COVID-19 Vaccines And Diabetes: Vaccine Access Issues For People Of Color
Editor’s Note: We have a simple goal: tap into the power of the global diabetes community to save lives. Visit coronavirusdiabetes.org to learn more about what you can do as a person with diabetes to keep yourself and others safe from COVID-19 until we’re all safe.
This is news coverage from June 2021 that will not be getting updated. For up to date information on COVID vaccines and diabetes click here.
On April 21, 2021, the Kaiser Family Foundation released updated data that found that Black and Hispanic people received a smaller share of COVID-19 vaccinations when compared to their share of coronavirus cases and deaths. Throughout the pandemic, communities of color have borne the disproportionate burden of COVID-19, highlighting the importance of equitable vaccine access. Vaccine access is not only crucial for people of color, but for those with underlying medical conditions such as diabetes. When overlaid with disparities such as implicit bias, it creates a compounded healthcare issue for communities of color with diabetes.
Unfortunately, vaccine access for communities of color has been all but fair. In Arizona, Hispanic people have only received 14 percent of vaccines despite accounting for 40 percent of COVID cases and 31 percent of deaths. And in Michigan, Black people only received eight percent of vaccines despite comprising 23 percent of deaths.
“Because of long standing economic discrimination, communities of color are much more likely to find themselves in jobs where they can’t take off work without docking their pay. They have to work certain hours and aren’t able to get away for a vaccine appointment,” Michelle Andrasik, PhD, clinical health psychologist and affiliate assistant professor of Global Health at the University of Washington tells Beyond Type 1.
Communities of color have an increased burden of COVID-19 for a variety of reasons including required exposure during work. For Black and Hispanic people, 24 percent were employed by service industries compared to 16 percent of whites. These industries include restaurant, hospitality, and retail work, all of which require people-facing interactions.
People of color are also more likely to live in multigenerational households and in densely populated urban areas and housing situations, further exacerbating coronavirus transmission. In urban counties across the U.S., people of color comprised 56 percent of the population. Additionally, data showed that four in ten Black people (41 percent), Hispanics (38 percent), and Asians (38 percent) lived in areas surrounded by multi-unit residential buildings compared to 23 percent of whites.
Another driver of inequitable vaccine access is vaccine hesitancy due to broken trust in healthcare providers among communities of color. Mila Clarke Buckley, a diabetes and food blogger who created the Hangry Woman, was diagnosed in 2016 with type 2 diabetes–a condition where the body cannot properly use insulin. However, after months of failed medications and skyrocketing blood sugar levels, Clarke Buckley discovered—after taking an antibody test with an endocrinologist—she had type 1 diabetes. “I was misdiagnosed with type 2 diabetes which has given me a little bit of distrust in the healthcare system,” Clarke Buckley says.
Clarke Buckley is not alone in her experience. Phyllisa Deroze, a global diabetes patient advocate and blogger, shares that she wanted to get vaccinated, but did not want to be the first due to the legacy of the nation’s medical racism. “The field of gynecology in America was created on the wounds of Black women who were enslaved. And so there’s just really a long history in America of just not treating Black people like human beings and using them as experiments,” Deroze says.
Deroze was told by one healthcare provider that her electrolytes were off, which prompted her to ask her provider for an antibody test. But that provider was offended when Deroze asked to be tested for antibodies. “I was once again denied antibody testing. It was clear that the endocrinologist was offended by me even asking,” Deroze says.
Deroze was misdiagnosed twice for type 2 diabetes, once in 2011 and another time in 2018, albeit having type 1 diabetes. Her misdiagnosis led her to experience diabetic ketoacidosis (DKA). “My life was on the line. And that shouldn’t happen,” Deroze says. “If a person is diagnosed with type 2 diabetes, what is the harm in testing for antibodies just to make sure you’re treating the right condition?” It wasn’t until 2019 when Deroze was properly diagnosed with type 1 diabetes by her gynecologist
Clarke Buckley also recalls suggesting antibody testing on numerous occasions to medical providers. However, her idea kept getting shut down, putting her at risk for long-term complications as a result of untreated type 1 diabetes. These complications include: foot problems, urinary tract infections, eye disease, skin infections, heart disease, kidney disease, and even death. “It’s communities of color that are subjected to the system that essentially puts us at additional risk,” Clarke Buckley says.
Misdiagnosis of diabetes among people of color is not uncommon and is just one example of the bias of the medical system. Research shows that glycated hemoglobin (HbA1c)—a measure of average blood sugar over three months that can show evidence of diabetes—is not an adequate health measurement for all genetic ancestry groups. Particularly for African ancestry groups, additional screening may be necessary to diagnose diabetes. This leaves hundreds of thousands of African Americans with type 2 diabetes undiagnosed. Additionally, a high HbA1c measurement alone does not prove that a person has type 2 diabetes. It only proves that blood glucose levels are consistently high. Therefore, an autoimmune antibody test must be done to confirm or rule out type 1 diabetes. Because type 1 diabetes differs heavily from type 2 diabetes in that type 1 always requires insulin treatment, a misdiagnosis could be fatal and lead a person without insulin into diabetic ketoacidosis, a complication that occurs when the body does not receive enough insulin to break down blood glucose. DKA can lead to coma and even death.
Some states have made efforts to curb the unequal distribution of vaccines. For example, in Vermont, Black adults and other people of color were given priority status for vaccines. But despite these intentions, many state efforts have fallen short.
Kia Skrine Jeffers, PhD, RN, PHN, assistant professor at the University of California Los Angeles School of Nursing tells Beyond Type 1 that in California, the state distributed vaccine access codes to improve COVID-19 vaccine availability and access for hard-hit Black and Latino communities. “The special code that people of color could use to register to get the vaccine were being distributed among people who were not people of color,” Jeffers says. Instead, wealthier populations who work from home were misusing the system, the Los Angeles Times originally reported.
Anna Lopes, MD, family physician based in Southern California explains that the underlying culprit of vaccine inequity is systemic racism. Lopes references the Tuskegee Syphilis Study, an ethically abusive study that failed to treat and inform Black men of syphilis in the 1930s and the forced sterilization of Puerto Rican women. “There was significant hesitancy in the Black community, and other communities of color, specifically because of institutional racism,” Lopes says.
Achieving Vaccine Equity
Jeffers suggests that to achieve health equity, health leadership must reflect and have representation from the communities they serve. “If you don’t have community stakeholders involved in the planning, then community perspective is often overlooked or underappreciated,” Jeffers explains.
In addition to having representation in health leadership, Jeffers and Andrasik add that equity involves recognizing and rectifying historical injustices and distributing resources like vaccines to populations that need it the most.
“What we have found in terms of access is that you really have to take the vaccine where people are. We have partnered with Black churches, community centers, and community organizations to open up vaccination sites,” Andrasik explains. “In doing that partnering, the vaccination sites then reach out to their local communities they have long standing relationships with.”
Still, people of color are struggling to access vaccines due to transportation, financial, language, and nebulous registration barriers. To achieve equity, Andrasik, Jeffers, and Lopes stress that states need to be more intentional with their vaccine rollout process to make equity intentional. “All of these access issues really create barriers that are easily mitigated when we really think outside the box and think about how we can do things differently, and in partnership with communities,” Andrasik says. Vaccine access for people of color with diabetes is just the first step toward equity.