Statewide disparities in COVID-19 vaccinations expose barriers that underserved populations face in avoiding life-threatening infection. Maryland’s early vaccination rollout shows a pattern of racial disparity mostly among Black and Latino residents.

Healthcare disparities hold a firm grip on communities of color in Maryland, a reality that has only worsened with the pandemic. According to state data, an average of 62% of vaccine doses have gone to white residents, with only 21% of doses going to Black Marylanders.

In Prince George’s County, Latino residents make up 20% of the population but only 5.7% have received two doses of a COVID-19 vaccine, according to the county’s vaccine dashboard.

As of April 6, Black people in Baltimore City have received 28.5% of the total vaccinations administered, despite accounting for 62% of Baltimore’s population.

“We need to see decisions and structures put in place, for those with the greatest need for the vaccine, because they are the ones that are getting sicker, and that we provide the support so that those populations are able to access the vaccines,” Baltimore City’s first Chief Equity Officer, Dana Moore said.

Health officials say they are working towards prioritizing vaccines for minority residents, but so far the data has not shown significant changes.

Gov. Hogan created a Vaccine Equity Task Force with the goal of increasing vaccine distribution in minority communities, using the state’s first Tactical Operations Plan.

The ongoing plan, announced on March 4th, involves partnerships with community and private organizers including several churches to launch vaccination sites for hard-to-reach populations and improve vaccine allocation. The task force is working with the National Guard to send out mobile vaccine clinics to underserved communities. The buses are currently set up in Western Maryland and the Eastern Shore.

The task force is also working with the Maryland Department of Health to send out mobile education units in Prince George’s County where there are lower vaccination rates. The truck is decorated with informational banners about COVID-19 and broadcasts messages about how to get vaccinated in both Spanish and English.

Lack of access to technology, transportation or language barriers may further contribute to disparities with Black and Latino populations.

While 31% of Maryland’s population is Black, Black residents accounted for about a third of the state’s confirmed COVID-19 infections and 34.8% of COVID-19 deaths, when race was reported.

Latino residents account for 11% of Maryland’s population, but make up 17.7% of COVID-19 cases and 9% of deaths.

White residents make up about 59% of the overall population, representing 40% of COVID-19 infections and 51.5% of deaths, according to U.S. Census data.

In early March in Montgomery County, 66% of the county’s white residents were preregistered for the COVID vaccine despite making up 43% of the population. Meanwhile, only 8% of Black residents were preregistered while making up 18% of the population and only 9% of Latino residents were preregistered despite accounting for 20% of Montgomery County’s population, according to a letter from the Montgomery County Council sent to Gov. Hogan.

Dr. Panagis Galiatsatos, a Pulmonologist and Assistant Professor at Johns Hopkins University, said that health isn’t achieved by one strategy. The biggest thing to emphasize is equitable strategies for vaccine access and enrollment, Dr. Galiatsatos said.

Addressing health inequities through vaccine rollout

Six Flags America in Prince George’s County is one of 12 mass vaccination sites in Maryland. State data shows that a majority of people vaccinated at the site in Bowie are living outside Prince George’s county.

Vaccination rates for Prince George’s County and Baltimore City are among the lowest in the state, according to data from the Maryland Department of Health. Both localities currently are within the top four areas with the most positive cases.

Many Black Marylanders were among those that plan to receive a COVID-19 vaccine, showing little hesitancy towards the emergency treatment, according to a recent poll conducted by Goucher College.

In a press release about the poll results, Mileah Kromer, director of the Sarah T. Hughes Field Politics Center at Goucher College, said “Vaccine hesitancy has declined among Maryland residents over the past few months. Notably, our poll results also show that Black Marylanders are not significantly more hesitant to get the vaccine than their white counterparts. There are, however, differences across party lines: Republicans are more resistant to taking the vaccine than Democrats. The big picture is that most Marylanders will get the vaccine as soon as it’s available to them.”

Dr. Kim Dobson Sydnor, Dean of the School of Community Health and Policy at Morgan State University, said the conversation of vaccine hesitancy should be reframed to ask if the medical system is worthy of people’s trust in receiving a vaccine.

Sydnor points to a historical distrust towards medical systems by pockets of people in minority communities. Sydnor said a desire to better understand the vaccine is a logical response. “I think that gets interpreted as hesitancy but in reality it’s a logical response to a history and set of current conditions that would make someone pause.”

Efforts to reach more Black and brown communities during the COVID-19 vaccination process allows for healthcare professionals and community organizers to address key barriers.

“One is that every hospital invests in their community engagement officers…energize them, where they have to approach the communities in a grassroots manner, work with them to achieve community-identified health interests, and then the resources to do just that…build that trust over the next decade or so,” Galiatsatos said.

Offering support toward outreach and encouraging community-specific health initiatives leads to more hard-to-reach populations receiving public resources and protection from the virus, according to Galiatsatos.

Challenges in vaccine rollout

Amber Allen is a special assistant in Prince George’s County’s Health, Human Services and Education department. Allen believes the greatest issue the county faces is an inequitable vaccine supply. “Prince Georgians really want this vaccine right now. Vaccine demand has been outpacing the supply,” Allen said.

More than 232,000 Prince Georgians are pre-registered and about 62% of those people have already been vaccinated as of April 6, according to Allen.

Prince George’s County is the second-most populated county in Maryland but has the lowest vaccination rate in the state, according to the Maryland Department of Health’s COVID-19 vaccine dashboard.

Prince George’s County is still falling behind in registering and vaccinating a majority of its Latino population and residents from low-income neighborhoods who were hit the hardest by the pandemic.

Allen said home-bound senior citizens are having trouble accessing vaccination sites. Other residents don’t have access to wifi or tablets to register online. The county is working on transportation issues and said residents without wifi should call 311 to preregister via phone, according to Allen.

Outside of county government outreach, Adventist Healthcare, the Latino Health Initiative and CASA, an advocacy group for Latino and immigrant people, are working to vaccinate at least 600 Latinos a week in Montgomery and Prince George’s counties.

The Federal Emergency Management Agency recently opened a mass vaccination clinic at the Greenbelt Metro Station. The site is able to provide up to 3,000 shots per day. Prince George’s County Executive Alsobrooks said that 65% of vaccines at the site will be reserved for Prince Georgians.

Brigadier General Janeen Birckhead is the head of the Maryland Vaccine Equity Task Force. She said the new site located at Greenbelt Metro station gives greater access for Prince George’s county residents to vaccines, especially those without transportation. Birckhead said the community vaccination site will drive vaccine data to be more equitable. “This is where the whole of government meets equity,” Birckhead said.

As of April 8, only 13.4% of Prince George’s County residents are fully vaccinated. In Baltimore City, 16.9% of residents are fully vaccinated, according to the Maryland Department of Health.

Dr. Sydnor, Dean of the School of Community Health and Policy at Morgan State University, said that health inequities already exist for underserved communities in Baltimore and that nobody made adjustments to address these issues when distributing the vaccine.

“If you start distributing things based on what you think is already an equitable and fair system, you would think you’re getting the outcome you’re looking for, but in reality, because the system and structure is already inequitable, that allocation also becomes inequitable,” Sydnor said.

Sydnor points to transportation as an example of inequity. “Baltimore City in particular does not have a mass transit system. If you don’t have a car and you have to get a vaccine — and some of these vaccines are being made available on a relatively short notice — that inequity that is already built in the system just gets amplified on top of what’s happening with the vaccine and the short supply in the first place.”

Outside of transportation and technical issues, a lack of consistent messaging about signing up for vaccinations has caused confusion and distrust for some residents.

Michael Scott is the Chief equity officer at Baltimore nonprofit Equity Matters. He said registering his mom for the vaccine in Baltimore was a complicated experience. Scott said the lack of a consistent and trusted source sending messages about the vaccine early on made it difficult to discern what the right course of action was when registering and making an appointment.

“Having a foundation of trust matters and trusting the wisdom of those relationships and those people will reduce the inequity and disparities,” Scott said.