Minnesota's COVID-19 vaccine equity efforts to move beyond high-risk areas

Minnesota continues to make progress in delivering COVID-19 vaccines to underserved communities, but as the pace of first doses slows, state officials are preparing new strategies for closing the gaps, especially among racial and ethnic minorities.

Although Minnesota has focused efforts on geographic areas, specifically 209 ZIP codes that historically have been underserved, the approach doesn't always reach those in vulnerable groups, including 50% of Hispanics and 45% of Blacks who live somewhere within the other 670 ZIP codes across the state.

Dr. Nathan Chomilo, vaccine equity director at the state Department of Health, said the next phase will be to increase the lower vaccination rates among the Black, Hispanic and Indigenous communities outside the high-risk ZIP codes.

Statewide, roughly one-half of those 15 and older in those groups have received at least one COVID-19 vaccine dose, compared with 62% of the white population.

"There is progress," said Rodolfo Gutierrez, executive director of HACER, which works with Latino communities. "However I think there is a big difference between the metro area and rural areas particularly."

Gutierrez said vaccination rates are worrisome among those working in agriculture. Some are concerned they will lose their jobs or wages if they take time off to get the shot or develop serious side effects.

Migrant workers who recently have arrived for Minnesota's growing season often aren't familiar with local resources and are not offered vaccines on the job.

"They don't know where to go because there is no opportunity where they are working," he said.

Minnesota began its vaccine equity push in early May as vaccine distribution was moving away from reliance on "max vax" venues, such as state-sponsored clinics in convention centers or central locations like hospitals.

Bringing the vaccine to the community became the focus, with Metro Transit buses repurposed into mobile clinics and events held at churches and community centers.

To maximize impact, the Health Department encouraged vaccinators to focus efforts in ZIP codes that score the highest on the social vulnerability index, or SVI, which is a broad measure used to identify high-risk areas.

"SVI is quantifying where you might see the worst outcomes in a disaster such as a flood or disaster such as pandemic," said University of Minnesota public health researcher JP Leider.

Race and ethnicity are among 15 components used to measure vulnerability, which includes poverty level, unemployment and percent of population that is elderly, disabled or non-English speakers.

"These areas that are disadvantaged or deprived or socially vulnerable are the places where health outcomes are the worst and where we have seen the worst outcomes in COVID," Leider said.

In Minnesota, the highest risk ZIP codes are scattered across the state. They account for 29% of the state's 16-plus population, but most recently have seen 32% of new COVID-19 cases, 39% of hospitalizations and 38% of deaths related to COVID-19 complications. Forty-two percent of children who required hospital care for complications also live in these ZIP codes.

Since the state began its equity efforts, the number of first doses administered has grown faster in communities that are most vulnerable to the pandemic.

"What we see is that there has been a decrease in the gap between the statewide [vaccination] average and Minnesotans who live in those high-risk SVI ZIP codes," Chomilo said.

Since May 1, there has been a 13% increase in residents age 16 and older who have received at least one shot in the high-risk ZIP codes, compared with 11.6% in other parts of the state.

Even as vaccine uptake has slowed across Minnesota, the high-risk ZIP codes continue to show the largest increases.

The equity gap persists. In the lowest-risk ZIP codes, vaccination rates are 73%, 10 points higher than the 63% rate in the high-risk ZIP codes.

Chomilo said details of the next phases of the equity program could be announced later this month.

"My hope is to provide more specific guidance down to the ZIP code level of areas that are both either high SVI and or low rates for our Black, Hispanic and Indigenous Minnesota communities," he said.

In the meantime, health care providers and community organizations are still scheduling clinics.

"The clinic pace has not slowed down at all," said Ingrid Johansen, senior manager of clinical care and outreach for M Health Fairview. "We are completely booked the entire month of June."

Some events are scheduling during the evenings or weekends to attract those who can't show up during weekday business hours.

"I don't think these are issues specifically around vaccine hesitancy," said Laura Andersen, health protection division manager with St. Paul-Ramsey County Public Health.

"I think what we are seeing here probably is younger families, busy families, people working multiple jobs."

But even in the metro area, vaccination efforts are not always coordinated among the dozens of community groups, clinics and other organizations that are staging the vaccination events.

"We are not really working together. Everybody is doing their own efforts, and sometimes we are doing the same time at the same place," Gutierrez said. "Coordination efforts are something that is still needed."

Chomilo said that disparities in vaccination rates could remain.

"That structural inequity has been developed over decades and it isn't going to go away in one vaccination campaign," he said. "This is a step toward really not only addressing it in the pandemic response in vaccination but hopefully looking at how we invest in our public health infrastructure in the state as a result."

Glenn Howatt • 612-673-7192

Twitter: @GlennHowatt