As COVID-19 (novel coronavirus) vaccine distribution ramps up, the St. Louis Regional Health Commission (RHC) advocates for the State of Missouri to take immediate action to respond to vaccine deserts and ensure equitable access to COVID-19 vaccinations in the St. Louis region. The following recommendations uplift prioritized actions for equitable pandemic mitigation efforts.

State Level Recommendations

The RHC encourages Missouri to continue to shift vaccine eligibility prioritization in a manner that allows for alignment of distribution with disease burden, ensures racial equity, and leverages regional insight and networks in its vaccine distribution plan to respond to the COVID-19 vaccination desert in the St. Louis Region.

Underserved communities of color have borne a disproportionate burden of COVID-19 incidence and mortality nationally and in the St. Louis metropolitan area. According to Saint Louis University sociologist, Chris Prener, PhD, Black residents of the City of St. Louis have a 29% higher per capita incidence rate and 70% higher per capita mortality rate compared with Whites; in St. Louis County Black per capita incidence is 28% higher and mortality is 15% higher. Given the disproportionate burden that underserved communities have shouldered, it is critical that Missouri’s COVID-19 vaccine distribution plan leverages the critical role community partners, principally health departments and Federally Qualified Health Centers (FQHCs), play in equitable distribution. An effective plan must prioritize equitable distribution by engaging a shared collective network [including Health: centers, departments, systems and intermediaries] using multiple modalities to strategically dismantle barriers to vaccine access for communities with highest risk and lowest engagement.

The following data from the State of Missouri COVID-19 Response Vaccine Desert Analysis 2.0 and the Vaccine Distribution Analysis published in February and March 2021, inform our request for guidance from the State Equitable Distribution Committee that incorporate the enclosed recommendations:

  • Urban areas within St. Louis have been identified as vaccine deserts
  • There is a growing inequity in vaccine access within the St. Louis city center
  • A large proportion of the State’s Medically Underserved Census Tracts (92 of 223) exist within St. Louis
  • St. Louis County (#1) and St. Louis City (#4) are among the top 5 counties by numerical vaccination gap
  • The St. Louis Region is one of two regions with the largest share of eligible population and the lowest percent vaccinated
  • St. Louis City and County have the largest vaccination gap across all vaccine phases

An equitable vaccine distribution plan in response to the COVID-19 distribution desert in the St. Louis Region would require the following commitments from the State:

  1. Center data-driven rationale in decisions regarding resource prioritization and allocation. While addressing urgent needs, build infrastructure to uniformly collect and share disaggregated data (including GIS data) across health systems to help inform both local and statewide decisions.
  2. Include representation from a shared collective regional network on decision-making bodies and use multiple modalities to ensure engagement of individuals and communities with multiple barriers.
  3. Incentivize collaboration to leverage economies of scale across multiple systems to identify and engage individuals and communities in vaccination efforts.
  4. Participate in target zip code distributions by prioritizing standing and mass vaccination sites in zip codes with the highest incidents of COVID-19 related illness and mortality. To support this strategy, it is important to report COVID disease burden and death in relation to COVID vaccine administration and need, and disaggregate data by race/ethnicity, age, zip code, proportion of medically vulnerable residents, etc.
  5. Advocate for a HRSA waiver to permit staff from other approved vaccinator sites to volunteer with Federally Qualified Health Centers to expand capacity by administering vaccine.

Regional Recommendations

The RHC will work with regional stakeholders to prioritize the following actions for the St. Louis Region to implement a local Equity Distribution Plan in response to the COVID-19 pandemic:

  1. Build closed PODs with community partners in local sites to eliminate persistent barriers for individuals living in high need areas to access available resources.
    • Approved vaccinators will partner with community entities that serve a significant number of individuals in a community that is disproportionately affected by
    • Designated PODs will develop and monitor the list of individuals to be vaccinated while the vaccinator partner will be responsible for administering and reporting vaccinations
  1. Determine the age break point for increased mortality among African Americans and how it differs from the white population.
    • Develop age-based prioritization criterion based on life expectancy for the populations/communities served
  1. Clearly define what financial information will be gathered on people who are not patients.
    • Clearly articulate why this information is needed and how it will be used to facilitate informed consent for individuals who are choosing to be vaccinated
  1. Apportion vaccine allotments among multiple sites based on priority characteristics of the community members most likely to be served by each vaccinator.
    • Large systems should distribute vaccine allocation between sites based on the priority characteristics and need in the surrounding community and/or service population of each location
    • Prioritize community paramedicine programs
  1. Send staff to be volunteers at other vaccinator sites outside of their organization/system.
    • Allocate staffing and resources (including mobile units), at no cost, to facilitate and accelerate mitigation of the regional vaccine desert
    • Prioritize clinical effectiveness in vaccination efforts to ensure that process and staffing align with best practices for community engagement
  1. Breakdown demographic data collection to create clear access lanes for internal populations with disproportionate vulnerability including, but not limited to:
    • Race/Ethnicity
    • Age
    • Zip Code
    • Chronic Disease
  1. Prioritize specialty patient populations.
    • Prioritize specialty programs that often exclusively see a disproportionate number of higher risk individuals
  1. Engage in robust communications efforts to elevate awareness, answer questions, and inform choice in communities bearing the disproportionate burden of the impact and aftermath of COVID-19.
    • Deploy multi-modal communication approaches to intentionally mitigate digital access barriers that exist in communities experiencing the greatest COVID-19 burden and risk

To learn about the RHC’s recommendations, please contact Riisa Rawlins-Easley.

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