As demand continues to outpace supply for COVID-19 vaccines, local officials and healthcare advocates are questioning whether Tennessee’s poor, Black and brown residents are getting an equal shot.

For more than a week, access to vaccines has been open to Tennesseans age 75 and older through public health departments and hospitals. 

Health departments’ rollouts of vaccines to elderly residents got off to a rocky start with seniors forced to wait for hours in their cars in some Tennessee counties. In response, county health departments have created appointment systems and standby lists, but the supply remains extremely limited.

  It's that hospital systems used (vaccine distribution) as an opportunity to reserve vaccine for established patients knowing those patients are disproportionately higher income and predominantly white.   – Brian Haile, CEO, Neighborhood Health

Hospitals, after first inoculating the healthcare workers and staff first in line for vaccines under the state’s plan, have their own supplies available for elderly Tennesseans. But many, including all five hospitals in Nashville with vaccine, have chosen to make the government-funded vaccine available only to their existing patients. 

“My criticism is not that they chose to start giving vaccines to hospitals,’ said Brian Haile, CEO of Neighborhood Health, which provides primary healthcare to 30,000 low-income residents across Middle Tennessee — nearly all of whom live in poverty. 

“It’s that hospital systems used that as an opportunity to reserve vaccine for established patients knowing those patients are disproportionately higher income and predominantly white.”

Haile said his staff has been fielding calls and questions from their elderly patients who have been unable to get through to county health departments’ phone lines and are worried about how to get a vaccine. Neighborhood Health is the largest provider of doctor services to African-American residents in Middle Tennessee and nearly one in four patients are Hispanic, he said. Neighborhood Health has registered to be a COVID-19 vaccine provider with the state, but thus far has not been given any vaccine — or a timeline for getting it. 

In the meantime, clinic staff are telling anxious callers to be patient and that the scarcity of vaccine is not in the control of local officials, he said.

“But patience is running thin because people feel exceptionally vulnerable,” he said. “We serve so many people of color and their life experiences suggest to them access is always limited.” 

Incomplete data posted by the Tennessee Department of Health shows that fewer than 2% of the state’s Hispanic residents and fewer than 4% of the state’s African-American residents have been vaccinated thus far — a figure that encompasses the initial rollout first among healthcare workers and first responders and current rollout among senior residents. People of color are disproportionately more likely to contract COVID-19 — and to die from it.

In Nashville, Vanderbilt University Medical Center, Meharry Medical College, Nashville General Hospital, TriStar Centennial and Ascension St. Thomas Hospital are the only facilities outside the public health departments where non-nursing home residents 75 and older are slated to get a vaccine — but only if they are already an existing patient, according to Brian Todd, spokesman for the Nashville Department of Public Health.

While many elderly Americans have Medicare to pay for hospital and doctor care, “most people establish their care relationships before they turn 65,” Haile said. 

Hospitals either don’t accept or limit TennCare enrollees and often only provide emergency care for the uninsured, Haile said. “The lowest income individuals on Medicare, which are disproportionately persons of color, are much less likely to have ongoing relationships with these health systems.”

Immigrants and marginalized communities, including people experiencing homelessness, are also less likely to have established relationships with hospitals. 

While the state “welcomes partnership in vaccinating the general public” between hospitals and government, they are not required to do so under the state’s plan, Christian.

Health care advocates say they should be.

It made sense for hospitals to receive the initial batches of vaccines first, advocates said. The initial doses of Pfizer vaccine require specialized cooling systems that clinics or other healthcare centers may lack and healthcare workers are at the front of the line of those deemed critical for early vaccinations. The state now, however, is receiving doses meant for a broader population and that include Moderna vaccines, which don’t need specialized refrigeration.

Michele Johnson, Executive Director of the Tennessee Justice Center

“Policies to distribute vaccines through hospitals result disproportionately in communities of color being unable able to access them,” said Michele Johnson, executive director of the Tennessee Justice Center, a healthcare advocacy organization.

Tennessee is one of 12 states that has not expanded its Medicaid program and more than 400,000 Tennesseans lack health insurance.

“We know that people without insurance are unlikely to have a healthcare provider,” Johnson said. “They are essential workers, people who don’t qualify for the ACA or TennCare (Tennessee’s Medicaid program) and predominantly Black and brown. If a hospital gets vaccines they shouldn’t put their patients over others. It should be treated like an emergency room situation.”

Amid a slow rollout of vaccines across the nation, U.S. Health and Human Services Secretary Alex Azar this week criticized state governments for being too focused on delivering vaccines to hospitals rather than expanding vaccine sites to clinics and pharmacies. 

“We’ve got to get to more channels of administration. We’ve got to get it to pharmacies, get it to community health centers,” Azar said. “It has been overly hospitalized so far in too many states. We have the vaccine. The demand is there. We have supplies that have not been ordered.”

Thus far, 132,100 vaccine doses have been delivered to county health departments for distribution, according to state data. Pharmacies that have agreed to provide vaccinations in nursing homes have received 192,400.

A separate stream of vaccines has been earmarked for nursing home staff, residents and others with disabilities who cannot live independently. Healthcare workers and first responders continue to have priority for the vaccine.

Other providers — almost all are hospitals — have received 252,725 doses, first distributed to staff and frontline workers and now available for patients 75 and older.