UNC Health finds that distributing COVID-19 vaccines fairly isn’t easy
UNC Lenoir Health Care, the hospital in Kinston, began offering COVID-19 vaccines to the public on Jan. 11 and soon noticed something about the people who were showing up.
Instead of locals from Lenoir County or even surrounding counties, the majority were from Raleigh, Cary and other communities in the Triangle, more than 80 miles away. In fact, 70% of the shots UNC gave out that first week in Kinston went to Triangle residents, while only about 10% went to people from Lenoir County.
“We pulled the data and could immediately see that, ‘Houston, we had a problem’ with who was getting the vaccine that the state had allocated to Lenoir hospital,” said Dr. Lynne Fiscus, president and CEO of UNC Physicians Network, which led the vaccination effort.
The same thing was happening at many of the other vaccination sites affiliated with a dozen UNC hospitals across the state. Even at the Friday Center in Chapel Hill, the largest share of vaccines that first week went to residents of Wake County.
Not only that, the people getting vaccinated were overwhelmingly white in communities that were much more diverse. At the Friday Center, just 1.5% of those being vaccinated the first week were Hispanic and 2.5% were Black, in an area where residents are about 20% Black, said Elizabeth Ramsey, who runs two UNC vaccination clinics in Orange County.
“It was pretty apparent in opening the doors at the Friday Center that the patients that were being seen were not representative of the community in terms of race and ethnicity,” Ramsey said.
Hospitals and public health departments across the state initially struggled to make vaccines accessible to everyone in the community. During that first week of public vaccinations, state Department of Health and Human Services data shows that only 2% of vaccines went to Hispanics, who make up about 10% of the state’s population, and 11% went to Blacks, who account for 22% of the state’s residents.
Increasing those numbers meant altering the strategy for distributing vaccines.
UNC changed how it scheduled appointments at its vaccination sites, to make it easier for local residents to get one. And rather than sitting back and waiting for people to come to it, UNC began reaching out to its patients and others in the communities it serves to invite them to get vaccinated.
The results have been dramatic. In Kinston, by early February, more than 86% of appointments were going to residents of Lenoir County, while the portion to people from the Triangle had dropped to 2.5%.
“We’re trying to figure out how to make sure we’re delivering vaccines to patients in a way that reflects the communities that we serve,” said Robb Malone, a pharmacist who has led UNC’s vaccination equity efforts. “Initially, that is not what we saw.”
Relying on the internet is easy but unfair
UNC officials say the advantage Triangle residents enjoyed initially can largely be explained by the internet. With the state under pressure to use up its allocations of vaccine so the federal government would keep sending more, UNC started out making all of its appointments online, in large part because it was easy. Almost as quickly as slots were made available, they would fill up, without much effort on UNC’s part.
“Automatically you see issues with that,” Malone said. “Not everybody has equal access to broadband or internet or smartphones or is internet savvy. So there are immediately large groups of people that were left out of that first wave.”
In addition, Triangle residents were willing and able to travel; were more likely to be established UNC patients, and had the time to devote to chasing down scarce appointments, Fiscus said.
“People who had stable internet connections, were digitally savvy and could sit on their computers all day and click refresh, refresh, refresh, waiting — those were the people who were able to access those appointments,” she said. “And those folks were highly concentrated in the Triangle.”
When word got out in Kinston that UNC was offering vaccines at a clinic near the hospital, residents began showing up without appointments, said Heather Rouse, who helped oversee the operation for the UNC Physicians Network.
“So many would come in. They’d say, ‘I’ve been trying. There’s not a number,’ and things like that,” Rouse said. “We were hearing from the community pretty early on.”
What residents wanted was a dedicated phone line, staffed by human beings, where they could make an appointment. UNC quickly established one and began sharing the number with local governments, school leaders and community groups, such as the Council on Aging. The hospital and physicians groups even put it on billboards where locals could see it.
UNC Lenoir began offering appointments exclusively by phone or in person, making them available online only if it had trouble filling them. UNC Lenoir hasn’t had to do that until this week, when it got an unexpectedly large shipment of vaccine, Rouse said.
Sure enough, many of those online appointments were snapped up by people from outside the county, she said.
“And within minutes,” she said. “It fills within minutes.”
Rouse says she has enjoyed meeting people from the Triangle through the vaccination process.
“We have had some of the most precious individuals I think I’ve ever met,” she said. “Some had not been out of their homes since March.”
Outreach and keeping it local improves diversity
But UNC Lenoir wants to serve its community, where residents vulnerable to the coronavirus couldn’t get vaccinated. In addition, giving shots to people close to where they live makes it more likely they’ll get the second dose needed to make it effective.
UNC has also found that making it easier for local residents to get an appointment and reaching out to Black and Hispanic residents through churches, community groups and physicians’ practices helps diversify who gets vaccinated. The goal, said Malone, is that people getting shots at UNC sites should match the demographics of the surrounding ZIP codes.
What that means in Kinston is that 41% of people getting vaccinated from Jan. 24 through Feb. 13 were African American, matching the county’s demographics. That compares to the first week, when everything was online and Triangle residents got the majority of shots and only 8.3% were African American.
Malone said UNC has achieved this without designating appointments for any individual or demographic group. But it takes work.
“What we’ve learned is that you have to be more patient,” he said. “The most efficient means for us to fill up slots to put shots in arms is to put everything online, and it will go. That would be efficient for us, but it would not serve our communities well.”
Similar strategies have helped hospitals and health departments across the state broaden the reach of vaccination efforts. At a press conference this week, Gov. Roy Cooper noted that 20% of people receiving first doses of vaccine statewide over the past month were Black, nearly matching their share of the state’s population.
“We continue to emphasize fairness in our vaccine distribution,” Cooper said. “We’ll continue pushing these efforts so that everyone, no matter what you look like or where you live, has a spot to get their shot.”
This story was originally published March 10, 2021 at 12:17 PM.
