Letter to Dr. Marcella Nunez-Smith, Chair of the Biden-Harris COVID-19 Health Equity Task Force - Duckworth, Booker Request Guidance from Biden-Harris Health Equity Task Force on Addressing Disparities in Covid-19 Vaccination Rates

Letter

Dear Dr. Nunez-Smith:
We write to respectfully request that the Biden-Harris COVID-19 Health Equity Task Force (the
Task Force) provide guidance and recommendations to States, localities, territories and Tribes on
best practices to address disparities and eliminate inequities in COVID-19 vaccinations. We are
encouraged by the actions that the Biden administration has taken thus far in addressing this
devastating public health crisis, which has killed more than 528,000 Americans. We look
forward to continuing to work with you on behalf of the many communities that continue to be
underserved and face disproportionate impacts from COVID-19.
The COVID-19 pandemic has wreaked havoc on millions of individuals and families across the
country, but it has highlighted longstanding disparities in our healthcare and economic systems.
With respect to COVID-19 hospitalizations and deaths, Black people in this country are about
three times as likely to be hospitalized from illness caused by the virus SARS-CoV-2 compared
to white Americans, and twice as likely to die. These disparities are even worse for
Hispanic/LatinX and American Indian / Alaska Native people. Older adults and people with
disabilities are also more likely to become severely ill and die from COVID-19. For example,
people with intellectual and developmental disabilities are three times more likely to die from
COVID-19 when compared with all other patients with COVID-19.
Given these data, which provide only a small glimpse into the overall disparate impacts that the
pandemic has had on underserved communities, it is important that policymakers, public health
officials and providers work together with--and are informed by--the impacted communities so
that the COVID-19 vaccine rollout is equitable. President Biden and Vice President Harris took
an important step towards this goal by establishing the COVID-19 Health Equity Task Force, to
"help ensure an equitable response to the pandemic." The Task Force is only one facet of the
administration's COVID-19 response, which also includes (among other things) improving data
collection and reporting and providing COVID-19 vaccines directly to community health centers.
However, gaps in data reporting remain, and people in underserved communities continue to face
hurdles in getting vaccinated. As of March 1, 2021, race and ethnicity data were available for
about 54 percent of people who had received at least one dose of a COVID-19 vaccine. Further,
of this group, only 7 percent of people were Black, and 9 percent were Hispanic, despite having a
disproportionate number of COVID-19 cases and deaths compared to white people. Nonelderly
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people with disabilities in particular, many of who live in congregate settings and receive longterm services and supports, continue to be left out of many States' vaccination prioritization
plans, despite being disproportionately impacted by COVID-19.
There have also been several barriers to getting the vaccine for many Americans at the State,
local, territorial, Tribal and vaccination site level, which are contributing to these disparities.
Such barriers include:
 vaccination misinformation campaigns targeting communities of color;
 online-only appointment signups being inaccessible for people who do not have computer
or internet access;
 appointment signups requiring hours in one's schedule to spend in a "virtual waiting
room";
 websites being incompatible with text-to-speech software for individuals who are blind or
low-vision;
 language barriers online, on the phone and in person; and
 difficulty getting to and from appointments due to lack of transportation, not being able
to take off work or vaccination sites being open for limited hours, especially as local
clinics and providers have struggled to gain access to the vaccine due to supply
limitations.
It is important to note that systemic and structural racism have created, and continue to
exacerbate, these and other challenges.
Currently, there is a confusing patchwork of recommendations, guidance and practices across
States, localities, territories and Tribes regarding who should get the vaccine when, how to sign
up, where to get vaccinated and what to bring to the appointment. Further, recognizing the need
to ensure an equitable distribution process that centers the hardest-hit communities, many States
and other jurisdictions have been implementing certain policies, only to find that these solutions
themselves can perpetuate inequity.
Mounting a coordinated, equitable response to address this historic public health crisis has been,
and continues to be, a challenge for stakeholders at all levels, from policymakers to frontline
workers. However, public health departments at the State, local, territorial and Tribal level are
particularly essential in coordinating that response. We therefore respectfully request that the
Task Force engage communities of color, people with disabilities and other disproportionately
impacted groups and provide guidance and recommendations to States, localities, territories and
Tribes on best practices to eliminate inequities in COVID-19 vaccinations. Such guidance and
recommendations should take into account, at minimum, the following:
1. How should vaccine administrators report race, ethnicity and disability data regarding
COVID-19 vaccinations?
a. What specific steps should they take to provide as complete a picture as possible
on who is getting vaccinated?
b. Are there barriers to collecting and reporting this information, such as privacy
concerns, lack of provider training, workforce capacity or legal limitations, which
may contribute to gaps in data reporting? If so, how can they be overcome?
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2. How should States, localities, territories and Tribes prioritize nonelderly people with
disabilities in their vaccination prioritization plans? What factors should be taken into
account?
3. What information should or should not be collected when a patient makes or arrives at an
appointment to get vaccinated?
a. Should vaccination sites or providers avoid collecting information from
individuals, such as Social Security numbers, proof of residence or identification
requirements, which would pose a unique barrier for certain communities?
4. What programs and services can State, local, territorial and Tribal governments provide
to help individuals arrange to be vaccinated, especially those who do not have a
computer, smartphone or internet, or who face other barriers with the current vaccination
signup systems?
5. What actions should State, local, territorial and Tribal governments take to make vaccine
information and appointment signups accessible for people with disabilities and people
with Limited English Proficiency (LEP)?
6. What steps should be taken to ensure that people in underserved communities, who may
not have the resources or ability to travel far from home, are able to get vaccinated?
a. Particularly as our vaccine supply increases, how can State, local, territorial and
Tribal governments ensure that vaccination sites are located in the communities
that have been most impacted by COVID-19?
7. What steps should be taken to provide transportation to and from vaccination sites, and
how should such transportation be paid for?
8. How should leaders and trusted members of the community be identified and engaged in
partnership to dispel misinformation, encourage and, as appropriate, administer
vaccinations?
9. How should individuals and communities be informed about the vaccine being provided
at no cost?
10. How should States, localities, territories and Tribes balance equity and speed to ensure
that no vaccine is wasted, such as when there are leftover doses at the end of the day?
We further urge the Biden administration to take concrete steps to ensure that public health
officials at the State, local, territorial and Tribal level have all the data and information they need
to make decisions regarding the equitable allocation and distribution of vaccines. Further, the
administration should continue to make available Federal resources and funding opportunities to
facilitate partnerships and collaboration between health departments, State and local agencies,
healthcare providers and other vaccine administrators and community-based organizations. We
also ask that you provide an update to Congress on the development of the aforementioned
guidance and recommendations.
While an increase in vaccine supply--which we also strongly urge the administration to quickly
provide--will help in getting our country back on its feet, we are concerned that inequities will
continue to grow unless we take specific and concrete steps to address them right now. We
appreciate your efforts and your timely response to this request.
Sincerely,