the community, so through that we use our COVID community coordinators, in addition to that, our COVID community engagement contractors, as well as our diverse media vendors. We’re trying to use our relationships that have been developed throughout the pandemic to put these messages out.
Another tool that I’m exploring more in the coming weeks is combining Town Hall–style question-and-answer sessions with actual vaccine opportunities where folks can come in, get their questions and concerns addressed, and then if they feel ready, get a vaccine right there. I think that type of closer pairing of information with availability will help. The hope is that we’ll get more vaccines into physician offices, so doctors and nurses and other providers can have those conversations with the patients who trust them.
We are launching a partnership this week with our health plans who serve Medicaid enrollees. They’re going to be doing really targeted outreach. They’ve submitted their list of members to our database, so then they can see the members who haven’t gotten their COVID-19 vaccines, and then target them.
They can share information about the vaccine, hear concerns folks might have, and schedule them for a vaccine or let them know where, close to them, are walk-in opportunities, and even arrange transportation if needed through their Medicaid benefit to help them get access to the vaccine.
Also, if they need interpreter services, that’s another thing that they usually have identified in their Medicaid records.
State statistics show Asian American Pacific Islanders are getting vaccinated at the highest rates of all races in Minnesota. What do you think explains this?
I think there’s been a lot of great organizing, so I definitely recognize that. The community has really done a good job kind of creating different opportunities and getting the word out about it.
I do know that when you look at areas with a low Social Vulnerability Index, that’s where you see a lot of the higher vaccination rates amongst Asian Americans. And when you go to areas with a high Social Vulnerability Index, Asian Americans have a gap similar to what you see with African American and Hispanic Minnesotans.
I think some of it is because none of these racial categories are super precise. When you are trying to kind of define a community, there’s so much heterogeneity within each of them. When a part of them is better resourced to get the shots, you can get a false sense of security.
CAAL put out that report looking specifically at the impact of COVID-19 among Karen and Hmong refugees in particular, and how that their data is much different, particularly in certain zip codes. That’s some of the similar patterns we’re seeing.
When we last spoke, before you became the state’s vaccine equity director, you said any data showing people of color getting vaccinated at rates lower than their demographic representation in the state should trigger “swift and notable change” to how the state distributes vaccines. Vaccine inequality still exists today. Is the state making swift and notable changes to close those gaps?
I would say notable changes. We are making equity metrics and making specific goals for our vaccinators and our state to reach in efforts to really disproportionately give the vaccine to communities that have been hit hardest by COVID-19. That’s what I was talking about last time and still believe.
Equality in vaccination rates is not equity, because the COVID-19 pandemic has not equally impacted communities in Minnesota. It’s had disproportionate impact in our Black, Indigenous, Hispanic, and Asian communities. It’s had a disproportionate impact on communities of lower incomes. The data that MDH has put out for close to a year now show that the burden of cases, hospitalizations, ICU admissions, and deaths have all been disproportionate—when you adjust for age—in communities of color in Minnesota.
I’d say there’s been notable action so far on trying to address these gaps.
With any vaccination campaign, you’re going to have an upper ceiling. You’re not going to get 100 percent of folks vaccinated in our current environment, in our current political public health discourse around vaccines. To some extent, it’s going to be really hard to drive those numbers a lot higher, proportionately, at this point, amongst adults, at least.
My hope is that as we start vaccinating more of the teens and then younger kids, that we do a better job of not seeing those gaps emerge. Or if they do, they’re much smaller, and it gives us a chance to catch up quicker.
As vaccine equity director, how much power do you hold making and guiding these policy decisions?
Power can mean a lot of different things. I don’t have final say. I’m a senior advisor to the state health commissioner and the governor’s administration. I bring them my proposals and it gets decided from there.