Mary Barnett is one of about a dozen seniors who got a COVID-19 vaccine on a recent morning at Neighborhood Health, a clinic tucked in a sprawling public housing development on the south side of downtown Nashville, Tenn.
"Is my time up, baby?" Barnett, 74, asked a nurse, after she'd waited 15 minutes to make sure she didn't have an allergic reaction. Barnett, who uses a wheelchair, wasn't in any particular rush. But her nephew was waiting outside, and he needed to get to work.
"Uber, I'm ready," she joked, calling him on the phone. "Come on."
Seniors of color like Barnett are lagging in COVID-19 vaccinations, and the Biden administration plans to redirect doses to community clinics as soon as next week to help make up for the emerging disparity. Tennessee is one of a few states already allocating vaccines to the network of clinics known as FQHCs, or federally qualified health centers.
In most of the states reporting racial and ethnic data, a KHN analysis found that white residents are getting vaccinated at more than twice the rate of Black residents. The gap is even larger in Pennsylvania, New Jersey and Mississippi.
The Biden administration will distribute up to a million doses to federally funded clinics to start with — at least one in every state — which is enough for 500,000 patients to get both doses, said Dr. Marcella Nunez-Smith, who leads the Biden administration's COVID-19 Health Equity Task Force.
"Equity is our North Star here," Nunez-Smith said at a briefing Tuesday, announcing the vaccine shipments to the federally funded clinics. "This effort that focuses on direct allocation to community health centers really is about connecting with those hard-to-reach populations across the country."
Eventually, 250 community clinic sites will participate. The administration said roughly two-thirds of those served by FQHCs live at or below the poverty line, and more than half are racial or ethnic minorities.
Seeking people out
In Nashville, more than a third of eligible white residents have gotten their first shot, compared with a quarter of Hispanic residents and fewer than one-fifth of Black residents.
Unlike many local health departments, Neighborhood Health is not fending off crowds. They're seeking people out. And it's slow work compared with the mass vaccination campaigns by many public health workers and health systems.
Barnett lives in a public housing complex that gathered names of people interested in getting the vaccine. She was lucky to have her nephew's help to get to her appointment; transportation is a challenge for many seniors. Some patients cancel at the last minute because a ride falls through. Often, the clinic offers to pick up patients.
Aside from logistical challenges, Barnett says, many of her neighbors are in no rush to get their dose anyway. "I tell them about taking it, they say, 'Oh no, I'm not going to take it.' I say,' what's the reasoning?'"
Usually, Barnett says, they don't offer much of a reason. Her own motivation is a sister with kidney disease who died of COVID-19 in July.
"You either die with it or die without it," her brother told her in support of getting the vaccine. "So if the shot helps, take the shot."
A new chapter in the same story
People of color have made up an outsize share of the cases and deaths from the pandemic nationwide. And, predictably, the same factors at play driving those trends are also complicating the vaccine rollout.
Rose Marie Becerra received an invitation to get the vaccine through Conexión Américas, a Tennessee immigrant advocacy nonprofit. A U.S. citizen originally from Colombia, she's concerned about those without legal immigration status.
"The people who don't have documents here are nervous about what could happen," she says, adding they worry that providing personal information could result in immigration authorities tracking them down.
And unauthorized immigrants are among those at the highest risk of COVID-19 complications.
Even with 1,300 total community health centers around the country, Neighborhood Health CEO Brian Haile says his 11 clinics in the Nashville area can't balance out a massive health system that tends to favor white patients with means.
Haile says everyone giving vaccines — from hospitals to health departments — must focus more on equity.
"We know what's required in terms of the labor-intensive effort to focus on the populations and vaccinate the populations at the highest risk," Haile says. "What we have to do as a community is say, 'We're all going to make this happen.'"
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