Dr. Andrea Phillips and other Black physicians in the state gathered at her small solo clinic in Jackson for a press conference on Jan. 5, a day after Mississippi’s general elderly population became eligible to receive COVID-19 vaccines.
The physicians wanted to help show other Black Mississippians that the vaccine was safe to take while acknowledging America’s history of racist, abusive medical practices like the Tuskegee Experiment that eroded trust in government health care.
When Phillips organized the event, her focus was the barrier of mistrust among Black Mississippians. But now, more than a month into the vaccine’s rollout for the general population, Phillips realizes trust was not the sole obstacle.
“The perspective we, me and some other doctors, were coming from initially is that we have to get our people ready and willing to take this vaccine,” Phillips told Mississippi Today. “We never dreamed there would be a problem of access.”
As of Feb. 10, 19% of total shots went to Black Mississippians, a group that comprises 38% of the state. During the early stages of the pandemic, the state’s Black population felt the brunt of both cases and deaths, although now both figures are more in line with the state’s overall demographics. Nationally, though, people of color still see more cases, deaths and hospitalizations than white Americans.
For weeks now at press conferences and social media Q&As, State Health Officer Dr. Thomas Dobbs has addressed the racial disparity in vaccine distribution by emphasizing “trust and access” as the two key roadblocks. In a Kaiser Family Foundation poll from December, nearly two-thirds of Black respondents were hesitant about taking the vaccine.
So far, the state health department’s primary avenue for promoting the vaccine among Black residents has been to gain trust through community leader endorsements. On Feb. 1, MSDH held a similar event to Phillips’, broadcasting Black pastors from around the state taking their first doses. MSDH has also worked with county officials, such as Holmes County Supervisor Leroy Johnson, to localize the effort.
Johnson, likening himself to the canary in the coal mine, said he took convincing to get the shot because of a history of premature deaths in his family but also a larger distrust in the government.
“It’s how do you trust the feds, but in Mississippi it’s also how do you trust the state government?” Johnson said. “There’s been no good will between the Black community and the state of Mississippi.”
Eventually, Johnson said, he was convinced by his brother, who’s a doctor, but also by the number of his constituents who have died in the past year. Holmes County, which has the third-highest percentage of Black residents and the eighth-highest poverty rate in the country, also has the eighth-most COVID-19 related deaths per capita in the state.
After getting both shots, Johnson said he’s discussed the experience with community members. But gaining the trust to give someone the vaccine, he said, only goes so far without the supply to back it.
“They ask us, these majority Black boards of supervisors, to get the vaccine in order to show our community that they need to not be afraid and take the vaccine,” Johnson explained. “But then you turn around and don’t provide enough vaccine for the folks who want it. Then your constituency comes at you and says, ‘We’re trying to get it. We don’t believe in it but we trust you.’ And then they can’t get the vaccine. I know that hurts my credibility.”
Dr. Laura Miller, a white physician based in Prentiss who works in predominantly Black and underserved rural areas in Jefferson Davis County, said she saw the same issue.
“We can talk about educating people about the vaccine, but at the end of the day access is first,” Miller said. “If I convince someone to get a vaccine and I don’t have access or a way to give it to them, that lessens their agreement to get it.”
The main root of the access issue for the state overall, as well as much of the country, is a limited supply. MSDH estimated that more than a third of the state, or over a million people, currently qualifies to receive doses. With a weekly supply that’s just recently increased to about 45,000, appointments fill up rapidly.
Since the general population became eligible, a vast majority of the state’s shots have been given to MSDH’s drive-thru sites, which are scattered around the state and located near more densely populated areas. Gov. Tate Reeves asserted that the drive-thru sites have been far more efficient and reliable for getting shots in arms than hospitals and other community partners. In late January, MSDH estimated that more than 80% of the state’s supply was going to the drive-thru sites, which has meant limited availability outside of that system.
As of the first week in February, there are as many as 21 drive-thru sites on a given day:
The reliance on drive-thru sites, though, may be part of the cause of the racial disparity. Dobbs tweeted on Feb. 4 that only 18% of shots at the drive-thru sites went to Black Mississippians, compared to a share of 71% at community health centers and 72% at hemodialysis centers.
Moreover, the locations the state selected for drive-thru sites may also have caused disproportionate distribution, Phillips, the Jackson physician, explained. She and others pointed to the late addition of a first site in Hinds County, which opened Jan. 22 at Smith-Wills Stadium.
“Hinds County until about a month ago had the highest number of cases,” she said. “Hinds County still has the largest number of deaths. Hinds County houses the largest city in Jackson. But more pointedly, Hinds County has the largest black populous.”
Even with the site, she said, “a lot changes when you cross Lakeland Drive,” referring to the whiter, more affluent demographics around Smith-Wills Stadium compared to the county as a whole; Census tract data shows the neighborhood is 89% white with a median household income of $89,704, compared to the rest of Hinds County which is 72% Black and has a median household income of $44,625.
Phillips and Miller both said that another layer to the trust and access barriers is that patients want to receive shots from their own personal care provider. Phillips said nearly all of her patients, almost all Black, go to her to receive flu shots.
“The ideal thing would be for us to have access to it because we know our patients,” Miller said. “So it’s really easy for me to see a geriatric patient, or whether they’re a minority or socioeconomically disadvantaged, to talk to them about it to discuss their concerns and to, if they agree, then get them the vaccine, as opposed to going, ‘Let’s look at scheduling you in the next two or three weeks.’ It’s a lot easier if I can go ahead and give it to them.”
But state leadership said that an increase in the federal allocation will mean a bigger share of doses going to community partners. In January, only about 7,000 doses out of the state’s weekly allotment went to those partners; last week, Gov. Tate Reeves said that number increased to 21,000. In addition, a new federal partnership targeting the racial disparity will send about 10% of Mississippi’s vaccine to Walmart pharmacies around the state, starting this week.
Whether it’s through expansion of the MSDH sites or increased allocation to community partners like herself, Phillips said the state needs to be more intentional about providing the vaccine to Black residents.
“We’re playing catch up now,” she said. “This is not about keeping the number equal. Equal is not equitable. We are failing the minority communities in this state.”