In late January, Dr. P.J. Parmar, who runs Ardas Family Medicine, converted a section of an international business center in northwest Aurora into a COVID-19 vaccine clinic. He wanted to immunize refugees in the city, where vaccination rates were trailing neighboring communities.
But in the first few days, he said, about half the vaccine clinic’s shots went to white people, even though the clinic is in a ZIP code where only a fifth of residents are white.
He wanted to immunize more refugees from countries such as Nepal, Burma, Ethiopia, Iraq and Rwanda, many of whom are patients of Ardas Family Medicine and face language, cultural and trust barriers to accessing the vaccine.
So he enacted a policy to vaccinate only people who live in the 80010 ZIP code, which has approximately 43,000 people and is among the poorest and most racially and ethnically diverse in the Denver metro area. He wrote a disclaimer on a sign outside the clinic and occasionally asked people to show their IDs.
But his policy is at odds with Colorado’s vaccination equity plan, which seeks to remove barriers to access for anyone who is eligible. Colorado’s vaccine provider rules prohibit asking for an ID. And on Monday, a top aide to Gov. Jared Polis notified Parmar his policy violated the governor’s directive.
“We share your commitment to the residents of 80010, but it is not allowable for you to offer vaccines exclusively to the residents of a single ZIP code,” Rick Palacio, a strategic consultant for the governor, wrote in an email to Parmar. He added, “Identification and proof of residency are barriers to access to many Coloradans, and disproportionately affect those in our immigrant communities and Coloradans without a home.”
This conflict means Parmar may be forced to open up his clinic to more people — and, he said, potentially serve fewer refugees — or risk losing his access to the approximate 500 state-issued vaccines he said he receives and administers each week.
Parmar decided to open up his vaccine clinic to people outside the ZIP code by requiring them to sign up to get on a waiting list. He’s doing so begrudgingly, calling the state’s policy “vaccine equality, not vaccine equity.”
“At this point even health equity is not enough,” Parmar wrote in response to an email from the governor’s office, “we need health affirmative action.”
He’s protesting the directive on Facebook. In a post on Tuesday, he responded to what he considers allegations of discrimination.
“Did you realize how many health care entities have been doing this for decades? I can give you some of their names. If you have Blue Cross, you get an appointment today. If you have Medicaid (i.e. are poor), your appointment will be months from now, or not at all.”
The standoff is the latest challenge to the governor’s COVID-19 vaccine distribution plan. In February, Denver Mayor Michael Hancock unsuccessfully requested that the governor relinquish some control so Denver could immunize more racial and ethnic minorities, jail inmates and people experiencing homelessness. This week, Chaffee County health officials received an exemption under the state’s plan to vaccinate inmates at a prison in Buena Vista after a South African strain of the virus infected prisoners. Colorado’s vaccine plan doesn’t prioritize prisoners.
The tension comes as Black and Latino residents, whose numbers were the hardest hit by the pandemic, are receiving the vaccine at disproportionately low rates. Parmar’s clinic is a case in point. In April, he said 45% of the 300 refugees he tested had COVID-19. And in the 80010 ZIP code, which is 51% Latino and 16% Black, about 4% of residents have been vaccinated, compared with 10% of the total Colorado population, according to data released March 2 by the Colorado Department of Public Health and Environment after an open records request.
To help vaccinate communities facing barriers to vaccines, Colorado has partnered with non-profits and faith-based organizations to create 132 “equity vaccine clinics,” targeting census tracts with large numbers of low-income and minority people. According to the Colorado Department of Public Health and Environment, the state has given these clinics more than 50,000 vaccine doses. These clinics are generally open to anyone with an appointment.
But Glen Mays, who chairs the Colorado School of Public Health, said the state could do more to use clinics to target ZIP codes. He said the state’s prioritization of vaccine distribution takes into account a number of important risk factors, including age and preexisting health conditions.
“But what it doesn’t do is recognize that those risk factors are tightly correlated and interwoven with geographic place,” Mays said. “We are in a stratified society and we have very pronounced levels of geographic segregation.”
He said that’s why Washington, D.C., and California, for example, are targeting vaccine distribution based on ZIP codes. He said it’s a common public health strategy to acknowledge underlying social and economic disparities tend to show up based on where people live. In the end, he said, the state’s vaccine distribution plan will help determine whether health disparities in Colorado grow. It will also determine “who gets hospitalized, whose health status gets compromised by this virus, and ultimately, who lives and who dies.”
Many of the health equity clinics in Colorado run for several days and require appointments. But Parmar said this creates a barrier for some residents who don’t have access to a phone or computer. Until Tuesday, he was trying to keep his clinic open six days per week and accept only walk-ins. He said he’s worried making changes could upend his vaccine strategy, which is largely reliant on word of mouth, convenience and trust.
Betelihem Getahun, a 19-year-old from Aurora, said she considers the Mango House a trusted resource. Getahun, who came to Aurora from Ethiopia two years ago to seek asylum, returned to the clinic last week after it helped her with paperwork for her green card. She’s a nursing student working as a caregiver, so she was eligible to get the vaccine in January. But she was hesitant. She said her cousin had to go to the emergency room after getting a shot. Getting COVID-19 in February helped change her mind.
“I just don’t have a lot of trust in (the vaccine),” Getahun said. “I believe in it, that’s why I’m taking it. But not to the point where I’m, like, no mask.”
Parmar said many people show up to the clinic wary of the vaccine. He said he’s there to help counsel and persuade them to get the shot. Others, he said, are suspicious. He said some see the vaccine clinic’s advertisements and think it’s too good to be true.
“You just assume in this neighborhood that nobody is going out of their way to help you,” Parmar said.
Parmar’s dispute with the governor’s office is one of many conflicts with the government. In March 2020, an Aurora police officer pointed a gun at him when he was carrying supplies out of the Mango House. And in February, the city of Aurora cited him for a code violation and ordered him to remove a sign suspended between the mall and Colfax Avenue. The sign is still there. Parmar said he plans to leave it in the tree until the city comes up with a better way for him to advertise his vaccine clinic.
Similarly, rather than regulating his clinic, he suggested someone from the governor’s office speak with him about equity. He said he welcomes the debate. But it’s sad he needs to keep standing up for himself, he said.
“You’ve got to have a spine to do this work,” he said. “To do what? Vaccinate the poorest people?”