Over the last 13 weeks, more than 175,000 COVID-19 vaccines have been administered in Jefferson County. But in that time, a rather troubling picture has begun to emerge about those who are receiving …
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Jeffco residents who are currently eligible for vaccination but having trouble scheduling an appointment can call 303-239-7000 and press option 1.
Resources to find an appointment can also be found at www.jeffco.us/4247/JCPH-COVID-19-Vaccination-Clinics
Over the last 13 weeks, more than 175,000 COVID-19 vaccines have been administered in Jefferson County. But in that time, a rather troubling picture has begun to emerge about those who are receiving the doses of the still-limited vaccine and those who are not.
Numbers “a concern”
On Feb. 23, Jefferson County Public Health Executive Director Dawn Comstock told the county’s board of commissioners that it had become clear early in the vaccination effort that persons living in Jeffco communities with a relatively lower risk of COVID-19 disease were “having better success at getting vaccinated.”
At the same time, those communities with a history of higher COVID-19 hospitalization rates had lower vaccination rates at that point.
“That’s concerning to us and something that we are definitely working to address,” said Comstock.
Among the most significant concerns, Comstock said, were the disparities between the number of white residents over 70 who had been vaccinated and those of other races.
Comstock said that as of Feb. 23, 70% of county residents over the age of 70 had received at least one vaccination. In contrast, only 50% of the Black, non-Hispanic 70-plus population in Jeffco had received one.
Even worse, Comstock said, was that among the county’s Hispanic population in that age group only 20% of residents had received a shot.
“We recognize that is a very concerning disparity and we now have numbers to be able to start looking at that and the maps to be able to identify which specific geographic areas have been most hard hit and we are starting to address that,” Comstock said.
Those numbers have improved somewhat since that meeting with 62% of Black and African residents 70-and-over having received a vaccination as of March 3. However, they remained stubbornly low for Hispanics with just 23.1% of that 70-plus population having received a vaccine.
In contrast, the percentage of White residents who had received a vaccine was at 74.5% while those falling into the “other groups” category have the highest rate of vaccination at 85%.
Comstock also cautions that there is one limitation to the data that is important to keep in mind when considering those numbers: people are able to choose whether or not to disclose their race.
As of Feb. 23, the number of vaccine recipients in the county declining to do so was 11%.
“That does make it difficult for us to really accurately gauge these race and ethnicity distribution patterns of vaccine,” said Comstock.
“We know traditionally there are some racial and ethnic groups that are a little more hesitant to disclose their race on these documents and if that 11% disproportionately includes them we might be doing slightly better than these numbers show,” she added.
Still, even if that 11% consisted solely of minorities, there would still be a significant discrepancy between vaccination rates for white residents and Hispanic or Black residents.
Lack of trust presents a challenge
That continued discrepancy in vaccination rates is likely the product of public health systems that have consistently failed to connect with minority populations, said Paulina Erices, the manager of JCPH’s Whole Community Inclusion program, which was created last year to ensure that COVID-19 efforts were effectively responding to the needs of minority populations in Jeffco.
“It’s not just that we don’t do a good job getting to them,” said Erices. “It’s that we don’t have relationships — authentic trusting relationships- that will support trust between these communities and the formal systems of care.”
The need to build those relationships is what led JCPH to create the Whole Community Inclusion program, which is staffed by five full-time employees as well as volunteers who work as navigators to connect minority residents with resources.
The program is currently undertaking several efforts to encourage and help more Jeffco minorities to get vaccines, including offering Spanish language navigation services for eligible residents trying to set up a vaccine appointment.
However, Erices said the county has also been involved in lobbying the state to consider how vaccine eligibility is determined so to ensure and increase equity. For example, Erices said the program has been advocating to expand eligibility for vaccines to unlicensed childcare providers, which she says provide more than 50% of childcare in Jeffco but were not made eligible when licensed providers were. Many of those providers are minorities, she said.
As part of its efforts to reach more minorities, JCPH will also be transitioning away from its central vaccine distribution center in Arvada to focus more on targeted vaccination efforts, including those that would target underserved populations.
The central site in Arvada has worked well for serving anyone who has the ability to get there but is not the best option for those Comstock called “transportation challenged.”
“We will be working with our community partners to go into community sites with admittedly smaller but more targeted efforts intentionally trying to address the equity we are seeing, that’s where we will be evolving our efforts,” Comstock said.
Other efforts include working with community-based organizations to better reach priority populations and encouraging residents to sign up for vaccination efforts organized by the Colorado Department of Public Health and Environment specifically aimed at improving equity of access. Comstock said multiple such events have already taken place in Jeffco and more are planned.
However, Comstock said JCPH knows even those efforts won’t reach every member of an underserved group.
“We are trying to approach it from several fronts but if there is somebody at home who is frustrated we encourage them to call our call center and we will try to get them connected to assistance,” she said.
Inclusion program manager optimistic
Erices, meanwhile, said she is optimistic that the vaccination rates for Jeffco’s minority populations will increase as the process continues.
That’s in part, she says, because she finds that while minority residents often tend to have a lot of questions about the vaccine and misinformation they may have been exposed to, she finds that they express interest in getting the vaccine after talking to her staff.
“They just need to receive information in a way that they trust and can understand,” she said. “But once they get that information in a way that works for them, they are very, very likely to want to get vaccinated and I am not seeing huge hesitancy in our work.”
Meanwhile what hesitancy does seem to exist is often a result of “people from other cultures and other communities sharing information “in a way that is not culturally relevant or not timely or just that they do not trust,” she said.
However, a bigger issue is that minority communities often are not connected to traditional providers like Kaiser Permanente or one of the local hospitals, which presents additional barriers as people do not have experience communicating with those providers.
“The systems are not friendly at all,” she said. “The website is complicated to navigate, on the phone you have to make so many selections before you can talk to someone and, of course, people hang up the first time.”
But even as Erices said she believes Jeffco’s minority vaccination rates will increase as community knowledge and confidence grows, she feels a focus only on numbers obscures the true significance of the work that her program and JCPH are doing — as well as the magnitude of what still needs to be done.
That’s because building community trust, repairing past damage and building successful relationships with the community it serves means the Community Inclusion program is, and must be, involved not only in efforts to encourage vaccination but also to provide much broader support to minority communities as they whether the pandemic.
For example, early in the pandemic, the program held sessions to help teach residents how to use Zoom.
“Comparing the data that’s only related to vaccine to work that is involving vaccine, life, heart, education, access to health care and years of disappointment is just not fair,” she said. “I really wish in the data we present we could include everything that is related to this work.”
Another significant challenge, Erices said, is that JCPH only manages a small quantity of the vaccines allocated to the county, with hospitals, pharmacies and other providers responsible for the bulk of it.
Given that reality, JCPH’s role is to try to influence those other providers to take into account the special needs of underserved populations by working with community organizations that already strong ties to minority communities, to ensure residents are getting vaccines when they are eligible.
It’s a difficult task, but inroads are being made, Erices said.
“It’s hard to establish but we are getting there,” she said. “Now that there is more vaccine available we can get that moving but before that everyone was so tied up with who could and couldn’t get the limited vaccine that there wasn’t much being done to reach out to those populations yet.”
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