Health officials consider changes to Virginia’s vaccine distribution strategy amid concerns over equity

By: - February 22, 2021 12:03 am

Nurses wait in numbered stations to administer the Moderna COVID-19 vaccine at Richmond Raceway in Richmond, Va., February 2, 2021. (Parker Michels-Boyce/ For the Virginia Mercury)

Fairfax County is ranked as one of the wealthiest communities in Virginia. It’s also one of the healthiest. 

As of 2020, Fairfax led the state in measures including length of life, access to exercise opportunities and low rates of poor health indicators such as smoking and adult obesity, according to annual rankings by the Robert Wood Johnson Foundation. From 2015 to 2019, the county’s median household income was $124,831 (nationally, it’s around $68,703, according to the U.S. Census Bureau).

Currently, Fairfax County is also leading Virginia in vaccine distribution. In late January, health officials shifted the state’s strategy, routing doses through local health districts based on their percentage of the state’s population. As Virginia’s largest locality with more than 1.1 million residents, that left Fairfax with the largest share. 

Even before then, the Fairfax County Health Department had requested — and received — more than eight times as many shots as other local health districts, according to data from the Virginia Department of Health. From Dec. 22 to Jan. 23, Fairfax received a total of 74,625 doses. Over the same time period, the Richmond-Henrico Health District, received a total of 19,550 doses for both localities, which have a combined population of nearly 560,000. 

As Virginia continues to struggle with limited weekly vaccine allocations and a slower-than-expected rollout, the state’s population-based distribution strategy has begun to raise questions from residents and lawmakers in smaller areas with worse health outcomes or a greater proportion of vulnerable workers.

That includes Del. Lashrecse Aird, D-Petersburg, who secured an additional 2,000 doses for her constituents from VDH. 

Del. Lashrecse Aird, D-Petersburg. (Ned Oliver/Virginia Mercury)

The vaccines will be prioritized for residents 65 and older at a Friday clinic, but Aird said questions remain about vaccine allotments.

“I’m not saying Fairfax County doesn’t need vaccines,” she said. “But ultimately, their community is healthier overall.” 

“That’s not equitable,” she continued. “So, the one thing I tell people is that this vaccination clinic is a one-time event for now, but we’re not done having this conversation.”

Aird said she’s heard the same concerns raised by leaders in small communities across Virginia, where vaccine allotments are lower despite the fact that a large percentage of their residents are living in poverty or working in frontline jobs that put them at greater risk of contracting COVID-19.

Petersburg, for example, is part of the Crater Health District, which covers three cities and five counties south of Richmond. The district serves roughly 150,000 residents, but includes many predominantly Black communities with low incomes and poorer health outcomes.

“Petersburg is 133 out of 133 in health rankings,” Aird said. Other parts of the district, including Hopewell, Emporia and Sussex County, are also ranked low. 

But Crater has struggled to administer vaccines compared to much of Virginia, and the district has received a lower share than many other areas of the state. The disparity has attracted the attention of U.S. Rep. Donald McEachin, D-Richmond, who said in a letter sent in early February to state Health Commissioner Dr. Norm Oliver and vaccine coordinator Dr. Danny Avula that “rural communities and communities of color will be hardest hit by a lack of coordinated distribution and administration efforts.”

Aird said historically strained resources in the largely low-income community, coupled with a shortage of staffing at local health departments, also complicated distribution efforts in Crater. But like other legislators, she’s questioned basing vaccine shipments solely on population.

“When you look at the basic question of what is equity, it means you can’t just treat everyone the same,” she said. “Because there are already existing disparities that are going to make the approach you’re taking inequitable.”

Much of the criticism has stemmed directly from the state’s own emphasis on fairness when it comes to vaccine distribution. “It’s really important to make sure that equity is baked into our vaccination program,” Gov. Ralph Northam said at a news briefing in late January, emphasizing that available shots should go to Virginians who are most vulnerable to severe illness.

Health officials say those include not only residents over the age of 65, but “frontline essential workers” such as grocery store clerks and bus drivers. Addressing existing gaps in vaccination rates has also been cited as a key priority for state leaders. 

More than half a million vaccine doses have been administered in Virginia with no accompanying race or ethnicity data — making it difficult to determine if shots are being given out equitably. The state also hasn’t released data on vaccine refusal, so it’s unclear if minority residents are seeking out the shots less frequently (though health experts worry that already limited supply will further constrain efforts to educate and vaccinate those communities).

But available numbers indicate that nearly 680,000 White Virginians have received vaccines compared to 113,676 Black residents and 53,375 Latino residents. Top health officials have repeatedly urged providers to collect the data, describing it a vital tool for the state’s distribution strategy.

“This information is critical for helping us understand gaps in vaccination coverage so we can follow up with targeted education and ensure equitable access to COVID-19 vaccination in Virginia,” Oliver wrote in a recent clinician letter. Data from the Virginia Department of Health shows that Black and Latino residents have borne a disproportionate percentage of COVID-19 cases and hospitalizations compared to their share of the state population.

The state’s often-repeated goal of distributing vaccines to areas that need it the most have made its current population-based strategy confusing to Virginians like Kathleen Smith — another Petersburg resident who has taken note of the city’s low share of vaccines compared to its high percentage of people living in poverty.

“You’re comparing apples — which is population — to oranges, which is all those categories for prioritization” Smith said. “And in some areas, that’s created problems. In Petersburg, we have so many essential workers who are grocery store clerks and fast food workers because we’re high-poverty. We don’t have a middle class in Petersburg that’s been working from home.”

State health officials say they’re also in the process of reconsidering the state’s distribution strategy. Avula has emphasized that the limited supply of doses makes it particularly challenging to develop an equitable framework given the number of Virginians clamoring for doses — from seniors to teenagers with chronic health conditions that raise their risk for severe illness.

But he also acknowledged that the current population-based model doesn’t always account for underlying risk factors and socioeconomic determinants of health within different communities. Over the past few weeks, Avula said VDH has driven nearly 10,000 doses to localities who were behind in vaccinating assisted living and other congregate care facilities.

Moving forward, he said the state was working to develop a more “systematic” model for distribution that considered factors beyond size — though there isn’t a clear timeline for implementing it. 

“That could be things like the weight of your 65 and up population,” Avula said. “Or perhaps we look at either just racial distribution or we look at hospitalization and death rates in particular communities.”

“The distribution will get more nuanced as we move forward,” he added. “But right now, there’s just so many high-risk folks and so little vaccine.”

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Kate Masters
Kate Masters

An award-winning reporter, Kate grew up in Northern Virginia before moving to the Midwest, earning her degree in journalism from the University of Missouri. She spent a year covering gun violence and public health for The Trace in Boston before joining The Frederick News-Post in Frederick County, Md. While at the News-Post, she won first place in feature writing and breaking news from the Maryland-Delaware-DC Press Association, and Best in Show for her coverage of the local opioid epidemic. Before joining the Mercury in 2020, she covered state and county politics for the Bethesda Beat in Montgomery County, Md.