By Sherri Zink and Dr. Bryan Heckman; originally published in The Tennessean, November 2020
Nine months into the pandemic, a great deal of uncertainty remains. COVID-19 continues to spread, our schools assess whether to stay open, and our economy struggles.
Pfizer and Moderna’s recent announcements on their coronavirus vaccines have offered a beacon of hope. But there’s still much we don’t know as to when the vaccine will be approved and widely available — or if the public will embrace it.
That’s why thorough research, reliable data, and unbiased conclusions are essential to our communities’ health more than ever before.
Joining forces to effect change
Earlier this year, BlueCross BlueShield of Tennessee and Meharry Medical College embarked on a partnership to collaborate on making Tennesseans healthier. The team’s primary goal is to improve COVID-19 response by examining health disparities and addressing social determinants of health in minority and underserved populations.
These determinants are comprised of the health-shaping conditions in which people are born, grow, live, work and age. BlueCross uses its data to gain insight around these factors. To apply the data and remove barriers to care, BlueCross developed the Social Vulnerabilities Index (SVI), an aggregate score that ranges from 0 to 19. The SVI quantifies the number of social determinants (19 total) for which a member may be at risk and is used to help identify and engage with vulnerable populations.
Nashville’s Meharry Medical College is the largest private historically Black college in the United States and is committed to educating tomorrow’s health care professionals and scientists. Since the beginning of the pandemic, Meharry’s been battling the virus on numerous fronts. Meharry is operating COVID-19 testing sites, exploring treatments and vaccines, conducting clinical trials, and researching vaccine hesitancy.
Minority vaccine hesitancy, or the reluctance to be vaccinated, is rooted in longstanding systemic health and social inequities and distrust in the health care system.
BlueCross and Meharry’s shared concern is that vaccine hesitancy could increase in underserved minority populations if left unaddressed. But we see a clear path forward for data-driven decision making and quality improvement.
Our goals are to:
- Identify social determinants of health that may influence COVID-19 vaccine acceptance
- Develop strategies for reducing disparities in COVID-19 vaccination
- Provide recommendations to public health officials and policymakers on resource allocations
The data shows that COVID-19 severity varies by race. Hispanic people have the highest average number of social vulnerabilities, and Black people have higher social vulnerability rates across many different factors. When BlueCross looked at high severity cases of COVID-19 among its Commercial plan members, the percentage for Asian Americans is twice as high as others in the Commercial population.
BlueCross notes similar results for Black people in our Medicaid population. Approximately 9% of our Medicaid members tested positive for COVID-19, 50% of those testing positive for COVID were Black. These individuals accounted for 72% of the high-severity cases.
Why COVID experiences vary
Following significant medical events like heart attack, stroke, and hospitalization, members experience the health care system differently. We’re seeing a direct correlation between cost and severity of each COVID-19 patient journey. For the more severe COVID-19 journeys, in many cases, we see a larger minority population group.
Data has already shown that COVID-19 vaccine acceptance levels will vary by location, demographic and socio-economic conditions. We’re using flu vaccine acceptance to help us understand the negative perception brought on by decades of distrust in the health care system.
Phase 1 of our collaboration, already underway, involves mapping communities at high risk for COVID-19 vaccine hesitancy and using predictive modeling to identify individual- and community-level risk factors. The results will help inform public health messaging.
One size of care doesn’t fit all. Ultimately, we’re working to uncover the best approach to optimizing health equity for all Tennesseans.
Bryan Heckman, PhD, is director of the Center for the Study of Social Determinants of Health and associate professor of psychiatry and behavioral sciences at Meharry Medical College.