In COVID vaccination race, no one, especially the most vulnerable, should miss this shot

One of President Joe Biden's favorite COVID-19 lines works both as a rebuke of his predecessor and a clear plan of attack against the virus going forward: "It's one thing to have the vaccine. It's another thing to get it in people's arms."

Truer words never spoken. But the reality is that six weeks into Biden's term, even with three vaccines now available after emergency approval Saturday of the single-dose Johnson & Johnson shot, it's still another thing to get it in people's arms.

More than 50 million Americans have received at least one vaccination, at an average of 1.82 million shots a day in the past week. That's plenty to meet Biden's December pledge of 100 million injections in his presidency's first 100 days, but far short of the 2 to 3 million shots per day needed to reach herd immunity this year. (Biden flirted in January with raising the goal to 150 million in 100 days, but backed off.)

Most likely to get sick and die

Meanwhile, distribution has been cruelly uneven, cheating many of the people most likely to get sick and die out of a lifesaving immunization. This includes older Americans too befuddled by complex sign-up processes, essential workers too busy to keep refreshing websites for the elusive vaccination slot, and minority and rural communities too inaccessible for distribution.

Racial disparities have been jarring, according to Kaiser Family Foundation data: 40% of California residents who are Hispanic made up more than half of the state's COVID-19 cases and 46% of the deaths, but they have been only 18% of those vaccinated. Black people make up 30% of Maryland's population, 33% of COVID-19 cases and 35% of deaths, but they have been only 16% of those vaccinated. By contrast, white residents have received vaccinations at a percentage higher than their proportion of the population in most of the 34 states tracking the data.

How could this happen?

Look at what unfolded in Washington, D.C., when 7,000 vaccinations for people 65 and older were rolled out: 40% were snapped up by residents of the city's whitest and wealthiest ward that had suffered only 5% of the district's COVID-19 deaths. Experts speculated the disparity was because wealthy residents had more time and were more computer savvy when it came to grabbing online appointments, and Black and Hispanic communities were more skeptical about the vaccine.

'Let's not let COVID get us'

An equitable vaccination protocol can be disrupted many other ways: By a persistent anti-vaccine mindset. Or a historical hesitancy about government-driven health initiatives (as happens in the Black community). Or poor access to good health care and transportation.

Leaders at all levels need to be more imaginative about more thoroughly and equally distributing the vaccine. One good start recently was a plea by the nation's first Black and South Asian vice president, Kamala Harris, urging people of color to take the vaccine: "Let's not let COVID get us."

Biden should also set a more aspirational, if risky, goal of 2 to 3 million vaccines a day, something that could deliver the nation herd immunity by summer.

States and communities are working on ways to target hard-to-reach communities. In addition to mass vaccination sites and distribution through pharmacies, there's a Bronx initiative to set up vaccination sites in public housing. Fairfax County, Virginia, is offering free transportation to vaccine sites from far-out neighborhoods. Baltimore officials plan to go door-to-door to reach the elderly in housing projects. In Montgomery County, Maryland, health officials are prioritizing ZIP codes with high infection rates.

The new single-dose Johnson & Johnson vaccine that can be stored in a common refrigerator would be well suited for the offices of family doctors and community clinics. And to avoid instances where people game the system to cut in line, communities could offer a one-time sign-up with a weighted lottery for a more fair distribution.

The reality is that while COVID-19 rates have sharply declined, they remain as high as they were last autumn. And in many areas, the fall-off has stabilized. The nation is in a race against time as new, sometimes more dangerous, virus strains emerge every week.

It's a race where no one, particularly the most vulnerable, should be left behind.

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This article originally appeared on USA TODAY: COVID-19 vaccination equity: No one should miss their lifesaving shot