States are leaving behind some of the people most vulnerable to contracting or dying from Covid-19 in a quest to quickly administer shots.

The U.S. vaccination campaign that started off slowly has accelerated in recent weeks with online systems to book appointments and mass clinics that immunize thousands of people a day. Yet the pressure to ramp up vaccinations is promoting tactics that favor people with access to technology, transportation and spare time. Others who may be at greater risk of death from Covid are less equipped to navigate systems built for efficiency.

“I don’t think the solution is to move slower so we bring everyone along,” said Shivani Patel, a social epidemiologist at Emory University. “I think the solution is figuring out ways of bringing everyone along.”

Two months into the campaign, the focus on speed highlights the inequities it can create. White and Asian people are generally receiving shots at a higher rate than Blacks and Hispanics in states that collect information on the race and ethnicity of vaccine recipients, according to Bloomberg’s vaccine demographics tracker.

Efforts to hasten vaccination are showing progress: 79% of doses distributed have been used, according to Bloomberg’s vaccine tracker, a significant improvement from the early days of the rollout in December and January. Reaching communities of color, or elderly people less comfortable with technology, could take longer.

The Biden administration has pledged to ensure vaccines get into arms quickly and equitably, and has taken steps to expand vaccination sites and send shots to pharmacies and federally qualified health centers. However, opening vaccination sites in minority and low-income communities doesn’t always mean the shots go to residents.

“The idea that in many places the primary way to sign up for the vaccine has been through the computer, through all these websites, that in itself has been a major barrier, especially for many of our older adults for whom you’re not tied to your phone 24-7,” said Tanjala Purnell, associate director at the Johns Hopkins Urban Health Institute.

In Maryland, 12% of the state’s White population has been vaccinated, compared with about 6% of its Black population, according to Bloomberg’s analysis of state data. In North Carolina, 14% of White residents have received a shot, compared with about 8% of Black residents. The disparities are narrower in some states, including Washington and Oregon, though they still exist.

The scope of racial inequities in vaccinations isn’t fully understood, because the U.S. lacks race and ethnicity data on about half of the people vaccinated. And the reasons are complex: Minority communities in the U.S. experience greater barriers to health care and more hesitancy about vaccination than White people. Yet hesitancy alone doesn’t explain the disparities.

“For somebody to say African-Americans just don’t want to do it, I would be asking them: How many African-Americans have you really sat down and talked to? We have the same concerns as everybody else when it comes to our livelihood,” said Suzette Parham, 61, who has been trying to find vaccination appointments for herself and her husband, Harold, 74, in the Baltimore area; both are Black.

Information Gap
Parham and her husband registered with about half a dozen vaccination sites. They’re eager to be immunized so they don’t have to worry so much about catching the virus, as they have medical conditions that put them at higher risk. But they are struggling to secure appointments.

Online portals have been difficult to navigate for many older adults, said Purnell of Johns Hopkins. She’s working with faith leaders in the Baltimore area to survey people’s feelings about the vaccines. The frustration is evident.

“The transparency of how this process works has been one thing we’ve heard directly, in particular from communities of color, is one area we’re really failing,” she said.

The tension between speed and equity also is clear in the experience at mass vaccination sites. In Mississippi, drive-through clinics are being used to ramp up vaccinations. But Black people accounted for only 18% of patients at such clinics compared with their 38% share of the state’s population, Mississippi State Health Officer Thomas Dobbs said in a media briefing this month.

Access Barriers
Dobbs said Black communities face historical barriers to health care that “are not going to be any different for coronavirus vaccination than they are for access to health care for any other reason.” The need to book appointments online or through a call center can impede some people from getting vaccinated.

In smaller sites at community health centers and dialysis clinics, the majority of patients are Black, he said. “If we don’t also have a parallel focus in addressing health disparities, we won’t really get to the health gains that we’re hoping to make,” he said.

It’s much the same case in Los Angeles, where mobile clinics that provide shots in neighborhoods have found 70% of appointments going to Black people, according to CORE, a nonprofit working with the city. The distribution is less efficient in terms of overall numbers than the giant site at Dodger Stadium, but they “are much more accessible and will go straight to those communities,” said Ann Lee, chief executive officer of CORE, a nonprofit she co-founded with actor Sean Penn to do relief work in Haiti after the earthquake.

“If you sit around refreshing multiple websites repeatedly, you can get a slot,” said Mike Pykosz, CEO of Oak Street Health Inc., which runs the Waukegan clinic among 80 sites in 11 states. “No matter what the location is, the appointments will get overwhelmed by people who tend to be higher income, tend to have more resources.”

In response, Oak Street Health has made thousands of phone calls to older adults in the neighborhoods it serves to help them get appointments. It’s also working with churches and community groups to alert local residents when vaccines become available.

While a slower approach, such outreach can help. Rosie Parks, a 71-year-old grandmother in Chicago, initially didn’t seek to be vaccinated despite knowing hypertension and diabetes put her at higher Covid risk. When Oak Street Health called to offer her an appointment, she took it.

Worker Hesitancy
A challenge for the health-care industry is getting its employees vaccinated. Hesitancy persists even among medical personnel on the front lines: About half of New York nursing-home staff declined a shot, in a field where about one-third of workers nationwide are Black, according to federal employment data.

At SCAN Health Plan, a nonprofit Medicare health plan in Southern California, reassuring staff was the first step in addressing hesitancy among patients, said CEO Sachin Jain.

SCAN hosted a virtual meeting with Michael Rosenblatt, a scientist involved in developing the Moderna vaccine – and Jain’s former boss when they both worked at Merck & Co. – and posted the recording on social media for the public. “You’re hearing directly from the makers,” Jain said.

SCAN is holding online sessions about the vaccine in both English and Spanish. It’s also working with two local hospitals—Martin Luther King Jr. Community Hospital and Hollywood Presbyterian Medical Center – to alert members to vaccine appointments. “A lot of what we’re trying to do is reduce the barriers that people face,” Jain said.

—With assistance from Jeff Green.

This article was provided by Bloomberg News.