At issue is the rate at which people of different races and ethnicities are getting the COVID-19 vaccine compared with their overall population in a given county. The Observer's analysis of state data released last Friday found significant racial and ethnic disparities in urban, suburban and rural counties, and from the coast to the mountains.
Among the findings:
- Black people are underrepresented in at least 77 of 100 N.C. counties.
- Such disparities even appear in six counties where Black people comprise the majority of the population: Bertie, Hertford, Edgecombe, Northampton, Halifax and Warren.
- White people were most over-represented in the vaccine rollout compared with the overall population in Swain, Mecklenburg, Guilford and Durham counties.
- Hispanic residents are underrepresented in at least 93 of 100 counties.
- And in the 27 counties where Hispanics account for 10 percent or more of the population, they are underrepresented in 26 counties, including Cabarrus, Catawba, Chatham, Durham, Johnston, Mecklenburg and Union.
At a news conference Tuesday, Gov. Roy Cooper said Black people accounted for 18 percent of those vaccinated in North Carolina last week, up from 11 percent four weeks ago.
"This is an improvement, but there is more work to be done when North Carolina's population is 22 percent Black," Cooper said. "We're working to address those inequities. We can start by making sure every community has access to these vaccines."
And while new cases statewide have moved down from post-holiday peaks, North Carolina just passed a grim milestone, reporting more than 10,000 COVID-19 deaths since the pandemic first hit the state last March.
New Data, Big Concerns
North Carolina was one of the first states to release demographic data for vaccinations, DHHS Secretary Dr. Mandy Cohen said Tuesday. The state began releasing that data at a county level on Friday.For its analysis, the Observer reviewed first-dose vaccination rates by race and ethnicity for all 100 counties, in data reported to the state as of Feb. 4.
(In some cases, the state did not have data for every race or ethnicity category per county, either because the population size is so small there were privacy concerns or not enough demographic information was provided to the state. But based on the population and reported vaccination rates of other races, the Observer was able to estimate if there appeared to be an under-representation of a minority group in some of those counties.)
The details offer a snapshot in time for vaccination rates by race and ethnicity at the county level, in the midst of the vaccine rollout.
Asian residents represent a small slice of the state's total population. But in counties with the highest Asian population rate — Orange, Wake, Mecklenburg and Guilford — all were under-represented in vaccine participation.
Or consider Duplin County, north of Wilmington, about an hour from the coast. It had the greatest disparity of any county when it came to the rate in which Hispanics were getting vaccinated. Hispanic people comprise 22 percent of the population there but just 2 percent of those vaccinated so far. Meanwhile, white residents account for about half the population and three-fourths of the people vaccinated in Duplin.
Duplin County Health Services officials were not available to comment.
The Government Should 'Step It Up'
Héctor Vaca, organizing director for Action NC, isn't surprised to hear that Black and Latinx people are underrepresented in the vaccine rollout."It's terrible," Vaca said of the disparities. "It has a lot to do with the system and the way it's designed. Certain more affluent communities get the news a lot easier and have access to this."
Vaca said "the system" was designed to prioritize white people, leaving marginalized communities as "an afterthought."
That echoes the thoughts of local Black leaders. Charlotte-Mecklenburg NAACP President Corine Mack and the Rev. Willie Keaton told the Observer last week they weren't surprised there was a disparity in vaccine access at the state level.
Keaton called the disparity a "manifestation of institutional racism."
"We have a divide when it comes to access," Keaton said. "We shouldn't be surprised. It's just reality."
In Charlotte, Vaca said, local entities like hospital system Novant Health have been working to address the inequities. But the state and federal government need to make a greater effort to address the issue, he said.
That should include broadcasting state news conferences live in Spanish, along with the currently broadcast English and sign language, Vaca said.
"We're always an afterthought, especially immigrants," he said. "...We need our government to step it up."
Disparities in Charlotte and the Triangle
Strong race and ethnicity disparities also are found in the state's biggest urban centers around Charlotte and Raleigh, the Observer's analysis found. For instance:- In Mecklenburg County, Black residents account for 31 percent of the population, but just 16 percent of the vaccinations. Meanwhile, white residents are 47 percent of the population and received 72 percent of the vaccines so far.
- Hispanic people in Mecklenburg, who comprise 13 percent of the population, received 4 percent of the vaccinations.
- Union County is 11 percent Hispanic, but just 4 percent of the vaccines have gone to Hispanic people there.
- In Wake County, Black people make up 20 percent of the population, and 12 percent of those receiving the vaccine. White people are 60 percent of the residents, and account for 76 percent of those getting the vaccine.
- Durham County is 36 percent Black, and so far, 21 percent of the vaccines went to Black people there.
Working to Ease Tensions
The state is now asking local providers to prioritize equity in vaccine distribution by ensuring vaccines go to marginalized communities at rates that meet or exceed the county's population estimates for those groups, Cohen said.And the state is setting aside a portion of weekly vaccine allocations to go to events focusing on under-served communities, she said.
In Charlotte, hospital systems Atrium Health and Novant Health have both launched initiatives targeting vaccines to marginalized communities.
Atrium's mobile vaccine effort has vaccinated more than 1,800 people — 61 percent of those people were Black and 10 percent were Latinx, Cohen said. And Novant hosted a vaccination event at the Park Expo & Conference Center last week, partnering with the Park Church, one of Charlotte's largest African-American churches.
Mecklenburg County Public Health is also working to get more vaccines to marginalized communities through community vaccine clinics, Deputy Health Director Raynard Washington said in a statement.
"Public Health and our local vaccine partners are committed to equitably distributing COVID-19 vaccines in our community, including among our Hispanic residents," Washington said. Later this week, the county will hold a vaccine clinic in partnership with the Camino Community Center, targeting the Latinx community, he said.
In the Triangle, 16 Raleigh churches held mass vaccine events recently to whittle away at the disparity in vaccine distribution.
The partnership between WakeMed and Wake County Public Health provided 1,700 vaccinations at the churches and a community center in Southeast Raleigh, the (Raleigh) News & Observer reported.
"By placing it in the community, in the care of trusted community partners such as churches and other community partners, it eases the tensions and the concerns of the community," Pastor Joe Stevenson of Macedonia New Life Church told the paper.
Mistrust and Access
There are a number of potential reasons for vaccine disparity among marginalized communities, Novant Health infectious disease expert Dr. David Priest told reporters Tuesday.Access to transportation can be an issue, Priest said. And some people in marginalized communities may not have had access to health care resources in the past, or don't have a regular primary care physician.
Novant Health is targeting vaccines to marginalized communities by making sure materials are translated into Spanish, and setting up community vaccination events.
"The state and all the health care systems are working on that," Priest said. "... I think that's going to get better, but it certainly is a part of everyone's strategy."
And some may be hesitant to take the vaccine due to mistrust, Charles Evans, president of the N.C. Association of Black County Officials, said at a state health news conference this week.
"Some Black and brown citizens may mistrust the vaccine," Evans said. "And I understand why, based on long-standing and continuing racial and ethnic injustice in our health care system. I trust the vaccines because they have been tested — they are safe and effective.
"If we are going to gain control of our lives, we need to get vaccinated," he added.
But Vaca said that while some people may be hesitant to get a vaccine, that is not the only reason for inequity in distribution. In fact, most people Vaca hears from say they want the vaccine.
"What I've been hearing (from the Latinx community) is they want to get vaccinated," Vaca said. "They want to be able to go back to work, they want to have their families be safe."
Some health experts say the way groups are prioritized for vaccines could be a reason for the disparity.
Right now, the state is offering vaccines to health care workers, residents and staff at long-term care facilities, and anyone age 65 and up. People in those groups in North Carolina may be predominantly white, UNC School of Medicine professor of social medicine Rebecca Walker told the Observer.
Looking for Fairness
The makeup of eligible groups also could explain a disparity in vaccine distribution in Cabarrus County, Cabarrus Chief Community Health Officer Marcella Beam told the Observer in a statement.Approximately 10 percent of the county population is Hispanic, census estimates show, placing it among 27 counties with a Hispanic population of 10 percent or more. But only 3 percent of people getting the COVID-19 vaccine in Cabarrus have been Hispanic, according to state data.
Meanwhile, whites make up 66 percent of the population, and have had 83 percent of the vaccines in the county.
Cabarrus Health Alliance community partners have reported that most people in the Latino community in Cabarrus are not over the age of 65 — so they are not yet eligible for shots, Beam said.
"We anticipate having a larger opportunity for vaccine administration when we hit (the next eligible group), but we have to start education and engagement now," Beam said.
That next group will include front-line essential workers. Black and Latinx workers are much more likely to work in those roles, according to a community survey by advocacy group Action NC on the effects of the COVID-19 pandemic on Latinx, Black and immigrant communities.
But access limitations will still remain, Vaca said. That's why the state's initiatives to increase equity will be so important in the coming weeks.
"Once they have access to it, we start seeing more equity," he said. "We start seeing more fairness."
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