Dr. Manuel Pastor
Originally published in the California Health Report

California and so many other states initially launched an inequitable vaccine distribution system.

Consider that once we got beyond vaccinating health care workers, the emphasis was on inoculating those over age 65. That makes sense in terms of the risk of death, but a simple glance at California’s demographics reveals a major shortcoming: 56 percent of California seniors are white, but two-thirds of those of prime working age — those most likely to be exposed to COVID-19 — are people of color.

Add to that a vaccination enrollment system that privileged people who were eligible by age or occupation and happened to have a computer, high-speed internet, the tech savvy to automate the refresh function, a job that allowed time off when appointments opened, and a car to drive to a vaccination site. 

Efficient? Sure. Fair? Not close

Both state and local authorities have begun to address the racial disparities that are inevitable under such a system. For example, California has now set aside 40 percent of available vaccine for residents in areas facing the biggest economic and health challenges. 

Locally, counties and cities have recruited community organizations and others to do outreach, and have been distributing more vaccines through local clinics, mobile pop-ups, and vaccine events in low-income neighborhoods of color. While there are concerns that these local approaches may get displaced by the state’s new contracts with Blue Shield of California and Kaiser Permanente, community activists will likely demand good monitoring and accountability.

While this more inclusive approach is welcome, let’s not repeat the mistakes of the first wave. That means putting equity first as we begin to prepare for the post-vaccine world.

When we emerge from this crisis, it will be a bit like the end of a movie about an imagined apocalypse: Many people will be crawling out of their homes with their savings demolished, health shattered, jobs lost and education interrupted — and they will be suffering from trauma. Expecting everyone to just bounce back is a bit like thinking a computer-based vaccination system will give everyone an equal shot at a vaccine.

California needs to make major investments in stabilizing housing, restoring employment, and making up for educational and digital inequality. And it must help communities deal with the trauma and loss that has wracked families and neighborhoods.

So let’s think ahead. We are going to need a “healing surge” that will match our vaccine surge — and health equity must guide how we allocate those resources.

The California Health Report has already pointed out that funding for mental health care for low-income residents has gone unused even as COVID-19 drives up anxiety and depression. We need to mobilize those untapped funds and start thinking of new ways to assist communities at scale.

We have learned the lesson in this crisis that public health is critical to our individual health — we all do better when we protect those who are most vulnerable. We also understand that mental health is not just an individual condition but a collective challenge in communities that were stressed by racist policing, economic inequality and deportation threats long before COVID-19 appeared on the scene.

Making things right post-pandemic will mean addressing the systems that left so many at risk. It will also require a process of personal, familial and collective healing. Let’s hope we plan for this with equity and inclusion as our north stars.