Will children of color get vaccinated at the rates of other kids? Experts say equity is key

Now that a COVID-19 vaccine is available for children as young as 5 years old, community leaders, clinicians and officials are ramping up grassroots efforts to ensure children of color have equal access to the shot.

The rollout charges forward at drug stores, pediatrician offices, family health clinics and hospitals. But access may be challenging for some, as an estimated 53% of children throughout the nation lack a medical home, according to a Kaiser Family Foundation analysis in 2019. Doctors said the barriers adults in communities of color faced in getting vaccinated are likely to be mirrored in children of color.

“We obviously had disparities with their parents, so why shouldn't we have disparities with their kids?" said Dr. Georges Benjamin, executive director of the American Public Health Association.

From living in pharmacy deserts to neighborhoods without pediatric care, underserved children, often Black and brown, face complex barriers to getting the shots. And they have been most vulnerable to COVID-19. 

Since the start of the pandemic, Black, Hispanic, American Indian and Alaska Native children were hospitalized more often than white children, according to the Centers for Disease Control and Prevention.

About 37% of children ages 5 to 11 hospitalized with COVID-19 were Black, and 31% were Hispanic, compared with 22% white, according to a CDC analysis. Underlying conditions were most often asthma or obesity, the report found. Both conditions disparately affect children of color.

Though severe illness, hospitalization and death from COVID-19 are rare among children, those of color suffer disproportionately, and getting children vaccinated equitably is essential to community protection, experts said.

As soon as the Pfizer-BioNTech vaccine was authorized for younger kids, Sara Bode, a pediatrician at Nationwide Children’s Hospital in Columbus, Ohio, said the majority of appointments for shots weren’t made by inner-city parents surrounding the main downtown hospital.

Most of those 3,000 slots were filled by parents of children in suburban, well-off white neighborhoods, said Bode, director of school-based and mobile clinics in the capital of Ohio, a state where about 45% of children statewide lack a medical home.

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“Our children’s hospital is downtown – it’s in an urban, underserved area. But when we are tracking who is coming to our main clinics to get the COVID vaccine, it’s really not that population that lives around the hospital,” she said. “What we’re seeing is when we have this mass clinic site at the hospital, it’s not really serving (those) families. … We need to have a different way of reaching those families. That’s not going to work.”

Bode said along with mobile health units, the hospital’s 13 satellite clinics and 14 school-based clinics will be key to vaccinating children in Black and brown neighborhoods where families primarily rely on Medicaid.

The health system hosts evening hours and “vaccine days” at schools – a “trusted” place and ideal space to meet underserved kids where they already are, Bode said.

In Texas, about 56% of children lack a medical home. In Dallas County, where pharmacy deserts are a barrier, health officials hire temporary community health workers and send them to vulnerable census blocks with lower vaccine coverage rates, said Dallas County Health and Human Services Director Philip Huang, a physician.

A biweekly internal analysis helps health officials determine specific neighborhood blocks to focus outreach, pinpointing elementary schools and churches in those areas.

“We can actually see … where the different levels of protection are,” he said. “We’re trying to be as data-driven as we can.”

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The county works with schools, hospital systems, community health clinics and churches to recycle the grassroots efforts to reach adults of color.

“We’ve been most successful where we really coordinate the outreach and education, then mobilizing" trusted leaders, Huang said.

Mass text messaging lets residents know of pop-up vaccination sites in the neighborhoods, he said.

Marissa Castro Mikoy, director of the Jubilee Park and Community Center that serves a majority-Black and Hispanic neighborhood in southeast Dallas, counts on its after-school program and door-to-door approach to reach children of color.

“The neighbors know us and trust us – that’s what we leverage and use,” Mikoy said.

For the past 25 years, the center has served families in ZIP codes where adults are more likely to have diabetes and shorter life expectancies, according to community health assessments.

"Our communities of color are not getting vaccinated at the rates that they should be," she said, adding the center is not going to rely "on folks going to a doctor’s office that they don’t have."

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Along with giving shots at the center’s after-school program, staff work with the Visiting Nurses Association and a national vaccine initiative, Communities Rise Together, to bring on more community health workers and give vaccines to kids at home.

“Now that kids are eligible under 12, we’re going to use our after-school programs,” Mikoy said. “We’ll target those families, but in addition, we’ll also do the door-to-door walking with an extended team that we haven’t had before.”

Hesitancy is another huge barrier communities grapple with as misinformation runs rampant.

IllumiNative, a national nonprofit aimed at increasing Native American visibility and representation, awarded $30,000 grants to 13 Indigenous organizations throughout the Great Plains, Arizona, the Midwest, Alaska, Oregon and California. The grants support on-the-ground and digital vaccine outreach campaigns in Native communities, a second phase of the group's vaccine outreach initiative, For the Love of Our People.

From tapping into young Native American TikTok influencers to supporting Native children service centers in rural reservations, the campaigns aim to adapt to each community's needs.

"It's very iterative. We're really looking for feedback. It's rapid response," said Crystal Echo Hawk, executive director. The nonprofit's surveys have found large-scale national campaigns ineffective, she said. "We really need to empower local communities and local organizers to really get out and do that one-on-one, peer-to-peer work."

The strategies are focused on combating misinformation among parents, supporting youth ambassadors and integrating vaccine pop-ups into events for children, she said.

Bode said many Black parents in Columbus communities have been afraid their children would have long-term fertility issues from the shots – a myth that’s done damage, as 12- to 17-year-olds of color have lower vaccine rates in the city.

Even so, there's an advantage with that age group: Teens could have conversations with their hesitant parents to allow them to get vaccinated. That's not so much of an option for younger children who are eligible, Bode said.

“We’re not even going to have that patient-level driver. Your 10-year-old is not going to be begging their parents to get this vaccine, whereas a 17-year-old might have their thoughts and ideas about that," she said.

At the South Minneapolis Community-University Health Care Center in Minnesota, a state where about 47% of children lack a medical home, doctors leverage the trusted relationship they have with families and work with charter schools in diverse neighborhoods.

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The center serves low-income families, a patient base of mostly people of color, including East African immigrants, Hmong families and Native people.

The center sends mobile health units to schools and mosques, but one-on-one conversations with parents to reassure them about the shots' safety for kids come first, said Dr. Roli Dwivedi, chief clinical officer.

“The biggest challenge is going to be the consent part when it comes to the vaccine. The parental consent will be needed,” she said. “A lot of times what happens is people of color are an afterthought. And what we are trying to do is be proactive and be out there as a trusted entity.”

Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers in California, echoed Dwivedi, saying the coalition's doctors, nurses and community health workers have found investing time in parent-clinician conversations most effective.

“Misinformation continues to be the biggest barrier, and no longer can you address the misinformation via a Facebook post or an ad in the paper or a community meeting. It has to be one-on-one conversations,” said Becerra, whose coalition serves many low-income, uninsured or Medicaid-covered Latino and Hispanic families, as well as Asian people.

Along with hosting vaccine events at schools and during evening hours and weekends when working parents are off, the center sends flyers home with kids that include information for parents. Mass parent notification text systems provide phone numbers for community health workers ready to answer concerns or questions.

The flyers and messages signal to the parent: “Here’s a number. Here’s a doctor, an expert, who is open and willing to take your call," Becerra said.

Reach Nada Hassanein at nhassanein@usatoday.com or on Twitter @nhassanein_.