The Trump administration has made pharmacies a centerpiece of the country’s historic coronavirus vaccination campaign — a decision that could bypass low-income and minority populations hardest hit by the pandemic.
The government has recruited about 60 percent of pharmacies in the United States, Puerto Rico and the U.S. Virgin Islands to vaccinate the public, including standalone pharmacies and those in grocery stores.
But just as many poor urban areas are considered “food deserts,” without easy access to affordable and high-quality fresh food, research suggests that poorer areas with high minority populations are more likely to be “pharmacy deserts.” A distance of a few miles can be insurmountable for people without reliable transportation or hourly employees who can’t afford to take time to be vaccinated.
That’s why mass vaccination campaigns — such as during the 2009 H1N1 flu pandemic — have traditionally relied on a broad mix of distribution sites, including schools and churches in addition to pharmacies, hospitals and clinics.
Public health experts say that a major effort is needed to ensure that communities of color and low-income Americans have equal access to coronavirus vaccines once the shots are more broadly available. Many states and local governments are working with the Centers for Disease Control and Prevention to plan a more comprehensive set of vaccination sites. But time is growing tight, with top Trump administration officials projecting that the public could have access to vaccines by late February.
“If everybody lives within five miles of a certain pharmacy chain, that’s all well and good, but if walking is your only form of transportation, five miles is prohibitive,” said Susan Bailey, president of the American Medical Association. “There are going to be definite situations where we need to bring the vaccines to the people instead of bringing the people to the vaccines.”
The health care system will need to go “above and beyond” to ensure minority communities that are disproportionately impacted by the pandemic have access to a Covid-19 vaccine, she added.
The virus has killed more than 311,000 people in the U.S. and sickened nearly 17.3 million. Black Americans are dying of Covid-19 at 1.8 times the rate of white Americans, according to The COVID Tracking Project. The risk for Native Americans and people of Latino ancestry is also elevated, at 1.4 and 1.3 times that of white people, respectively.
Studies from the CDC and other sources have also found that communities with lower average incomes have also seen higher rates of hospitalization and death than wealthier areas.
The Trump administration announced in November that it would work with several major pharmacy chains — including Albertsons, Costco, CVS, Publix, Walgreens, Walmart and Kroger — to distribute coronavirus vaccines. Federal officials said the intent was to help ensure vaccine access in medically underserved areas.
CVS, for example, says that about 85 percent of Americans live within 10 miles of one of its pharmacies. The company’s experience providing Covid-19 testing has also broadened its reach, said Chris Cox, the chain’s liaison with the government vaccine development program, Operation Warp Speed.
“We’ve made a focused and prioritized effort to make sure that we are serving even the populations where we may not have a pharmacy because 85 percent is not 100 percent,” he said.
But an analysis released this week by the University of Pittsburgh’s pharmacy school and the non-profit West Health Policy Center shows the extent of the potential gaps. It examined the distribution of health facilities — including pharmacies — that could give Covid-19 vaccines and found that more than a third of U.S. counties have two or fewer potential sites.
Mindful of the need for equitable access to coronavirus shots, the CDC is working with every state to provide feedback on formal vaccine distribution plans they submitted to the federal government, according to Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.
“The more information that CDC has about who is getting the vaccine, the more they can do things like mapping out the areas that aren’t getting the same kind of coverage as other areas and that can help the state better plan future distributions,” Plescia said.
The agency has decades of experience with planning vaccination campaigns, including during the last pandemic to reach the U.S. — the 2009 H1N1 flu.
Howard Koh, a professor at Harvard University and a HHS assistant secretary for health in the Obama administration who helped with the H1N1 vaccination effort, said there was “intense collaboration” in 2009 between federal, state and local officials to have a “one government approach.”
“There are issues about staff, storage, supplies and space,” Koh said. “State and local public health officials are scrambling right now to assure that all those are proactively addressed before the next waves of vaccinations occur.”
Some state plans — like North Carolina’s — propose using pop-up vaccination clinics to reach populations like migrant farm workers, incarcerated individuals and the homeless.
Public health experts say that working with the most trusted health care providers, community leaders and institutions — including pharmacies, churches, or community centers — is necessary to alleviate vaccine hesitancy and help deliver the shots.
Cities and towns, along with businesses, should consider organizing transportation to vaccine sites for residents and employees, said Georges Benjamin, executive director of the American Public Health Association.
“The private sector is going to have to participate in helping to do this,” Benjamin said. “They’re going to have to allow people the time off to go get vaccinated.”
Help could also come from parts of the health care system. Urgent care clinics have been lobbying for inclusion in states’ vaccine distribution plans with limited success, said Callan Young, an executive at software firm Experity, whose company serves the clinics. Many of the clinics have longer hours of operation than pharmacies, or are the most trusted providers for underserved communities, he said.
In the meantime, pharmacies are thinking hard about how to expand their reach. Walgreens is preparing to use mobile and off-site vaccination clinics, similar to those it runs for annual flu vaccines, to reach underserved areas when Covid-19 vaccines become available to the public.
“We’re going to do everything we can to be sure that some of the folks who’ve been hardest hit by the pandemic, people living in vulnerable communities and minorities get all the resources that they need,” the company’s chief medical officer, Kevin Ban, said Thursday during a webinar with the U.S. Chamber of Commerce Foundation.
While not everyone can easily get to a pharmacy location, the stores often have an existing relationship with people with high risk conditions like diabetes or heart disease, said Sandra Hernandez, CEO of the California Health Care Foundation.
Pharmacies will be in a position to leverage that patient-level knowledge to prioritize vaccination of those at high risk of poor outcomes, she said. For example, they could use that information to alert people via email or text message when they are eligible to get vaccinated — even if a clinic is not being run by the store — and answer questions about the process.
“At the end of the day, this distribution is very local,” she said. “For those who are most vulnerable and most at risk, how do we reach them and make it easy?”
Joanne Kenen contributed to this report.
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