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Duke must prioritize the marginalized for vaccines and testing

letter to the editor

Chancellor Eugene Washington, Katie Galbraith, and Stelfanie Williams,

We, the undersigned, urge you to prioritize Durham’s marginalized communities in vaccine distribution and testing. COVID-19 data continues to show that Black and Latinx communities are disproportionately affected by COVID-19, yet they have the most barriers to accessing vaccination and testing services. These very communities have sustained us with their frontline service throughout the pandemic. To this end, vaccinations, in conjunction with community-based testing, are of utmost importance to ensure the health of these communities.

Throughout the pandemic, Duke has led community health activities aligned with the institution’s commitment to testing, treatment, and community vaccination. However, it has become strikingly apparent that those vaccinated are not representative of the Durham community. In Durham County, which is 35% Black, only 24% of first doses thus far have gone to Black individuals across all vaccination sites. And while 14% of the county are Latinx, they only make up 4% of those who have received their first dose so far. There is a significant gap in vaccine equity for our Black, Indigenous and people of color (BIPOC) seniors. 

Although Duke’s COVID-19 demographic data have yet to be made publicly available, Duke University Health System (DUHS) has a history of providing unequal care to Black people, and trends in testing data indicate a disconnect from Black and Latinx communities that contributes to health inequities. Despite DUHS’s pledge to “acknowledge our history, engage as a partner with our community, and seek to understand and dismantle any systemic barriers and injustices,” no long-term commitment to expand community vaccination and testing efforts has been made.    

Disparities in vaccination access are multifactorial. First, information about vaccine registration was not equitably distributed from the beginning. By the time that many in these communities heard that Duke had begun vaccinations for the community, appointments were no longer available. Additionally, many BIPOC seniors have limited access to technology which consequently reduced access and further exacerbated these disparities.Transportation remains a significant barrier, and while assistance is now available, there was a period during which appointments were inaccessible, pushing historically marginalized communities further down the waitlist. Lastly, language barriers remain substantial. Scheduling resources have only been offered in English and Spanish, excluding many in Durham’s immigrant population.

The gap in vaccine equity is even more alarming when considering the exclusion of BIPOC from adequate testing and follow-up services. Sites for testing remain concentrated in North and West Durham, many in close proximity to each other in predominantly white areas. While healthcare institutions in Wake County and other neighboring counties established mobile testing resources (like UNC’s mobile unit) at the beginning of the pandemic to reach underserved and high-need communities and rapidly respond to outbreaks, Duke did not establish similar resources. 

Other cities have overcome these obstacles by taking vaccines and tests directly into the local community. In Charlotte, Atrium Health implemented mobile clinics, which have vaccinated more than 1,800 people, 61% of whom were Black and 10% Latinx. Similarly, Novant Health partnered with one of Charlotte's largest Black churches to host a vaccination event. In Wake County, WakeMed and the Department of Public Health have provided over 1,700 vaccinations at community sites, with the goal of addressing vaccine inequities. UNC’s mobile unit improved access to vaccines, testing, and social resources to those who otherwise might not have access.

Thus far, Duke has partnered with the community to provide four pop-up vaccination events at the Latino Community Credit Union, Nehemiah Christian Center, Union Baptist Church, and Southern High School and several community-based testing events. However, we have yet to hear a long-term commitment to expand community pop-up sites in the future. To address the disparities in vaccine distribution and testing, we urge Duke to 1) make publicly available demographic data of those the institution has vaccinated and tested at the level of institutional and community sites, 2) commit to allocating doses to Durham’s marginalized communities, 3) commit to recurrent community vaccination sites in cultural centers of activity, and 4) commit to amplifying mobile and community-based testing efforts for historically marginalized communities.

The information provided demonstrates ample opportunity for DUHS to fulfill the promises they made to engage with communities to advance health equity, racial equity and social justice in their fight against systemic racism and injustices. We must remember that Duke was built on the backs of Black and Brown people and continues to rely on these communities to operate today. To promote equitable distribution, we must prioritize historically marginalized communities in our testing and vaccination efforts. Without these actions, we are at risk of further worsening health disparities, which will be detrimental to our community for decades to come.

Sincerely,

Nguyên Thảo Thị Nguyễn, Cokie Young, and Njideka Ofoleta

La Semilla, End Poverty Durham, World Relief Durham, CityWell United Methodist Church, The River Church, Carolina Outreach, Root Causes

A complete list of signatories can be accessed here.

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