America is going back to normal as states reopen and Covid restrictions lift, but in many communities, the elderly, people of color and people with disabilities feel left out. Though vaccines have brought hope to millions of Americans, seniors are getting the invisible treatment in the race for population immunity. They are at the most at risk, the hardest to reach, and have suffered the highest fatalities from Covid 19.
Covid 19 vaccines are now available at no cost to everyone living in the US (over the age of 12+) regardless of insurance or immigration status. Given that the world is bracing for the next wave of infections spawned by the virulent Delta and Delta Plus variants, why aren’t vaccines reaching vulnerable seniors who need it most?
Advocates at a June 5th EMS briefing explained why seniors are getting left behind.
Why seniors in minority communities aren’t getting vaccinated
Overall, some 25% of people 65 and older have not been vaccinated though that number is possibly higher, said Kim McCoy Wade, Director, California Dept. of Aging, which co-sponsored the panel. Data showed shocking disparities about why older people in minority communities were not getting their shots.
Describing the vaccination trend in California, Wade said the variation in vaccination rates by race, ethnicity and age, and by community, was striking.
“The number that jumped out at me was that only 40% of Latinos over 60+ were vaccinated, compared to more than 75% of older adults (3 out of 4 seniors 65 + ) statewide – half of what the state is tracking for White and Asian American elders,” said Wade. The vaccination rate for white and Asian elderly in California is at 80%, and only at 60% for Black and Native American elders, she added. But older Latinos (60+) are the only racial group where the vaccination rate is much lower than for Latinos in their 50s and even lower for those in the 70-80 age range.
At issue in the vaccine rollout employed by the medical establishment, noted disability rights advocate Jessica Lehman, is that race hangs like a shadow over black and brown bodies.
It’s why people facing the greatest challenge accessing vaccines are seniors with limited English language ability from immigrant and low-income communities.
What’s stopping seniors from signing up for vaccines?
Typically, many seniors are isolated and hard to reach because they live alone, are homebound, not mobile, do not speak English, or cannot access the Internet. But there is a higher biological risk associated with age and disability, that the pandemic exposed with devastating effect.
Four percent of older Americas live in nursing homes and assisted living facilities, explained Dr. Louise Aronson, Professor of Medicine, UCSF, but accounted for 35% of deaths nationwide. Older people who contracted Covid when the pandemic hit were relocated to nursing facilities alongside the high-risk residents already there. There was limited or no access to testing or PPE for care givers, who in turn took Covid back into their communities.
For Infectious Disease specialist Dr. Rakhshan Chida, Medical Director at an OTP (opioid treatment program) clinic in New York, it was a nightmare that became reality. Working in inadequately ventilated treatment rooms when the pandemic hit, without access to masks, PPE, or testing, Chida described the inevitable disaster as “working in a den of covid.” Every day 2 or 3 patients tested positive.
In March, at the start of the pandemic, half her staff of 40 contracted the virus, and Chida took the infection home to her 87-year-old mother who lives with her. While her mother made a quick recovery, Chida experienced severe Covid symptoms and was ill for three weeks. But she was back on the frontlines after her quarantine, to attend to her vulnerable population of active and ex-users, including those who are in the 50+ age group.
But Chida was starting to see signs of vaccine reluctance in her patients. One 73-year-old patient who developed nausea, vomiting, and diarrhea after the first shot, refused to get the second because her reaction scared her.
Fear of the vaccine is not an uncommon barrier reiterated Aronson, an expert on aging and author of the book “Elderhood”. While some seniors are primarily concerned about unknown side effects or allergies, there is a prevailing distrust of vaccines that stems from how quickly they were developed, and suspicion of the people responsible for decision making around them.
One of Aronson’s patients confessed she feared the vaccine would insert a tracking device into her body. Others felt their existing illnesses should preclude them from getting the vaccine when in fact the opposite is true.
“There is so much misinformation, particularly for the limited English community,” added Anni Chung, President & CEO, Self Help for the Elderly.
The fault lies in the US public health structure, remarked Aronson. Without a nationwide system, federal, state, and county websites employ digital strategies that don’t reach or address the needs of at-risk seniors, for the same reason that census and voter registration drives did not work effectively.
With little or no Internet access, it becomes harder for the homebound elderly, people in rural areas, and people for whom English is a second language, to get or receive communication from Federal, state and county health systems.
“Digital strategies are adding to the problem and to the risk,” said Aronson.
A study of Black seniors in their seventies, by Cindy Cox Roman, CEO, Help Age USA, identified gaps in their knowledge of vaccine facts arising from difficulty with digital access, and also from conflicting information obtained via a mix of sources – TV news, senior centers, elected officials, and libraries.
“Everybody does not have access to the web and cable is expensive,” said one respondent. “When the library is closed, where do people go for information? We are the lost generation of the information age.”
Chung, a member of the California Commission on Aging, said that elders could not navigate the appointment system. Some had grandchildren who hovered over their computers for 6 to 8 hours to get two appointments for their grandparents. But a senior who has nobody to help them “is at the mercy of waiting for something to happen.”
Even when seniors did manage to sign up for vaccines at mega sites, they encountered long lines and no seating which drove them away said Aronson. Homebound people had no way to get there. Unfortunately, the mega-site vaccine roll-out also kept away older folk who had been advised to stay away from crowds for their protection.
At Chida’s clinic in New York, one patient refused a vaccine, saying “We don’t leave the house so why should I vaccinate when I’m not going out and meeting people?”
The problem when elders don’t come out of the house, is that they remain invisible in the public eye, warned Aronson, but an older person of color who is homebound – is triply invisible and gets left behind.
Seniors with disabilities are another group getting the invisible treatment, added Lehman, Executive Director at Senior and Disability Action in the East Bay. She said nearly 1 in 10 nursing home residents died of Covid, while 1 in 12 died in long-term facilities, a crisis that took a while to recognize. Instead, hospitals with limited beds or ventilators were guilty of care rationing – making judgment calls about who to treat based on who they viewed as having a better quality of life. Often it meant that older people and people with disabilities were low on the priority list because they are seen as ‘expendable”. In Texas, for example, Michael Hickson, a black, 46-year-old quadriplegic patient died of Covid after a doctor ordered his removal from a ventilator.
“The Covid pandemic is the most horrific manifestation of ableism and ageism we have ever seen in our lifetime,” remarked Lehman.
How are states vaccinating seniors and at-risk adults?
In California, there’s a push to funnel vaccines from mega-sites to community sites, offer free transportation, phone lines in addition to online sign-ups, and drop-in appointments.
Community groups are getting outreach grants from the state, so trusted messengers – community leaders and partners – can address people’s concerns. In California, public health officials have planned town halls to reach minority communities. For example, Surgeon General Dr. Burke Harris will meet with the African American community and similar strategies will be employed for the Latino and AAPI communities. Gov. Gavin Newson has also introduced a lottery and gift cards to persuade the unvaccinated to get their shot.
High-touch community programs are necessary to reach and deliver information at a local level, using trusted messengers such as the local press, faith leaders, and caregivers. Aronson urged people to contact their health department to identify community groups that are creating vaccine access for homebound elders – fire departments, in-home supportive services, Meals on Wheels, the YMCA, and other community partners.
At her clinic in New York, Chida offered mobile patients metro cards and arranged car services to assist with transportation. About 27 homebound patients were targeted with single-shot Johnson & Johnson vaccinations administered at home by nurses, and schedules for older patients were adjusted to sync vaccines with regular visits. Social worker representatives coordinated with the clinic to organize nurses, sharp boxes, PPE, consent forms and arranged dedicated outreach to patients at homeless shelters. And, the clinic coordinated with New York’s Department of Health to organize an in-house vaccination drive for its own patients, including seniors.
“The community really has to step in big time,” and rally the community agreed Chung, because many seniors, especially in immigrant communities, are unlikely to answer phone calls from “official government agencies.”
In San Francisco, her Self Help team asked the Department of Health to identify alternative ways to get vaccines out to where seniors need them instead of waiting for seniors to come to get their shots.
Local health departments listened. By March and April, they began to approve the distribution of vaccines through clinics, PCPs, primary care providers, and locations where seniors were more like to have access and are comfortable. At senior centers, people received shots along with their healthy meal packages.
“At one point 7 of our centers were reaching about 1500 people every day,” said Chung.
In April, Self Help and a community partnership team with providers from NICOS Chinese Health Coalition, YMCA, Chinatown CDC-Self Help Chinese Hospital, and the Chinese doctors association, headed to a Chinatown zip code with the lowest vaccination rates to administer doses at congregate housing facilities. Through an intensive phone call campaign and neighborhood canvassing, they identified and contacted almost 1000 people in the tract.
”We were just very fortunate there were no major outbreaks in Chinatown,” added Chung. What helped was door-to-door advocacy and education early in the pandemic advising people to mask and practice social distancing, and trust in local, community health professionals. In an initiative to reach vulnerable bed-bound and homebound seniors, Self Help mobilized 14 doctors, 10 volunteer drivers, and 10 social workers, to administer vaccines to about 130 seniors. Self Help’s next vaccination rally in partnership with Walgreen will include a small raffle to persuade seniors to get the vaccine.
The panel encouraged reporters to cover stories from their communities to remind the government to add more resources where they were needed.
The pandemic is far from over cautioned Wade, and a true comeback will depend on being ‘laser focused’ on vaccinating older and at-risk adults.
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In California, everyone age 12 can easily book a Covid 19 vaccine up via the MyTurn website, while entering to win Vax for the Win incentive program. My Turn also helps with organizing transportation and provides a list of hundreds of COVID-19 vaccine clinics accepting walk-ins, or call for services at 1-833-422-4255.
Meera Kymal is the Contributing Editor at India Currents.