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Why Vermont made all minorities eligible for the vaccine before white people under 50

Civil rights groups facilitating the rollout think it’s not too late for Vermont—the only state to prioritize vaccines this way—to serve as a model to help increase the uptake of shots among minority communities nationwide.

Why Vermont made all minorities eligible for the vaccine before white people under 50
[Source Image: Khusnul Faizin/iStock]
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Home to maple syrup, Ben and Jerry’s, and Bernie Sanders, Vermont is also demographically distinct in many ways. It’s largely rural, with few urban centers. In many ways, it’s one of the most politically liberal states, but it also has a Republican governor. After Wyoming, it’s the second-smallest state in terms of population, with about 630,000 residents; and after Maine, the second-whitest state, with a 94% white population, compared to the national average of 60%. Black people account for 1.4%, Latinos 2%, Asian Americans 1.9%, and Native Americans 0.4%.

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Despite Vermont’s demographic quirks, its population has experienced the same COVID-19 trends: Racial minorities have been overrepresented in coronavirus cases, but underrepresented in vaccine uptake. When the state’s early efforts didn’t correct the concerning trend, Governor Phil Scott, in a first-in-the-nation move, decided to open up a vaccine category specifically for racial minorities, creating eligibility for all minority adults before the general under-50 population (aside from those with high-risk health conditions or in essential professions). That rollout, bolstered by grassroots organizations most trusted in those communities, was designed to help increase access and decrease hesitancy. The move, which state officials say is showing success so far, didn’t come without a flare-up of political backlash—but organizers still think it could be a model for other parts of the country facing similar uptake lags.

If we make choices based on race, we want to have a very compelling reason for doing that. ”

From the very start of vaccine allocation, Vermont’s Department of Health closely monitored uptake among racial minorities, aware of historical vaccine hesitancy and barriers to access, according to deputy commissioner Tracy Dolan. It was clear from early on, Dolan says, that systemic racism and white supremacy were “the core drivers of what got us to this inequitable place.”

The department tried to remedy that as they moved through priority categories: After the initial phases, they moved to a household policy, whereby occupants sharing homes with elderly or high-risk individuals could get a vaccine too—a strategy proposed because the data showed that minorities were more likely to live in multigenerational households. The department also gave grants to community organizations to help educate folks on the ground level.

The state had resisted creating an exclusive category at first, hoping to avoid the impression of discriminatory practices. “We wanted to be thoughtful about an approach that where we would identify an entire racial group as an eligible category,” Dolan says. “If we make choices based on race, we want to have a very compelling reason for doing that.” But, on April 1, the state went ahead, opening up vaccinations to anyone over the age of 16 who “identifies as Black, Indigenous, or a person of color (BIPOC), including anyone with Abenaki or other First Nations heritage.” Those populations skew younger in Vermont, Dolan says, so its over-50s-only deployment up to that point had been “by its nature, inequitable.” This was a chance to “try to play some catch-up and get things to a more equitable place.” (The over-40 category was opened four days later, on April 5, and the over-30 category opened April 12.)

Tied to the announcement was an effort to tailor the rollout very specifically to minority communities, to maximize access. Civil rights organizations on the ground level formed a “BIPOC coalition,” says Steffen Gillom, president of a local NAACP chapter, which helped with the rollout in Southern Vermont. The groups helped set up pop-up clinics throughout the state, especially for minorities, at easily accessible and well-known locations. They created special registration forms that were easy to navigate and included options such as language interpretation services.

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Sometimes, you have to see people who look like you putting on something, to trust it.”

The state also hoped these trusted groups would help relieve vaccine hesitancy. When the Johns Hopkins Center for Health Security published its allocation recommendations last summer, it explicitly recommended that Black people not be prioritized separately for that very reason. “Directly prioritizing Black populations could further threaten the fragile trust that some have in the medical and public health system,” the document read, “particularly if there is the perception that there has been a lack of testing to assess vaccine safety and that they are the ‘guinea pigs.'”

The minority-run pop-up clinics were a way for people of color to feel more comfortable. “Sometimes, you have to see people who look like you putting on something, to trust it,” Gillom says. Setting up that infrastructure of reassurance was key, he says. “It was just creating this perfect ecosystem for people to come in and feel safe enough to get vaccinated.” The strategy immediately seemed to work: Within an hour of signup for the first clinic in southern Vermont, the 100 slots had been fully booked. By the end of the first day of signup across all state vaccination sites, Dolan says, 3,000 people had registered.

The decision, though, was not without backlash. When the governor, Phil Scott, tweeted the announcement on April 1, they were ready for retaliation. Within hours, the tweet had been “ratioed” with critical replies, accusing Scott’s administration of unconstitutionality and discrimination against white people. Fox News ran a segment featuring Ben Carson, who denounced the initiative as a “ridiculous policy” based solely on “superficial identifying qualities,” adding that Martin Luther King Jr. would have been “absolutely offended.” Dolan said about 15%-20% of calls to the Department of Health were complaints. Those have died down now; Gillom said they didn’t have much trouble but, just in case, had trained “peacekeepers” on site: white allies trained in de-escalation.

Four days after his tweet, Governor Scott issued a forceful statement explicitly calling the response “racist.” He mentioned “vitriolic and inappropriate comments” they’d received on social media and emphasized the burden of the virus on minorities and the need for an overall big uptake to immunize the whole population. “It is evidence that many Americans, and many Vermonters, still have a lot to learn about the impacts of racism in our country and how it has influenced public policy over the years,” he said, going on to mention recent anti-Asian-American xenophobia, the legacy of George Floyd, and the Capitol riots. “I implore all of us to respect one another.”

The political backlash may suggest why more states haven’t adopted this tactic. “Public health has been reduced to these political calculations,” says Jonathan Moreno, a professor of bioethics at the University of Pennsylvania. Calling the new strategy “unobjectionable,” Moreno also denounced the retaliation. “To complain that this is unconstitutional, when the physical access to vaccination has been restricted because of racism, doesn’t seem to be a strong moral position.”

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Initial national recommendations, such as those from Johns Hopkins and from the Advisory Committee on Immunization Practices (ACIP), focused profoundly on equity, says Bill Schaffner, professor of medicine in the health policy division at Vanderbilt University and a liaison to ACIP. “There wasn’t a single phone call that it was not talked about very explicitly,” he said. But, ultimately, decisions were left up to the states, and many were assured that minorities would be largely covered under other phases such as essential workers.

Some localities went the geographic route. Guided by ZIP codes or census data, cities such as Washington, D.C., Baltimore, and Dallas opened up registration and sites in underserved neighborhoods to objectively cover minority populations who may lack transportation, tech savviness, and the ability to take time off work. But wealthy white people still showed up to take the slots. Moreno, a D.C. resident, who’d originally leaned toward the geographic approach, admitted: “At the risk of sounding like white guilt—who went to the sites? People like me.” Furthermore, Dolan says the geographic approach would likely not have worked in Vermont due to its spread-out, rural makeup and lack of big, urban centers.

What we’re doing in Vermont should be a model for the nation.”

As of publication time, 11 days into the BIPOC rollout, 45% of Vermont’s white population had received at least one dose, compared to 26% of Black people, 30% of Asian Americans, and 12% of Native Americans. According to Dolan’s internal data, the gap in vaccine rates between minorities and non-Hispanic whites has closed by 1.8 percentage points, from 13.3% on March 28, to 11.5% on April 12. “There’s still an inequity, [but] I would say it’s successful so far,” Dolan says. “We’ve got a lot of people registered in the coming weeks.” Vermont will open vaccinations up to all adults 16 and over on April 19, but it’ll continue the minority-specific clinics, Dolan says, “as long as there’s demand.”

To outsiders, it may seem that this approach is easier in Vermont, given its liberal slant, small population, and tiny proportion of non-white residents. But Gillom says minority experiences mirror those of other states’ residents. “Vermont is definitely no safe haven for BIPOC folks,” he says. “We go through the same issues here: racism, white supremacy, and whatnot.” He says the initiative has been successful because of the “fast and furious advocacy” of the groups, the open-mindedness of the Health Department, and a governor who listened to the science. “What we’re doing in Vermont should be a model for the nation,” he says, “especially in states that are just gobs and gobs behind us.”

With all U.S. adults now set to be eligible by April 19, it may seem late in the rollout for this approach to catch on elsewhere. But Dolan says the timing is actually fitting, and that it perhaps wouldn’t have worked earlier on. “Maybe we hit the sweet spot,” she says, “because, wow, did we get a big jump in registration, from a pretty relatively small community.” Now that minority groups have witnessed white people getting safely immunized, and with shot supplies ramping up, it may be the ripest time to make vigorous outreach efforts to minorities.