ct post: advocates: ct’s new covid vaccine plan could worsen inequities

Gov. Ned Lamont announced this week that everyone age 16 and over would be eligible on April 5, with prioritization for people with medical conditions that put them at a higher risk of COVID complications.

But questions persist if high-risk individuals would need a doctor’s note or medical records to get priority.

“There are communities where access to a primary care physician is difficult, and I think to ignore that would be disingenuous,” Thompson said. “There are people right now who don’t have access to a primary care physician.”

Answers to questions like that will be key, advocates say, if high-risk patients living in vulnerable communities won’t be left behind.

“Even though they are high risk, they might not be prioritized in this plan,” Thompson said.

State officials said Tuesday that vaccine providers would be in charge of the logistics and details. According to Ohm Deshpande, of Yale New Haven Hospital, those details are not yet fleshed out.

“There is no clarity yet,” he said. “The goal is to not have an inequitable process. Any sort of construct that we come up with will have to be equitable.”

The difficult question is determining what puts someone at higher risk of a severe COVID-19 infection.

The Centers for Disease Control and Prevention has a list of medical conditions that increase a patient’s risk of a severe reaction to the coronavirus infection, but there has been no agreement yet among Connecticut’s vaccine providers if that list will be followed, and how a patient might prove they are at greater risk.

People with pulmonary disorders, obesity, or who smoke cigarettes are considered “at risk,” according to the CDC, but Thompson noted that people of color have borne the brunt of the pandemic from the start, dying at greater rates from the virus than their white neighbors.

“I don’t even think we can take race out of this,” she said. “This is not a race-neutral issue.”

Kathy Flaherty, executive director of the Connecticut Legal Rights Project, said she was not in favor of the state’s initial age-based rollout, but this week’s shift without any “specificity” has raised some ire.

“Going back and forth with no guidance, no specificity about what any of that means,” she said. “I have people asking me what that means, and I’m like, ‘I have no clue, go ask the governor.’”

Flaherty said she expects any system designed to help people at risk because of a disability, a medical condition or race to be exploited.

“We have laws to protect us that people with privilege will use to their advantage,” said Flaherty, who advocates for people with disabilities. “People of means will always figure out a way to manipulate a system to their advantage.”

As for how it will work, Deshpande said, “The simple answer is, I don’t know yet,” though equity will be “at the top of our list of priorities.”

“Just because you have a PCP (primary care physician) should not give you a leg up,” he said.

There have been efforts to prioritize ZIP codes in the state with a resident population considered vulnerable, those that fall high on the CDC’s social vulnerability index, and those goals “continue to be a strategic imperative,” Deshpande said.

But as providers now are structuring a system in which people more at risk have easier access to vaccines, those efforts will have to be “redoubled,” he said.

Requiring access to a primary care provider is one way a system could exacerbate existing health care inequities, Thompson said. People “should not be hindered by the fact that they don’t have a regular PCP.”

She and Flaherty suggested a sort of honor system, where a patient would schedule their own vaccine appointments and not be required to prove that they have a high-risk condition.

“What you could have done and what they did in other places is, you literally have people attest,” Flaherty said. “Will some people cheat? Yes, because some people always cheat.”

Jerry Smart, a community health worker in New Haven working with patients recently released from prison, said that lack of trust is also a concern.

“The Black and brown community really don’t trust the health care system,” he said.

There are issues accessing physicians and transportation, but people like Smart and Latoya Benton, a Bridgeport-based community health worker, often bridge that gap between patient and doctor.

“If you already have a doctor, it’s easy to prove what you have because it’s all in the records,” Benton said.

Another problem is finding those people who fall through the cracks, who have lost trust in the health care system or have no fixed address, and making sure they know they can get vaccinated sooner if they have a preexisting condition.

“Right now they’re trying to get the word out,” Benton said. “It’s harder for the community to know where to get the vaccine, and what days to get the vaccine.”

The solution, according to Smart, is not to ask people to go get a vaccine, but to send vaccines where the people are.

“Some people just don’t have cellphones. Some people don’t have addresses,” he said. “You have to get your troops out there, meet the people where they’re at. That’s how you have to do it.”