RJ Sangosti, The Denver Post Richard Karbowski gets his second dose of the Pfizer vaccine at a mobile vaccination clinic in a Walmart parking in Commerce City on Oct. 14, 2021. Karbowski said he needed to be fully vaccinated for his construction job.By MEG WINGERTER | firstname.lastname@example.org | The Denver PostOctober 19, 2021 at 6:00 a.m.
More than four out of five people in Colorado who have received COVID-19 vaccine booster shots are white, but it’s not clear how much of the gap is new or an echo of the disparities in who was inoculated months ago.
As of Monday afternoon, 269,872 people in Colorado, or about 8% of all people who are fully vaccinated in the state, have gotten a third shot.
The vast majority of those who’ve gotten that third shot are white, with people of color so far underrepresented. White residents have received 83.4% of boosters, but account for 70% of the state’s population, while Black residents have received 2.1% of boosters while accounting for 4% of the population and Hispanic residents have received 6.2% of boosters while accounting for 20.2% of the population.
Hispanic Coloradans also have gotten fewer first and second shots than their share of the population, though it’s harder to be sure how large the disparity is, since almost 10% of shot records don’t include race and ethnicity.
Latinos are more likely to work in frontline jobs that don’t offer paid sick time if workers don’t feel well after getting vaccinated, leading people to risk getting the virus rather than being unable to pay their bills, said Emily Cervantes, program manager for public policy research and analysis at the Colorado Latino Leadership, Advocacy and Research Organization.
“The biggest barrier remains getting people their first and second shots,” she said. “With boosters, there’s an extra challenge because there’s still a lot of confusion.”
There’s widespread agreement that the most important piece of making COVID-19 into a manageable disease in the United States is to get first and second doses to as many people as possible, because they dramatically reduce the odds of severe illness.
As of early October, Coloradans who were fully vaccinated — one shot of the Johnson & Johnson vaccine or two shots of Pfizer or Moderna — were about three times less likely to test positive for COVID-19 and five times less likely to be hospitalized.
But third doses can give an extra layer of protection to people who may not have had a strong immune response to their original shots, so if some groups of high-risk Coloradans aren’t getting them, it’s a problem, said Dr. Oswaldo Grenardo, a physician at Centura Health and member of the Colorado Vaccine Equity Task Force.
“No one is safe until everyone is safe,” he said.
Jessica Bralish, a spokeswoman for the Colorado Department of Public Health and Environment, said the department is working to bring vaccines to people who may have trouble getting them, and to answer questions and counter misinformation.
“We also acknowledge that systemic barriers to health have caused some communities of color to have greater pause toward the vaccine, health care systems and government generally. We know we have work to do to overcome these historical injustices, and we’re committed to doing it,” she said in a statement.
Currently, boosters are authorized for people who have a compromised immune system and received either the Pfizer or Moderna shot, or got the Pfizer shot six months ago and fall into one of the following categories:
* Age 65 or older* Work in a job where you risk exposure to the virus* Have one of 17 health conditions, including diabetes, obesity, chronic lung disease and pregnancy* Mixing and matching
On Thursday, a committee advising the U.S. Food and Drug Administration recommended that members of those groups who got the Moderna shots be able to receive a half-dose as a booster. On Friday, it recommended that anyone who got the Johnson & Johnson vaccine should be eligible for a second dose, though they framed it as a realization that the shot should have had two doses in the first place.
It would likely be at least a week before those recipients would be eligible for another shot — after the FDA makes an official recommendation, the issue goes to a panel advising the Centers for Disease Control and Prevention, with the CDC director making the final call.
The FDA also plans to allow recipients to “mix and match” vaccine types, though it won’t necessarily recommend that they do so, according to The New York Times. Some data suggests people who received the Johnson & Johnson vaccine develop more antibodies from boosting with Pfizer or Moderna, though it’s not clear if that translates into a significant increase in protection.
Boosters already account for more doses than first and second shots in Colorado, Gov. Jared Polis said last week. He estimated clinics and pharmacies administered between 10,000 and 15,000 booster shots each day in the last week, compared to 3,000 to 5,000 first and second shots.
The number of doses administered in Colorado jumped by 50% in the last week of September, to more than 107,000, coinciding with an expansion of eligibility for booster shots. Demand for shots remained higher than it was before boosters became available, but dropped off quickly: about 94,000 shots went into arms in the first week of October.
People of color were at a higher risk of being hospitalized or dying from COVID-19 before vaccines became available. So far, there’s no data available on whether race or ethnicity has any effect on a person’s risk of a serious breakthrough infection, Grenardo said. However, Black and Hispanic people do tend to have more chronic conditions that could raise their risk than white people of the same age, due to a complex mix of economic and environmental factors.
Since the CDC advises people who don’t have one of a list of immunocompromising conditions to wait six months before receiving a shot, it’s not totally surprising that Colorado’s booster numbers are lopsided. On April 18, about 71% of Coloradans who were vaccinated were white, 8% were Hispanic, and 2% were Black.
Still, that’s probably not the only factor, since access to information about boosters also influences who’s likely to get one, said Glen Mays, chair of the department of health systems, management and policy at the Colorado School of Public Health.
“My assessment would be it’s probably a combination,” he said.
Some of the same problems that came up during the initial rollout of vaccines are still interfering with distributing boosters, Cervantes said. People seeking shots don’t have to provide identification or proof of insurance, but if the clinic asks for it, it may scare them away, particularly if they’re undocumented, she said.
“People get the sense that it’s required,” she said.
Most of the state’s “equity clinics” targeting underserved neighborhoods used the Moderna vaccine, because it doesn’t require the ultra-cold storage the Pfizer does, making it easier to take on the road, Bralish said. While only people with compromised immune systems are eligible to get a Moderna booster now, the state is preparing to deliver third shots through clinics in the same areas when the CDC gives the go-ahead for wider Moderna boosters, she said.
“We’ve already begun outreach to all original clinic hosts to offer booster clinics,” she said.
Messaging on booster shots
Confusion about the relatively complex guidance on boosters also could be a factor that’s keeping some people from seeking a third shot, Mays said. There’s still a debate among scientists about how much of the general population needs booster shots, though there’s consensus that they can help people with compromised immune systems, he said.
Officials in the Biden administration have called for boosters for everyone at some point, and some European countries already authorized them for all adults. Some worry that emphasizing boosters will discourage unvaccinated people from getting the shot at all, while others think the third doses would go to better use if they were donated to countries where few people are vaccinated at all.
While the message about who should get a shot may be more nuanced than it was at the beginning, it’s important not to forget what public health has learned about how to get doses into arms — a relatively passive strategy, like sending email reminders to patients who are eligible, leaves out significant numbers of people, Grenardo said.
The biggest successes in distributing first shots came from working with people who marginalized communities already trust as messengers, who may not be health professionals, Grenardo said. It’s also vital to set up clinics in places that are easily accessible and part of the community, like churches and recreation centers, he said.
“Bringing vaccines to the communities where they need them most is critical,” he said.
The coming weeks will be a complicated time for the vaccine rollout, because of the need to reach people who are eligible but unvaccinated; those who newly qualify for boosters; and children between 5 and 11, assuming the FDA and CDC find Pfizer’s data sufficiently compelling when they consider it later this month, Grenardo said.
“Hopefully we’ll be able to fight multiple fronts,” he said.