Throughout Missouri's COVID-19 vaccination efforts, data have shown wide disparities in the vaccination rates of different racial and ethnic groups — and while recent weeks have shown some improvement, many gaps remain.
Although vaccine hesitancy runs high in many African American neighborhoods, critics say the state’s inadequate efforts to reach those vulnerable communities have added to issues of mistrust and lack of health care access that are keeping vaccination rates low.
Just 17% of Black Missouri residents have been fully vaccinated, well below the 32% statewide average, according to state data.
Dr. Jannette Berkley–Patton, a professor and community health researcher at the University of Missouri–Kansas City School of Medicine , says that without additional measures to boost vaccination rates in Missouri, African Americans as well as the community at large will remain at risk from the virus.
“We’re never going to get to herd immunity if we continue to see those low rates of vaccination,” Berkley-Patton says. “Sometimes it takes doing something a little bit different and doing it in a way that makes sense for our community.”
And as Missouri’s Gov. Mike Parson takes steps to urge residents to return to in-person work, health experts say the need for vaccinations has grown even more urgent.
Disproportionate impact
Black residents comprise 11% of Missouri’s population, but they account for 25% of all COVID-19 cases in the state and 12% of COVID-19 deaths, according to the Kaiser Family Foundation, a nonprofit health research organization.
The impact of the coronavirus is felt acutely in neighborhoods like the one surrounding St. James United Methodist Church in Kansas City, a largely Black urban church that recently resumed in-person services, although attendance has been kept limited.
Yvette Richards, director of community connections at the church, says the church has lost many congregants to the virus, and the church's empty seats serve as a reminder of what COVID-19 has taken from a community that's still reeling from the pandemic.
“People are really grieving not only the loss of the loved ones, but the loss of a whole year, a loss of being lonely, a loss being at home, not being able to come to church, not being able to go out into the community,” Richards says.
Vaccine equity reports published by the state health department show that, as of February, the urban cores of Kansas City and St. Louis, which have the state’s largest Black populations, had vaccinations rates well below the state average.
In an effort to reach those communities, the state channeled vaccine doses to clinics hosted by local organizations like St. James and Morning Star Missionary Baptist Church on the east side of Kansas City.
Parson recently visited the vaccine clinic at Morning Star, where he acknowledged the disparities but insisted the state’s commitment to equity has been consistent.
“There’s a lot of thing we learned — all of us have — dealing with this pandemic. Things we can always do better, and I think we want to do that. But I don’t think there’s ever been a doubt in this state we haven’t tried to look at every Missouri citizen trying to get as much vaccine to the most vulnerable people in this state,” Parson said.
Although vaccination rates have risen significantly in the Kansas City area since the state began taking steps to address urban/rural disparities, the metro still has more than a fifth of the state’s residents who are eligible for vaccines but who have not received shots, according to recent reports.
An equity report released this week said the recent increases in vaccination rates in the Kansas City area were driven largely by vaccinations in the suburbs, not the urban core.
“Kansas City is now falling further behind St. Louis in vaccinating its most vulnerable communities,” the report concluded.
Dr. Berkley-Patton says that, while mass vaccination events have brought more doses to urban areas, many residents have not been able to take advantage of them because of scheduling challenges or difficulties they ran into obtaining vaccination information.
“I do see those things really feeding into equity, because equity is all about getting people what they need when they need it so that ultimately we can have improved health outcomes,” Berkley-Patton says.
Vaccine hesitancy
St. James Pastor Jackie McCall, who leads the church’s south Kansas City campus, says uptake for the vaccines was initially strong when they first became available, but many in the community have remained skeptical though not necessarily opposed to the vaccines.
“I think people are being cautious,” McCall says. “People are reminded of the Tuskegee experiment, right? Some people don’t feel that there’s been enough testing, enough results regarding the vaccine.”
While health experts believe that vaccine hesitancy is a factor in the lower vaccination rates in Black communities, polling shows that Black Missourians have become more receptive to getting shots than many other groups.
For example, polls conducted in mid-April by American Viewpoint, a public opinion research firm, found that 34% of Black Missourians didn’t plan to get vaccinated. But greater resistance was found in other groups, including Republicans ages 18 to 45 (55%), residents of the Springfield area (45%) and people who described themselves as “very conservative” (51%).
Yet even in many of Missouri’s more conservative counties, including the Springfield area, vaccination rates are higher than those for Black Missourians.
The pause in mid-April of the Johnson & Johnson vaccine after a handful of patients developed blood clots sowed further skepticism about the vaccines. Richards, who speaks often with congregants in an effort to allay their vaccine fears, says the pause contributed to a dramatic drop in the number of people seeking the vaccines.
Tracking with national trends, vaccinations in Missouri have fallen consistently since peaking at more than 54,000 doses per day just before the Johnson & Johnson pause. Now, an average of just 25,000 doses are being administered in Missouri each day, the lowest number since February.
State shortcomings
But it's not just a matter of vaccine hesitancy. Critics have also pointed to shortcomings in Missouri’s vaccination approach.
Since February, state officials have acknowledged problems with the health department’s vaccination data on race and ethnicity. The data is important because it helps public health officials determine where more vaccine doses are needed.
In one of the more striking examples, the data show “multiracial” residents with completed vaccinations rates of 62%, nearly double the state average.
“So there’s some huge problem with the way the state is collecting race and ethnicity under COVID vaccination,” says Dr. Rex Archer, director of the Kansas City Health Department.
The state health department has acknowledged other problems too, including missing racial data for many people who have been vaccinated and multiple “unknown” and “other” categories, as well as using national census data to estimate the state’s racial and ethnic breakdown rather than actual demographic data for Missouri.
Though the state has taken some steps to address those problems, Archer says the state data is not considered reliable for tracking vaccinations and developing community outreach.
“We have to look at it, but it’s got too many variables to be something we can count on,” Archer says.
Missouri’s health department has also hosted weekly Missouri Advisory Committee on Equitable COVID Vaccine Distribution meetings, which are open to the public online.
The meetings, which initially included comment sections and discussion among advocacy groups, have been dominated in recent weeks by presentations touting the state’s successes and new initiatives.
Archer, who was outspoken about vaccine disparities in early meetings, says he now rarely participates.
“The first couple months, everything ... we were raising or saying needed to be thought about or planned about or done was ignored or not moved forward,” Archer, who is retiring in August, says. “It obviously became a waste of time.”
A spokeswoman for the health department, Lisa Cox, did not follow up on requests from KCUR to speak with Adam Crumbliss, director of the department's Division of Community and Public Health and co-leader of the committee meetings along with disability advocate and health department special advisor Sara Hart Weir.
Parson announced on April 5 that he would scale back the National Guard’s participation in vaccinations and end their deployment by June 1. He said they would be replaced where needed by vaccinators from AmeriCorps, the Federal Emergency Management Agency and the Missouri Disaster Medical Assistance Team.
In a news release, Parson said that demand had dropped dramatically and that vaccines were available for 80 percent of Missourians within five miles of their homes.
Parson has also taken steps in the last two weeks to urge residents back to in-person work, despite vaccination rates being well below the threshold for herd immunity. Parson has ordered state employees to return to the office and ended pandemic-related federal unemployment benefits.
Kansas City Mayor Quinton Lucas says that while vaccine supplies now appear to have outstripped demand, more individualized outreach efforts will be critical in boosting vaccination rates.
“It’s really us making sure we get people out there. It’s making sure that folks know where they can go, know how easy it is.” Lucas says. “Having walk-up opportunities. That’s where the difference is going to be made.”
Moving forward
Earlier this week, the Jackson County legislature authorized $5 million dollars in CARES Act funding for a program to boost vaccinations in six zip code areas with low vaccination rates. The program, which involves Truman Medical Centers, the University of Missouri-Kansas City and the Black Health Care Coalition, will extend from June 1 through Nov. 30.
Berkley-Patton, who will lead the project, says the work will address many of the underlying problems giving rise to the low vaccination rates.
“COVID-19 has really just shined a brighter light on many of these types of injustices. What are we going to do about our health care systems in making sure that people feel like when they walk through the doors, they’re going to be heard, they’re going to be respected, that there will be appropriate communication and that they are going to receive the same quality of care as other Americans?”
At St. James Church, the vaccination efforts have become more personalized. While Pastor McCall normally counsels her congregants about religious matters, she says she’s been asking them lately to consider a different kind of faith.
“We want to continue to be here, to be in purpose and do the things that God has called us to do,” McCall says. “So let’s go ahead and let’s trust. Let’s trust the process. Let’s trust God. Let’s trust the science.”
