One year into the COVID-19 pandemic, the rollout of vaccines against the disease has revealed a light at the end of Austin's coronavirus tunnel. But that proverbial light is not shining brightly on everyone.
Since last spring, the COVID crisis has exposed and entrenched Central Texas' long-standing health and social disparities. The worst impacts of the disease – the highest rates of infection, hospitalization, and death – have been among communities of color, for several reasons. As essential workers, Black and Latinx Austinites have endured greater risks of contracting COVID and then transmitting it within their households. Concurrent chronic medical conditions such as hypertension and diabetes have increased the risk and severity of COVID infection. And residents in disadvantaged neighborhoods throughout East Austin and the outlying Eastern Crescent (the arc of settlements around and beyond the SH 130 toll road) have less access to health care services. While Latinx Austinites account for just over one-third of Travis County's population, they account for nearly half of COVID-related deaths, according to Austin Public Health data.
These disparities persist as vaccines are slowly but surely distributed throughout the metro area. Data from the Texas Department of State Health Services shows 12.9% of Travis County's Hispanic population is fully vaccinated as of March 15; only 2.4% of the county's Black population is fully vaccinated. Using state data, as of March 2, the 78617 ZIP code (Del Valle, the area around Austin-Bergstrom International Airport) has received the fewest vaccine doses per 1,000 people of all Travis County ZIP codes, according to Matt Worthington, a vice president of the Del Valle Community Coalition and a senior project manager for data initiatives at UT-Austin's LBJ School of Public Affairs. As COVID-19 continues to ravage these communities, city and county leaders, grassroots orgs, and local health agencies are searching for immediate solutions.
"There's a lot of conversations right now about the inequities with the vaccine, but the inequity started a long time ago," says Paul Saldaña. Last spring, the veteran organizer and politico, formerly an Austin ISD trustee and a top aide to late Mayor Gus Garcia, reactivated the local nonprofit Austin Latino Coalition, which he co-founded in 2013, to address gaps in the local pandemic response. At first, those gaps involved access to personal protective equipment and COVID-19 testing across the Eastern Crescent; now, Saldaña and other community leaders see the same barriers to vaccine access, with a registration and notification process that's mostly online.
The Del Valle Community Coalition is a member of Saldaña's ALC. Its president, Susanna Woody, a Del Valle ISD trustee, says an online system is a challenge for residents without reliable internet access, or for English-language learners or the elderly without much digital proficiency. "It's harder for our people of color ... to access and to understand what's going on without having somebody walk them through [it] step by step," Woody told us on a Saturday afternoon earlier this month.
We were standing outside a Valero gas station in Creedmoor near one of Southeast Travis County's colonias – unincorporated areas that lack residential drinking water – as DVCC members and volunteers gave out food, water, PPE, diapers, and other essentials to residents driving through. The event was part of the ALC's "Uplift Austin" campaign across the Eastern Crescent, with community groups distributing $200,000 worth of supplies donated by Procter & Gamble. Such relief distributions have been regular grassroots events for ALC and DVCC throughout the pandemic (and also during last month's winter storm), so they could be promising places to connect with the residents hardest-hit by COVID-19 to get them in the queue for vaccines.
However, both Saldaña and Woody feel the city and county (which jointly operate Austin Public Health) are overlooking such opportunities, with potentially life-altering consequences for the people they represent.
Woody, who with DVCC has long pushed for better infrastructure, fresh food, and health care facilities in Southeast Travis County, says the agencies that have vaccines to administer "need to make a bigger effort into getting out to the people, going to those communities, instead of having the communities come to them." She and Saldaña both note that in areas that have historically been long neglected, working with the people and groups whom neighbors know is vital to gaining their attention and then their trust. For vulnerable residents in Del Valle, even knowing the dangers posed by COVID-19, making time to get vaccinated isn't high on the priority list, said Woody. "Going to work, feeding their families, that's important to them."
The Texas vaccine allocation program overseen by DSHS has, at least until now, been unable to provide enough doses to meet local demand and need, even with rationing measures to limit eligibility to high-priority groups. With three vaccines now authorized and available, including the new Johnson & Johnson jab that only requires one shot, and ramped-up federal efforts to get vaccines to retail pharmacies and grocers nationwide, both public and private providers eagerly anticipate large influxes of vaccine into Travis County. President Biden last week announced his goal to make all U.S. adults vaccine-eligible by May 1.
Until scarcity is no longer the norm, though, vaccine prioritization remains complicated and only partly within the control of local policymakers. There are more than 350 registered vaccine providers in Travis County, but Austin Public Health is the largest, consistently receiving 12,000 weekly doses of the two-shot Moderna vaccine since DSHS first designated it in January as one of Travis County's two "vaccine hubs." The other is UT Health Austin, the clinical arm of UT's Dell Medical School, which only gets 2,000 doses a week, many of which have gone to local health care workers. These hubs were intended to serve the most people possible, outside of clinical settings, with the limited amounts of vaccine available.
As a public health agency, APH is typically a safety-net provider of vaccinations for low-income and uninsured residents (it also works to control tuberculosis and sexually transmitted infections, including HIV, for all Travis County residents). Its regular outreach efforts, such as for seasonal flu shots, do target those burdened by existing health inequities. But as a hub, APH is required by DSHS to make the COVID-19 vaccine available to all eligible residents, which now includes an array of essential workers, anyone over 50, and adults with existing conditions that increase the risk and severity of the disease. For nearly three months, APH has effectively been the only option for hundreds of thousands of vaccine-eligible Austinites who've been urged to not delay getting their shots, a group that DSHS is allowing to grow larger without actually providing more doses to its hubs.
In recent weeks, Travis County has coordinated weekend events at a mass drive-through vaccine site at Circuit of the Americas, which lies between Del Valle and Creedmoor, to shoulder some of the burden that had been falling on APH. The COTA drives, which also reach nearby Bastrop, Hays, and Caldwell County communities, use doses allocated to Ascension Seton and CommUnityCare, the region's largest providers of care to the uninsured and medically underserved, and have sought to reach their patients as well as local educators and child care workers.
Recently, APH outlined two possible scenarios for the weeks ahead to Austin City Council and the Travis County Commissioners Court. If more vaccines are distributed by retail pharmacies and private health care providers as well as through the public and nonprofit agencies, 85% of Travis County (the upper threshold for herd immunity) could be vaccinated in 12 weeks, according to APH Director Stephanie Hayden-Howard. Alternatively, mass distribution events facilitated by APH, scaling up the current efforts at its sites and at COTA, could get the county to herd immunity in eight weeks. That plan could cost between $1.8 million and $2.5 million per week to cover staffing, with an additional $400,000 per walk-up or $800,000 per drive-through per month.
Beyond those scenarios, "the strategy is really out of our hands," Interim Health Authority Dr. Mark Escott told the Chronicle. "What we can infer from what the federal government has done is that it's likely they [will] increase allocations to the private sector, to the pharmacies, to the clinics, to the other traditional settings where people get vaccinated, rather than ... to the hub sites." City and county leaders have concerns that scenario would continue to miss people in Eastern Crescent communities that lack those access points. But Escott thinks that path could also free up resources to concentrate on "people from low-income communities, folks that don't have health insurance, our communities of color – those who normally depend on Austin Public Health. All of our resources can be focused on those individuals [at] smaller sites which are closer to home" – in other words, meeting people where they are, within the community, as Woody urges.
Council Member Vanessa Fuentes, whose majority-Latinx District 2 includes Del Valle and other hard-hit Southeast neighborhoods like Dove Springs, is bringing a resolution to Council on March 25 directing City Manager Spencer Cronk to find funding for mobile vaccine clinics, as well as for ongoing COVID-19 relief, and to mount outreach programs to employers of at-risk workers to encourage support (and time off) for vaccinations. Ideally, said Fuentes, a mobile vaccine clinic would serve walk-up patients without pre-registration through an online portal, which would address challenges APH knew it would face: "I feel like we should have been at a different place right now. We should have been more proactive and planning for vaccine distribution," Fuentes told us. APH says it's discussing partnerships with agencies such as Meals on Wheels Central Texas and Foundation Communities and with private vendors to implement mobile vaccine clinics.
The barriers and gaps to vaccine equity involve more than just physical and digital distance. Last week, Sendero Health Plans – the nonprofit health insurer created by Central Health, the taxing district that also provides funding to CommUnityCare and UT Health Austin – released a study exploring concerns and hesitations among its members about getting a COVID-19 vaccine. In a survey of 1,648 Sendero members, Black respondents were 47% less likely than non-Black respondents to say they plan to get their shots; those who identified as Mexican, Mexican American, or Chicano were 15% less likely than others. "There's a lot of people that are scared," said Latino HealthCare Forum Chief Operating Officer Isabel Lopez. "There is a lot of hesitation, and we want to find out why."
As with larger health disparities, the reasons for this vaccine hesitancy are varied. Some people are simply misinformed, said Lopez, believing they need to pay for the vaccine or have health insurance to receive it. Some people living with chronic conditions (such as diabetes, hypertension, and kidney disease) are afraid the vaccine will make them sicker. But mistrust of the health care system, with a legacy of medical racism and mistreatment that hasn't entirely been left in its past, is a baseline reality among communities of color.
Latino HealthCare Forum is also collecting data at community events like those put on by Austin Latino Coalition and, through working with Central Health and CommUnityCare, is helping residents register for vaccination. Its community health workers – in Spanish, promotores – gain feedback that helps LHCF shape its own outreach strategies. (The DVCC is also collecting data on community attitudes toward the COVID-19 vaccine; although similar to LHCF's objectives, it's a separate effort, part of a $25,000 outreach grant awarded to the coalition by APH.) LHCF leaders see these workers, typically women who receive training and support to educate members of their own communities, as a powerful front-line force to bridge COVID-19 equity gaps.
"They are the ones that can take the message back to the community – people know who they are, they are trusted," explained LHCF CEO Jill Ramirez, herself a state-certified promotora. "They also understand the barriers the community has, and so they will not [put on] activities or say things that make no sense to the community." CommUnityCare and other safety-net clinics (such as People's Community Clinic and El Buen Samaritano) and APH also employ community health workers, who Hayden-Howard says are already registering residents; LHCF not only employs but, through its PromoSalud program, also trains many of Austin's promotores, which it describes as a "core competency" of the nonprofit. "The thing is, one organization cannot address everything," said Ramirez. "We need to look at each organization: What is their strength, and what do they bring to the table? So that you have a well-rounded plan with lots of different organizations doing what they do best."
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