Politics and COVID: An Unhealthy Mix

British publisher and writer Ernest Benn wrote that “Politics is the art of looking for trouble; finding it everywhere, diagnosing it wrongly, and applying unsuitable remedies.” Nowhere is this more true that in Los Angeles County’s politically spearheaded COVID-19 vaccine distribution.

Front and center in this process has been Chair of the County Supervisors Hilda Solis who has announced successive expansions of efforts to those 65+ and now to include education and childcare workers saying – “And we’ll still continue to kind of go through a process of making sure that we’re as equitable as possible.”

However, Los Angeles County’s effort has been far from equitable, and in particular African-American populations have been left far behind.  Despite comprising 11% of the County population, they have only received 4.1% of all administered doses (source: https://covid19.ca.gov/vaccines/#California-vaccines-dashboard).  Latinx who comprise 44.6% of the population have only received 23.2% of vaccines.  Characterized by Dr. Barbara Ferrer, County Public Health Director, as a “glaring inadequacy.” Supervisor Solis’ comment that we will “kind of go through a process” to ensure equity is hardly reassuring, is not a plan and does not convey the urgency of effort that is needed.

To date, Los Angeles County has relied exclusively on large, county-run centers which have been their “unsuitable remedy” for the challenge of vaccinating the populace. Politicians here, as it is outside of their expertise, see the COVID-19 vaccination effort as a unique event ignoring the fact that there already is an annual mass vaccination campaign – the flu shot. This is in sharp contrast to states such as North Dakota who specifically relied on their flu experience (more specifically lessons learned from H1N1) to guide their rollout process.

So how do we manage the annual flu shot?  Those data are readily accessible from the CDC who reports these data (link: https://www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2018.htm). The most common setting for vaccination among both adults and children was a doctor’s office (children: 67.6%; adults: 34.3%). Other medical settings for flu vaccination included pharmacy (children: 6.0%; adults: 32.2%), clinic/health center (children: 13.5%; adults: 7.9%), hospital/emergency department (children: 4.4%; adults: 5.4%), school (children: 5.4%), and workplace (adults: 14.9%). 

Health Departments provide 1.7% of flu shots to children and 1% to adults. Yet,in Los Angeles, we are as a population entirely beholden to the Health Department for provision of vaccines. The Board of Supervisors oversees the Health Department and must see them as the only mechanism they can use. The classic man with a hammer, everything looks like a nail.

In fact a wider distribution of vaccines beyond County run mass vaccination sites will not only speed delivery but also ensure equitable access. Provision of doses specifically to centers and healthcare providers in those communities thus far left out of the COVID-19 vaccination campaign will narrow gaps. Involvement of pharmacies already in communities (both commercial and independent) will reach people where they live and work rather than having them spend hours traveling to and waiting at mass vaccination sites. Efforts should include vaccinations at Emergency Departments, schools and places of employment. On its current trajectory, the County’s approach when it comes time to vaccinating children will only magnify inequities given the proportion that receive vaccination with their own physicians – a group entirely left out (perhaps deliberately) from the County’s approach.

We are indeed in trouble – with the rising tide of variants, an incomplete and inequitable vaccination pattern has the potential to select out these or other more virulent strains of coronavirus. Our troubles have been misdiagnosed and misappropriated by politicians who lack the training, expertise or historical perspective to manage such a program. After the debacle that has been the last two months of vaccine distribution, it is time for a suitable remedy to be applied.

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