Helping Underserved Communities in the Fight Against COVID-19

April is National Minority Health Month, led by the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) and its partners. They urge both organizations and individuals to help racial and ethnic minorities, American Indians, and Alaska Natives achieve better overall health, while also finding ways to reduce the many healthcare disparities still faced by these groups.

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This year’s theme, “Give Your Community a Boost!,” is all about continuing to battle COVID-19—still a very real threat, particularly for older and immunocompromised people as well as communities of color. It is important that we as clinicians continue to discuss the significance of taking preventative measures and seeking medical care when needed.

COVID-19 is not over in the United States or around the world, and minority groups have been hit hard by the virus. Yes, the situation has improved in the past two years with testing, masking, social distancing, vaccines, boosters, and treatments. But new variants and subvariants continue to emerge, while just under 66 percent of the U.S. population is fully vaccinated, and only 45 percent has received a booster shot.

COVID-19 has also exacerbated chronic healthcare disparities among minorities, and we need to explore what can be done to help reach the goal of equitable care for all.

Statistics Tell the Tale of Deep-Seated Inequities

At the beginning of the pandemic, the Kaiser Family Foundation found that communities of color were at greater risk of both health and economic challenges because of the virus. Its early analysis indicated that people:

• Had a higher risk of serious illness if they contracted COVID-19 because they are more likely to have underlying health conditions than Whites; and
• Would have more difficulty accessing COVID-19 testing and treatment since they’re less apt to have health insurance or easy access to care than Whites.

Between March 2020 to 2022, the Centers for Disease Control and Prevention (CDC) found that overall COVID-19 hospitalization rates per 100,000 people have been highest for American Indian or Alaskan Natives, Non-Hispanic African Americans, and Hispanic or Latino Americans. In fact, all racial and ethnic groups had higher hospitalization rates than non-Hispanic White people in nearly every age category.

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) pointed out the “double jeopardy” of COVID-19 and behavioral health disparities experienced by African Americans and Latino Americans, noting that those groups already had limited access to prevention, treatment, and recovery services for substance use disorders prior to the pandemic. The report also reminds us that African Americans and Latinos with mental health and substance use disorders are more likely to be incarcerated and homeless—not exactly in the ideal circumstances for social distancing, hand washing, and self-quarantining. Plus, many behavioral health and addiction services have been impacted by the pandemic, some closing temporarily or permanently, or offering only online resources.

Promising Behaviors and Trends Have Emerged

Some non-White communities have made strides in their response to COVID-19. For instance, non-Hispanic American Indians and Alaska Natives have achieved the best first-dose and full vaccination rates of any racial or ethnic group since the program began in our country last year. Alaska Natives and American Indians—particularly vulnerable populations—responded positively to culturally appropriate communications, clear messages that resonated with their expectations, and efforts to gain their trust. An abundant supply of vaccines and a distribution guided by community leaders also helped increase their vaccination rates.

The latest data shows that racial disparities in vaccination rates have actually reversed for Hispanic Americans. From April 2021 until March 2022, the difference between White and Hispanic vaccination rates (13 percentage points) disappeared, and now Hispanic people have a slightly higher vaccination rate than White Americans.

There is evidence that vaccine hesitancy is changing among the African American community, too. A study published in JAMA Network Open found that over time, African Americans have become less hesitant to get COVID-19 vaccines than Whites, despite the fact that both groups initially had about the same level of intention to be vaccinated. But the African American community’s increased interest in being vaccinated has not yet translated into higher vaccination rates than Whites, due to the lack of vaccine access that African Americans face.

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Boosters Are Necessary tools in Our Medical Kit

It has been difficult enough to get all of our citizens to embrace vaccination against COVID-19. Now, we face the added challenge of convincing those who are vaccinated to get booster shots. People who have been inoculated against tetanus, diphtheria, and pertussis (Tdap/td) get boosters every 10 years. But with the virulence of COVID-19, and still much unknown about how it will change over time, we cannot wait that long to be boosted against this virus. As we receive more information on the effectiveness of COVID-19 vaccines, we have learned that while they are valuable in fighting against infection, hospitalization, and death, they lose efficacy over time.

While variant-specific boosters are being developed, getting a third dose of the existing vaccines can help reduce the transmission of COVID-19. And for all Americans ages 50 and older, the U.S. Food & Drug Administration (FDA) has now added the option of a second booster of the Moderna or Pfizer-BioNTech vaccine. It is also recommended for individuals ages 12 and over who are immunocompromised. For our citizens in these categories, boosters are especially important when you live in a multi-generational household, or with someone who has one or more chronic diseases. These scenarios are more likely to occur among our African American and Hispanic populations.

Can Our COVID-19 Respose Kickstart the Demise of Healthcare Inequity?

We must continue to pursue the enormous challenge of erasing the established disparities in our healthcare system. My colleagues and I are committed to advancing the physical and mental health of all of our citizens, both at home and around the world. Innovative thinking, thorough planning, and targeted action are all necessary elements to successfully meet this challenge.

The SAMHSA report outlines four areas in which we must focus our energy to reduce COVID-19 and behavioral health disparities for African American and Latino communities:

• Policy efforts
• Communication, health literacy, and public awareness
• Community partnerships, and
• Healthcare workforce and practice efforts

How can we best address each of these interwoven subjects? From a policy perspective, we need better data on COVID-19 tests, hospitalizations, ICU admissions, and deaths—categorized by race and ethnicity—to improve resource allocation. There must also be more flexibility in treatments, from payments for telehealth visits to the allocation of take-home methadone for people with substance use disorders. Communication will be more effective if materials are updated regularly in multiple languages, using culturally appropriate terminology, and then circulated through numerous channels accessed by all communities.

Many communities also rely on faith leaders and places of worship for information, support, and spiritual leadership; the key word here is “trust.” Admired and respected, faith leaders are known for extending their messages beyond religion, providing a space to build community, and addressing physical and mental health issues affecting African Americans and Latinos in particular. This includes explaining the importance of COVID-19 vaccinations and boosters.

To relieve our overburdened healthcare workers, we should expand telephone and video visits, open clinics where at-risk groups live to eliminate transportation barriers, and expand the workforce to include those with whom patients feel more culturally connected.

So during National Minority Health Month, let us all “boost” our efforts to address the imbalance of healthcare in our country, both physical and mental. Volunteer where and when you can. Give your neighbor or friend a ride to a COVID-19 booster clinic or offer to register them for an appointment. With deliberate action by individuals, private businesses, and government at all levels, together we can celebrate significant change in the years to come.