The Biden team wants to swiftly vaccinate people of color and others most vulnerable to COVID-19. But health centers are learning that speed and achieving racial equity don't always go hand in hand.



More than half a million people in the U.S. have died from COVID-19. President Joe Biden spoke to the losses in his address to the nation yesterday.


PRESIDENT JOE BIDEN: For some of you, it's been a year, a month, a week, a day, even an hour. And I know that when you stare at that empty chair around the kitchen table, it brings it all back, no matter how long ago it happened.

MARTIN: The Biden administration says its priority is to vaccinate the country quickly and equitably. The goal is to reach people of color and others most vulnerable to the coronavirus and to do it fast. But NPR's Yuki Noguchi reports those two goals do not necessarily go hand in hand.

YUKI NOGUCHI, BYLINE: San Diego County recognized early that its COVID-19 response needed to reach its large Latino population. So eight months ago, it set up a task force. Christian Ramers, a physician and executive at Family Health Centers, sits on it. He says the county placed vaccination sites first where the target population lives and works, close to the Mexican border.

CHRISTIAN RAMERS: And yet, even by physically locating the centers down south, a lot of those appointment slots are taken up by people that are from the north of the county and more technologically savvy.

NOGUCHI: Latino people make up a third of San Diego's population but account for about half of COVID hospitalizations and deaths. To date, only 15% received at least one dose of vaccine. So San Diego, like the rest of the country, is living a COVID-19 paradox. Those needing vaccine most aren't accessing the limited supply.

RAMERS: The challenges in ensuring equity are just very, very large. And even despite having our eyes on the ball, you know, the numbers don't really satisfy anybody.

NOGUCHI: The challenges include California's own vaccination appointment app. Its Silicon Valley sleek, says Ramers, but requires a smartphone and starts in English. But efforts are hampered most by the realities of life for racial minorities and the working poor. They make up a large share of frontline workers. Their daytime schedules don't allow time to hunt for appointments or stand in line. They might be undocumented or lack insurance, so many are waiting for assurance that vaccination is safe, both medically and legally.

RAMERS: Hesitancy is not just one thing. And in many cases, they're very unique to their own situation, like I just got treated for cancer or I'm on a certain medication or I've had an allergy in the past.

NOGUCHI: Those conversations take time, and that clashes with the other major goal of vaccination - speed. Ramer says California started cutting back shipments when vaccinators don't administer shots quickly.

RAMERS: There's an immense pressure on using the vaccines as quickly as possible. And that tends to favor these mass vaccination sites, which really don't have the ability to target the communities that need it.

NOGUCHI: Georges Benjamin is executive director of the American Public Health Association.

GEORGES BENJAMIN: We really haven't had a well-financed, well-structured national effort to get into communities that we knew would be more hesitant and were disadvantaged by all of those social issues.

NOGUCHI: All this happens, of course, as the country wrestles with racial disparities across public health, from policing to food insecurity. Disparity in vaccination is hard to track because race information is available for only half of those receiving doses.

Suzanne Lagarde is CEO of Fair Haven Community Health Care in New Haven, Conn. She sees how those gaps widen. Her center abandoned the CDC's online appointment system, for example. Its lengthy, difficult questions, all in English, turned off her mostly Latino clientele.

SUZANNE LAGARDE: One of them is, have you ever had an allergic reaction to polyethylene glycol?

NOGUCHI: So the clinic announced it would book appointments by phone. Within half an hour, 300 callers statewide crashed that system. So now Lagarde is rethinking again.

LAGARDE: I envision ultimately even going - literally knocking on doors because I think it might take that.

NOGUCHI: She wants to reach not just the clinic's patients, but also thousands of others who've never sought care. But that, again, will take time.

LAGARDE: I can't do 4,000 vaccines a day if my life depended on it. Right? But I can do several hundred. And I need to get to the folks who are not getting into the big hospital systems. It's much more time intensive, but they're both need it. As a country, we need to do both.

NOGUCHI: Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.