Shows a masked woman giving a shot to another masked woman.
Tanara Gilbert, part of the Environmental Services team at UNC Rex Hospital receives the COVID vaccine during the initial rollout in December, 2020. Photo courtesy: UNC Health

By Anne Blythe

As North Carolina crosses the bleak threshold of more than 10,000 deaths related to COVID-19, issuing a somber goodbye to nearly one out of every 1,000 North Carolinians, the race to get vaccines out efficiently and equitably becomes even more urgent.

Gov. Roy Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, outlined some of the strategies the state is using to make sure anyone 65 and older, or a health care worker, can get immunized against COVID-19 if they want

“Speed is critical, but we are also emphasizing equity,” Cooper told reporters during a briefing on Tuesday. “Communities of color have been disproportionately impacted by this devastating pandemic, and the state is working to reduce the high rates of sickness this population is experiencing.”

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In North Carolina, according to the DHHS dashboard, 1,436,745 doses of vaccines had been administered by noon Tuesday, with 13.77 percent of the inoculations going to Black residents, 2.4 percent to Hispanics, less than one percent to Native Americans and 2.47 percent to Asian or Pacific Islanders.

Though the white population is nearly 63 percent, 79.14 percent of the vaccines allocated to North Carolina have gone to white people.

“The health care coverage gap in North Carolina has left many without access to a doctor,” Cooper said, highlighting some of the reasons that he and his team are focusing on equity. “Add to that long-standing systemic inequities in our health care system, and you can get mistrust of this vaccine as well as lack of preventive care.”

To address those inequities, Cooper said, Cohen and her public health team are tracking racial and geographic data and factoring those into allocation formulas.

“Our team has ramped up efforts to include vaccine providers that serve communities of color,” Cooper said. “They’re reaching out to underserved communities and paying attention to equity in how they allocate doses, including weekly vaccine events.”

What’s working?

Cohen highlighted some of those efforts.

  • Vidant Health recently partnered with East Carolina University, Pitt County, and community and faith-based organizations at the Greenville Convention Center that has vaccinated about 1,500 people each day, 30 percent of whom are African American.
  • WakeMed and the Wake County Public Health Department partnered with churches and community centers to reach underserved communities in one ZIP code. With 150 volunteers, nearly 1,800 people, 91 percent of whom identified as Black or African American.
  • Novant Health in Charlotte partnered with Park Church, one of the largest African American churches in that city, to hold a large vaccine event.
  • Atrium Health has used its mobile unit to inoculate 1,800 people, 61 percent of whom were Black and 10 percent were Latinx.
  • Other community health centers also have administered more than 50 percent of their allocated doses to Black residents.

“These success stories show there are many different ways to ensure equitable access to vaccines if everyone is focused on the goal and is held accountable to it,” Cohen said. “We know that some people still have questions about the vaccine itself. We are equally committed to engaging communities as partners and working with trusted voices to share accurate information as well as their personal experiences.”

Charles Evans, president of the North Carolina Association of Black County Officials and chairman of the Cumberland County Board of Commissioners, joined Cohen and Cooper on Tuesday as one of those voices they want to broadcast far and wide.

“It has been almost a year since our lives changed because of a virus,” Evans said. “COVID-19 sent us home from our workplace and our schools. We are in a battle and our protective armor against this virus has included a face mask, keeping our distances from people and washing our hands.”

“This battle is raging on,” Evans added, noting the 10,046 deaths reported in North Carolina as of Tuesday.

“Each one of these numbers represents a daughter or son, a parent or grandparent, a neighbor or friend — people who are deeply loved and who were part of the fabric of our community,” Cohen said in a prepared statement.

Since the start of the pandemic, North Carolina has had 802,065 lab-confirmed cases of COVID-19, 2,786 of which were reported Tuesday.

Though daily case counts and hospitalizations have leveled off some since the winter holiday surge, there still were 2,374 people battling serious illness related to the virus in hospital beds on Tuesday, with 558 in intensive care units.

For much of the pandemic, masking, social distancing and modified work routines have been the tried and true battle tools. The focus has shifted in recent weeks to vaccines as being the badly needed weapon to get the fighting edge over the virus.

When will teachers and essential workers be eligible?

North Carolina only gets about 150,000 first doses of COVID-19 each week from the federal government, a number that has ticked up over the initial allotments coming from the Trump administration. White House officials informed Cooper on Tuesday the state could expect an additional 5 percent in doses in the weeks ahead.

Johnson & Johnson/Janssen asked the federal Food and Drug Administration recently for emergency use authorization for its one-dose vaccine. If that authorization is granted, there could be more options and doses to put toward the goal of getting more than 80 percent of North Carolinians vaccinated, enough to create herd immunity

Not only is North Carolina trying to make plans for how to add another vaccine into its allocation system, the public health team is trying to figure out a timeline for when essential workers will be eligible for vaccines.

There are thousands of people 65 and older, the age group in which more than 80 percent of the COVID-related deaths have occurred, still awaiting a vaccine.

Cooper said he hoped to have answers and a timeline to share later this week, especially as he and others are urging local school districts to open classrooms for in-person instruction.

Equitable distribution will be a part of those plans.

“Our health care departments, hospital systems and other providers across the state are trying to vaccinate as many of our citizens as possible,” Evans said. “I am here today to encourage everyone, especially others who are Black or brown, to get a vaccine when your time comes. Supplies are very limited now, so there may be a wait. But everyone will be able to get their shot as supplies increase.”

Black North Carolinians represent nearly 21 percent of the population. The Latinx population is about 10 percent of the more than 10 million people in North Carolina.

“Some Black and brown citizens may mistrust the vaccine, and I understand when based on long-standing and continued racial and ethnic injustices in our health care system,” Evans said. “I trust the vaccine because it’s been tested. They are safe and effective. If we are going to gain control of our lives, we need to get vaccinated. I want to encourage everyone to get the vaccine for yourself, for your family and for others who work around you.”

Advocates of health equity have encouraged vaccine administrators and others to not just brush off questions and hesitancies. Instead, they suggest listening to those who are not eager to get a shot and try to address their reluctance by sharing accurate information.

“I certainly understand the concerns,” Evans added. “But when it’s my turn to get a vaccine, I will. I am ready to take a shot.”

White House wants equity, too

The focus on equity came the same day that Jeff Zients, the White House COVID-19 response coordinator, held a half-hour briefing with national reporters in which he revealed some of what had been stressed on a call with governors across the country on Tuesday morning.

After President Joe Biden was sworn in on Jan. 20, Zients and the new administration took over a vaccine distribution plan that fell short of the first doses they had expected to be available.

The new administration has gone from distributing 8.6 million doses in the initial allocations to 11 million doses now and more expected as manufacturers ramp up production.

“I know Americans are eager to get vaccinated and we’re working with manufacturers to increase the supply of vaccines as quickly as possible,” Zients said. “As supply ramps up, we’re also creating new convenient locations for vaccinations. These include standing up community vaccination centers, deploying mobile vaccine units, and launching new programs with pharmacies.”

To help with equitable distribution of the available doses, the federal government plans to launch a new program next week in which they send out 1 million doses — 500,000 first doses, and 500,000 second doses — directly to Federally Qualified Health Centers, or community health centers as they’re more commonly known. These clinics routinely provide care for low-income patients and are often trusted partners in communities of color.

“Equity is core to our strategy to put this pandemic behind us, and equity means we’re reaching everyone, particularly those in underserved and rural communities and those who have been hit hard by this pandemic,” Zients said. “But we cannot do this effectively at the federal level without our partners at the state and local level sharing the same commitment to equity. They need to lead this work, as they know their community better than anyone.”

Marcella Nunez-Smith, founding director of the Yale University School of Medicine’s Pozen-Commonwealth Fund Fellowship in Health Equity Leadership and leader of Biden’s Health Equity Task Force, said it would be a phased approach that starts with 250 of the country’s more than 1,300 community health centers getting the initial doses.

At least one such facility in each state will be included in the first phase, but it was unclear late Tuesday which facilities in North Carolina might be included.

In most of the community health centers across the country, 60 percent of the patients identify as racial minorities.

“Equity is our North Star here,” Nunez-Smith said during the briefing with reporters. “This effort that focuses on direct allocation to the community health centers, really is about connecting with those hard to reach populations across the country. This includes people who are experiencing homelessness, and agricultural and migrant workers, residents of public housing and those with limited English proficiency.”

The tools being deployed, Nunez-Smith said, are meant to help out states, but are not substitutes for local efforts.

In North Carolina, Cooper and Cohen developed a strategy through which the initial allocations distributed in December and early January went to each of the 100 counties.

Vaccine distribution and administration in North Carolina and elsewhere across the country got off to a bumpy start. As local health departments added another weighty task for their workers to take on in a pandemic that has stretched their resources for nearly a year, many complained that doses were sitting on shelves too long.

After Cohen faced a tough grilling by mostly Republican lawmakers in January, her public health team changed the strategy to focus more on efficiency than equity.

After getting all the doses in the state into arms and creating a system that calls for providers to administer all doses received each week, the state has returned its focus to equity with efficiency.

That’s the approach the Biden administration is advocating, too. When asked whether such a plan created a natural incompatibility, Zients disputed the thesis.

“I don’t see any trade-off between the two, I think they go hand in glove,” Zients said.

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

  • 10,046 people total in North Carolina have died of coronavirus.
  • 802,065 have been diagnosed with the disease. Of those, 2,374 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • 730,454 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
  • To date, 9,334,437 tests have been completed in North Carolina. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • People ages 25-49 make up the largest group of cases (39 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 83 percent of coronavirus deaths in the state.
  • 780 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Monday, 558 COVID-19 patients were in intensive care units across the state.
  • As of Feb. 9, 1,436,745 North Carolinians have received at least one dose of the coronavirus vaccine.

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Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.