In Washington Park, where the streets are lined with multimillion-dollar homes, sushi restaurants and breweries, 247 of every 1,000 residents who are 70 or older have already received a first dose of the coronavirus vaccine.
The numbers are even better in the east Denver neighborhood of Central Park, formerly known as Stapleton, where 461 out of every 1,000 older residents have been vaccinated.
But then check out Sun Valley, one of the poorest neighborhoods in Colorado and home to several government-supported housing projects. Out of every 1,000 residents 70 or older in the west Denver neighborhood, just 42 have received the coronavirus vaccine.
And in Elyria-Swansea, a predominantly Latino neighborhood in the shadow of industrial plants in north Denver, 119 out of 1,000 older residents have been vaccinated, well below the rate of several wealthier neighborhoods. This is despite Elyria-Swansea’s high rate for the virus itself — the latest data from mid-January shows the area has a 10.6% positivity rate for coronavirus tests, compared with 3% in Central Park.
It’s still early in Colorado’s vaccination rollout, but the initial statistics about who is getting word about vaccine clinics, who is seeking out appointments and who is showing up to be immunized reveal gaping disparities along racial and economic lines.
Even though the work to create an equitable distribution began months ago, the way the first doses have been spread across the state has favored white Coloradans. Those who are active patients in a health system, who are tuned in via social media and online networks, and who are native English speakers are more likely to have access to the coronavirus vaccine, public health officials say.
In response, public health workers and newly formed vaccine equity task forces are mobilizing to bring the vaccine to places where vaccination rates have been lower historically in Colorado. To reach communities of color, the strategy is twofold — breaking down logistical barriers such as in language and transportation, and battling an ingrained mistrust of the government and medical providers, several advocates told The Colorado Sun.
A key strategy is locating the trusted community leaders who can spread the message, which is why advocates are setting up vaccine clinics at places including St. Cajetan Catholic Church rectory and the Denver public housing authority.
Sending invitations via email or social media is easy, but that won’t cut it for the 70-plus crowd or folks who are not connected to a health care system, particularly in low-income neighborhoods, said Dr. Ozzie Grenardo, co-chair of the Colorado Vaccine Equity Taskforce.
“For those harder-to-reach groups, and those who are reluctant, there needs to be a different type of effort,” he said.
Initial statewide data shows that white Coloradans have accounted for about 68% of those receiving at least one dose of coronavirus vaccine so far, which is roughly equal to white representation in the state. Black Coloradans, however, have accounted for just 1.8% of vaccinations, even though they represent about 4% of the population. And Hispanic Coloradans have received 4.3% of the vaccines despite representing 22% of the population. The data is incomplete, however, and in some cases, race was not recorded.
Those are total vaccination numbers from the Colorado Department of Public Health and Environment, so they include vaccines for health care workers, first responders and those 70 and older, the three groups at the top of the state’s priority list.
Brig. Gen. Scott Sherman, who is in charge of the state’s coronavirus vaccine distribution, said the data so far is heavily influenced by the makeup of the health care and fire responder workforces, which are predominately white. “It just mirrors what that demographic looks like,” he said. The state will release demographic data for vaccinations specifically among the 70 and older population later this week, he said.
Disparity exists even among health care workers
Grenardo, also the chief diversity and inclusion officer for Centura Health, was alarmed when he saw the racial breakdown of hospital system employees who have gotten the coronavirus vaccine.
Black, Latino and other minority staff were far less likely to get the vaccine than their white peers. By mid-January, Centura had administered 25,736 doses to its workers. Black workers were 44% less likely to get vaccinated than white workers and Latino workers were 22% less likely.
And they all got the same email inviting them to get vaccinated, said Grenardo, who also works as a family doctor for a Centura health clinic in diverse, southeast Aurora.
“It’s a sign that there is still, even in those who work in health care, a disconnect from either the information that people are receiving about the vaccine or the mistrust or issues around discrimination that have been present for many years in the industry with communities of color,” he said.
Grenardo is expecting similar results when Centura crunches the numbers on the racial makeup of patients age 70 and older who have gotten the vaccine so far.
“I can only imagine that those numbers are even more significantly problematic,” he said.
The doctor is one of three co-chairs of a vaccine equity task force that began its work this month to make sure COVID-19 vaccines are distributed equitably to communities of color, the same communities that have experienced the most severe outcomes from the coronavirus. The task force is working to overcome long-standing distrust of the medical community, language barriers and less access to health care.
The first step, he said, is messaging.
“Having the message come from a trusted community leader or provider is much more impactful than someone from the government or someone they don’t know giving the information,” Grenardo said.
Finding trusted, local leaders — whether a doctor at a health clinic, a pastor or a neighborhood organizer — to spread the word about the coronavirus vaccine is also high priority among a group of Latina government leaders who represent the west side of Denver.
Denver City Councilwoman Jamie Torres, state Sen. Julie Gonzales and state Rep. Serena Gonzales-Gutierrez meet weekly to discuss the effects of COVID-19 on Latino and immigrant communities in their districts. Now their conversations are focused on overcoming language barriers and trust issues to get their constituents vaccinated, and other government leaders, including a few other city council members and a representative from the mayor’s office, are joining the calls.
Torres thinks of an 88-year-old woman in one of the neighborhoods she represents, a woman who has no ID and has “very real fears around immigration questions,” even though the state and city have said they will not ask anyone to prove their citizenship status when it’s their turn to get a coronavirus vaccine. Torres knows that a government official — even a local city councilman — isn’t likely to persuade the woman.
“It’s more difficult for me to walk up to their door and ask them to sign up,” Torres said. “But she trusts someone in that neighborhood.”
The goal is to find that person.
The women are working with community organizations and housing programs for senior citizens, searching for the trusted community leaders who will spread the vaccine message. The older residents are some of the hardest to reach, considering they are less likely to use the internet.
“We recognized from the beginning how difficult it is to capture that population,” Torres said.
The data is concerning so far, Gonzales said, noting that her constituents already were less likely to get tested for the coronavirus. “It means that we’ve got to do extra work to make sure there is equity baked into who receives the vaccines,” she said. “We have seen COVID disproportionately impact Black and brown communities and other communities of color since March.”
While Latino people are 29% of Denver’s population, they make up 50% of the coronavirus cases in the city to date, according to Denver health department data.
The reasons for the disparity are in part logistical — folks in lower-socioeconomic neighborhoods are more reliant on public transportation, some don’t use the Internet, and some don’t speak English as a first language. But there is another factor at work: “a legacy of medical racism that has led communities of color to have additional questions that need answered before they feel comfortable,” Gonzales said.
“What I expect and what I need from the governor’s office, and what we are starting to receive, and I’m appreciative for that, is data, is process, is structure,” Gonzales said.
Still, the group is moving forward on building its own network in communities where vaccine numbers are low. They’re coordinating with St. Cajetan Catholic Church to set up a drive-up, appointment-only vaccine site at its Alameda and Stuart location, and for a second drive-up site at Servicios de la Raza, a Latinx community group that provides services ranging from behavioral health to employment.
“We just can’t wait anymore,” Gonzales-Gutierrez said. “We can’t just sit and wait for them to recognize our communities.”
Denver Public Health focuses on outreach teams, pharmacy access
Denver Health is attempting to email, text, call or mail letters to about 16,000 people this month, a roster of patients who are at least 70 years old and have yet to register for a coronavirus vaccine.
No matter whether those are active patients or people who visited the hospital or one of its clinics just once in the last few years, Denver Health hopes to find and vaccinate them. The hospital, which serves a huge portion of the city’s low-income and Medicaid population, has assigned the task to its patient navigators, who speak at least 13 languages among them.
The massive effort is but one part of a plan at Denver Health and its public health side, Denver Public Health, to try to reach patients in racially and ethnically diverse neighborhoods. Denver Public Health is also bringing vaccines to areas of the city with historically low vaccination rates for the flu vaccine and childhood immunizations, including through the public housing authority.
The effort began back in May, when a COVID-19 vaccine was only an aspiration, said Dr. Judy Shlay, associate director of Denver Public Health and a family physician. That’s when she started worrying about how the agency would equitably distribute a coronavirus vaccine.
Denver Public Health mapped out the pockets of the city where vaccination rates were low and then last fall used outreach teams to bring the flu vaccine and childhood immunizations, including the measles vaccine, to targeted areas. The teams set up in food banks, community organizations and fire stations.
“That’s the model we are using now for the COVID vaccine,” Shlay said.
During its trial-run last fall, everyone was invited — because flu vaccines are for all ages. Now, though, the clinics are targeted to the segment of the population currently eligible for the COVID-19 vaccine, which includes health care workers, first responders and people at least 70 years old.
So far, Shlay is not satisfied with the rollout, in terms of equity. “We’re very transparent and we’re not there yet,” she said, noting the west side of Denver, with a large Latino population, is lagging behind the east side. “Now we’ve got to build out those approaches to be able to reach other populations.”
Part of the problem, though, is that the incoming supply of vaccine has been inconsistent and too low, she said. It’s difficult to ramp up vaccination distribution and schedule clinics throughout the city when Denver Health doesn’t know how much vaccine to expect each week through its state health department allocation.
Denver Public Health has been giving out about 1,000 doses per day, but should be dispensing 7,000 per day or more than 200,000 per month, Shlay said. And it’s not just the weekly allocation that’s slowing the process — it’s the staff to administer the shots.
“It’s building a whole army of people to do it,” she said. “We’re at the beginning stages.”
Denver Public Health wants to make sure the coronavirus vaccine is available in about 25 pharmacies, including inside King Soopers and Safeway stores. Right now, it’s only available at three Safeways and one King Soopers in the city, Shlay said.
Denver Health has the vaccine available in three of its community clinics, but is trying to expand that to all 10 as soon as there are enough doses available.
The hospital system is trying to avoid a situation in which it would have to cancel a patient’s appointment because it didn’t have enough of the vaccine. “We are at the whim of the state right now,” said Rachel Hirsch, public information officer for Denver Health.
So far, the rollout is disjointed across the city. Denver Public Health, for example, was unaware that the city-county health department hosted a vaccine clinic at a historic Black church in north Denver, Shlay said, and had to field questions from patients who wondered why they weren’t invited.
Gov. Jared Polis has frequently used the church vaccination clinic to show the state’s commitment to equity. But Shlay said there needs to be a more systematic approach.
“It wasn’t equitable in the sense that anybody in the community was aware it was happening,” she said of the church clinic.
The Polis administration has announced plans for a broader equity effort, hoping to hold pop-up clinics in half of the state’s top 50 census tracts for low-income, high-density minority neighborhoods. And Shlay said she has hope that the vaccine distribution will improve as supply increases and public health agencies have an infrastructure in place.
“This work, if we do it right and we cover the community well, we could get back on track as a society,” she said. “I want to go and hug my friends. I want all my patients to come in and see me.”
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