Commentary: What vaccine distributive justice means for Black residents and other communities in Allegheny County

Four recommendations from a public health expert on how Allegheny County can reduce the toll of the pandemic and improve equity in vaccine distribution.

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A Black patient receives a vaccine

(Photo via Adobe Stock)

As the nation pins its hopes on the efficacy of vaccines to end the COVID-19 pandemic, we must take a realistic look at how we will reduce the raging spread of the virus in communities of color and ensure equitable vaccine distribution and access for the hardest hit populations in Allegheny County.

The COVID-19 case count in the United States has reached more than 16 million following the Thanksgiving holiday when the greatest number of people traveled by air since March of this year. COVID-19 is now the nation’s leading cause of death. With the virus running amok, hospitals are overwhelmed, and medical personnel are exhausted and overworked from coast to coast. 

For Black Americans throughout the pandemic, COVID-19 rates of hospitalizations and deaths have been higher, and case rates continue to rise at a disproportionate rate compared to white residents.

The unfortunate reality is that as goes the country so goes Allegheny County. In a coronavirus pandemic that spreads through contact with infected people, every opportunity to reduce the number of cases is an opportunity to keep more people safe and healthy. 

To this end and from my position as a professor of public health practice with a career spanning 40 years in the areas of human services, academia and public health, I call upon the county to implement four measures that will address the disproportionate impact of the COVID-19 virus on the Black community and to develop a plan that will inform equitable distribution of the vaccine to improve the safety of all residents and avoid “vaccine deserts.” It is crucial that the county establish trust with communities of color because of the historical harms caused by medical researchers on communities of color. 

Noble Maseru. (Courtesy photo)

I also invite our region to join me in applauding the county for its collaboration with community-oriented initiatives like Father Paul’s Neighborhood Resiliency Project, the Federally Qualified Health Centers, and The Black COVID-19 Equity Coalition. Working closely with entities that have long-standing and trusted relationships with residents is a proven formula for success. Such organizations have systems in place to reach a vast majority of people who call those communities their home. If these partnerships can be enhanced – let’s do so.

Now, let’s take a look at the numbers, keeping in mind these numbers represent people – souls. The numbers show an alarming situation in Allegheny County. 

New diagnoses of COVID-19 cases are spiking across the county. Between Nov. 25 – Nov. 27, Allegheny County diagnosed 1,642 new COVID-19 cases over that 48-hour period. More shocking, from Nov. 2 to Nov. 23 in some neighborhood clusters, total COVID-19 case count increases ranged from 243% to 1,333%. So, we know that the numbers are increasing at a rate that risks surpassing the capacity of government, community, and health care systems to manage. 

When we break the numbers down, we see that neighborhoods with the highest COVID test positivity rates are predominantly populated by Black residents and other persons of color. These neighborhoods include Larimer, Manchester, East Liberty and Homewood.

The Asian population COVID test positivity rate is 31% in Allegheny County, with the Bhutanese refugee population being particularly hard hit. As of Dec. 4, the 14-day positivity rate for COVID-19 tests among Black individuals was 30%. In some neighborhoods overall COVID-19 test positivity is as high as 50-76%. The Centers for Disease Control and Prevention [CDC] guidelines tell us that community spread is classified as “severe” when COVID-19 test positivity rates are 5% or higher. 

Due to longstanding and pervasive social inequities in Allegheny County, Black residents are more likely to live in multigenerational housing and to work in frontline and public facing jobs that could expose them to COVID-19. In addition, Black residents are the most likely in the county to contend with housing and food insecurity. 

Historical social inequities expose the Black community to increased risk of transmission. So when these residents must show up to their vital jobs at grocery stores and must travel via public transportation to provide services such as caregiving, they may well be (often unknowingly) also putting everyone with whom they come into contact at risk of contracting COVID-19. 

The question now, during the coronavirus pandemic’s resurgence, is what additional measures should the county consider in its approach to fighting the pandemic in these neighborhoods and populations at highest risk? 

We offer four recommendations.

Recommendation #1: A municipal COVID-19 expert advisory panel

Other local health departments have learned that utilizing expertise in the practice of health equity can improve effectiveness. This means employing a racial equity lens with targeted interventions and mitigation policies that enhance resources to lessen the burden of disease and death in communities of color.

We’re observing President-elect Joe Biden use this approach as he has surrounded himself with a diverse team of experts. 

We recommend that County Executive Rich Fitzgerald, with advice from Pittsburgh Black Elected Officials, appoint a Municipal COVID-19 Expert Advisory Panel. The panel would be comprised of subject matter experts to serve as a working group to assist the county in strategizing the response to the coronavirus pandemic. The panel would include experts from varying disciplines and socio-economic strata.

Recommendation #2: Distribution sites and prioritization of vaccination

The fact that a vaccine is likely to be available in the coming months to the general population is a testament to good science practice and incredible technology. It’s estimated the vaccine may become available to more than 100 million people in the United States in 2021.

Last week, the Food and Drug Administration authorized Pfizer’s COVID-19 vaccine for emergency use and the first doses are already being distributed to healthcare workers, including in Pittsburgh. The Pfizer vaccine, for example, requires a follow-up booster three-four weeks after the first shot.   There are other vaccine candidates nearing approval and emergency authorization usage. Each one comes from a different pharmaceutical company, with different reliability and effectiveness profiles and different requirements for infrastructure, operations, and staffing. This enterprise is very complex. The challenge will be to efficiently coordinate and vaccinate hundreds of thousands of county residents.

Bringing in community partners is a must, as trust in the vaccine and in distribution sites must be promoted to combat the skepticism and fear that exists in many communities of color based on historical patterns. Trusted partners will aid the county in making substantive health improvement and social equity decisions within these communities and will help keep all county residents safer at the same time.

Currently the Pennsylvania Department of Health establishes and directs the COVID-19 vaccination plan for all counties and regions. To date, Philadelphia is the lone exception. 

We recommend the county develop a COVID-19 vaccine distribution and management plan that would be vetted by the Municipal COVID-19 Expert Advisory Panel (recommended above) to determine and ensure equitable vaccine distribution and that vaccination sites are accessible equitably. 

The Pennsylvania Department of Health, which would need to approve a county-level plan, should have no less confidence in Allegheny County’s ability to devise and administer an equitable COVID-19 vaccine plan than they have for Philadelphia. 

Currently some pharmaceutical companies are contracting with commercial pharmacies and retail outlets such as CVS, Walmart, Walgreens, Kroger, Giant and Rite Aid pharmacies. Some of these sites are not in high-risk and vulnerable population’s neighborhoods. 

We don’t want to have vaccine distribution deserts. The county should consider alternatives such as dialysis centers as COVID-19 vaccination sites in hard-hit areas. Such places would cater to a captured high-risk conditions population that is also in the prioritization Phase 1A category.

We further recommend the county include community health workers, grocery retail clerks, and public transit employees as essential, critical workers, making them eligible to be in the Phase 1A priority group.

Recommendation #3: Wastewater surveillance

COVID-19 Wastewater-based disease surveillance is becoming widely used by water treatment plants and health departments as an early warning for emerging COVID hotspots, to complement existing COVID-19 individual testing and contact tracing efforts. This is an early warning tool with the overall goal of minimizing community spread. It can help determine COVID-19 infection in asymptomatic populations including congregate settings, schools, jails, and dense neighborhoods, thereby allowing a 5-10 day head start in mobilizing testing and care resources for the affected populations.

We applaud Pittsburgh Water and Sewer Authority Executive Director Will Pickering who is considering its value. A collaboration with ALCOSAN would be ideal.

We recommend the county assist in determining the feasibility of  wastewater surveillance as a mitigation strategy. 

Recommendation #4: Acquisition of federal assets and support

We strongly recommend that County Executive Rich Fitzgerald appeal to the Gov. Tom Wolf for an Epidemic Intelligence Science Officer [EIS] to be assigned to the Allegheny County Health Department [ACHD] from the Centers for Disease Control and Prevention and/or National Guard medical operations to coordinate and support planning for vaccine distribution. 

Given our observations of operations and the high COVID-19 positivity rates, we advise requesting additional aid now, rather than to be sorry later for waiting too long.  

We are at a COVID-19 mitigation crossroads regarding next steps in fighting this pandemic. We must choose the path that will lead to equitable and just vaccine distribution — and widespread acceptance of the vaccine — towards fulfillment of the goal of social equity. Indeed, the health and well-being of all residents here in Allegheny County may depend upon it.

Noble Maseru, Ph.D., MPH is professor of public health practice, director for social justice, racial equity and faculty engagement at the University of Pittsburgh Schools of the Health Sciences. Maseru is former health officer and health commissioner for the cities of Detroit and Cincinnati. He can be reached at nomaseru@gmail.com.

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