By Anna Almendrala and Sandy West
APRIL
22, 2021
California and Texas, the
country’s two most populous states, have taken radically different approaches
to the pandemic and the vaccination campaign to end it.
California has trumpeted
its reliance on science and policies it says are aimed at improving social
equity.
Texas state officials
have emphasized individual rights and protecting the economy, often ignoring
public health warnings but encouraging vaccination — while calling it a
personal choice.
Yet California’s
commitment to equity doesn’t appear to have put the state
ahead of Texas in vaccinating Latinos, who make up roughly 40% of the
population in both states. Latinos have suffered disproportionately from covid
because the poorest tend to live in crowded housing, get less quality health
care and have been more likely to work outside the home.
In California, 22% of Hispanics had been vaccinated as
of April 12; in Texas, 21%.
Texas, in general, has done much better than California at
reaching highly vulnerable groups during the first months of vaccine
distribution, according to a recent analysis by the Centers for Disease Control
and Prevention. Texas was seventh on the list; California was fifth from last.
Overall, however,
California’s pandemic metrics have been better. As it opened vaccine
eligibility to all ages on April 15, 49% of Californians 16 and older were
either partially or fully vaccinated, compared with 43% of Texans.
The two states were neck
and neck until a harsh winter storm in February knocked out power for a week in
much of Texas. “We never really recovered after that, and exactly why, beyond
our size, is not entirely clear,” said Dr. Peter Hotez, dean for the National School
of Tropical Medicine at Baylor College of Medicine.
California is also doing
much better when it comes to driving down infections. The state’s seven-day average is 52.7
cases and 1.8 deaths per 100,000 as of April 15, with a seven-day average positivity rate of 1.5%. Texas, meanwhile, is
at 73.3 cases and 1.5 deaths per 100,000, with a seven-day average positivity rate of 7%.
The states’ leaders have
reacted differently to those metrics. California Gov. Gavin Newsom has set June
15 as the day to end most pandemic restrictions, barring
major setbacks, but he plans to continue to require mask-wearing in public and
in high-risk workplaces. Meanwhile, Texas Gov. Greg Abbott on March 10 allowed
all businesses to fully reopen and lifted a statewide mask mandate.
The concept of individual
freedom plays well in Texas politics and has been front and center throughout
the pandemic and the vaccine rollout. While encouraging Texans to protect
themselves against the spread of the coronavirus, state officials at the same
time have fought local authorities’ efforts to enforce such measures.
While Newsom instituted
one of the earliest and strictest state lockdowns in the country on March 19,
Texas Attorney General Ken Paxton initially called local mask mandates and
business restrictions “unlawful and unenforceable.” Abbott finally
instituted a mask mandate and other restrictions in
July after a surge of the disease. Those measures met opposition within his own
party, with Texas Republican Chair Allen West leading a protest outside the governor’s
mansion in October.
Against this tense
political backdrop, Texas state leaders have been softer in their vaccination
messaging compared with California. Both governors received their vaccinations
on live TV, but each has offered different messaging about how their constituents
should view the shots.
In an April 8 tweet,
Abbott celebrated the state’s reaching 13 million vaccinations, adding,
“These vaccine shots are always voluntary.” That soft-pedaled message also
comes through in Abbott’s stance on masks. Despite lifting the order in early
March, the governor still urges residents to use them.
Public health experts in
Texas have been frustrated by what they see as a half-hearted endorsement of
public health measures. “It’s psychotic to have to listen to two very different
messages,” said Dr. Andrea Caracostis, CEO of the HOPE Clinic
in Houston, which serves minorities and immigrants. “Vaccines were not made
just for your individual protection. They were made for community benefit. It
is a message that has been lost in our society.”
Newsom, on the other
hand, talks about vaccines in terms of responsibility to others. “Getting
vaccinated is a vital step we can take to protect ourselves, our loved ones and
our community, and brings us that much closer to ending this pandemic,” Newsom
said on April 1, when he received his vaccination.
Newsom’s oft-repeated
“north star” value is equity — the notion that the well-being of those hurt
most by the pandemic should be essential to the battle against it. Starting
March 4, his administration allocated 40% of its vaccines to neighborhoods that
have seen 40% of covid cases and deaths. California has also invested $52.7
million to fund more than 300 “trusted messenger” community organizations to do
outreach on vaccines. He didn’t make the general public eligible for vaccination
until April 15 in order to prioritize more vulnerable and at-risk groups.
Texas, meanwhile, fully opened the vaccine spigot on March 29.
California’s struggles to
vaccinate racial and ethnic minorities and the most vulnerable, despite intense
public health investment and attention to these communities, raises questions
about the state’s vaccine eligibility decisions, said Elizabeth
Wrigley-Field, assistant professor of sociology at the University of
Minnesota.
Both Texas and
California, like many states, first vaccinated health care workers and
long-term care residents, populations that are majority white. But in Texas,
people with underlying medical conditions — like Type 2 diabetes, sickle cell
disease or obesity — also became
eligible for a shot Dec. 29.
In California, people
with underlying medical conditions weren’t added to the eligibility list until
mid-March, and the list of underlying conditions was
much more stringent than Texas’ guidelines.
“That gap between January
and mid-March, that’s kind of the story to me,” Wrigley-Field said.
California officials
decided Jan. 13 to prioritize people over 65. Many over-65 whites were at
substantially lower risk than younger people of color, said Wrigley-Field,
who argues that that age-based eligibility
benefited older, white populations at the expense of younger people of color
who were more at risk of covid hospitalization and death.
Prioritizing those over
65 immediately put Hispanics at a 2-to-1 disadvantage to whites,
concluded Thomas Selden, based on research conducted with co-authors at the
Agency for Healthcare Research and Quality (their conclusions don’t necessarily
represent AHRQ or HHS). Priority tiers for those with certain diseases and
essential workers would have benefited the poor and Hispanics, respectively,
and pushing them down the list “could be one of the factors why we’re seeing
lower rates for these groups,” he said.
Hispanics ages 20-54 in
California were 8.5 times more likely to die of covid than
whites of the same age from March to July, according to a University of
Southern California study.
In mid-February, first responders and workers
in education, food and agriculture became eligible for vaccination in
California. County health departments were permitted to set their own
schedules, however, and in Los Angeles these essential workers weren’t eligible until March 1 due
to limited vaccine supply.
In effect, from December
until March there was no eligibility tier that prioritized groups that were
predominantly Latino or Black in the state’s largest county and the epicenter
of the state’s covid cases and deaths.
The state’s approach
harmed efforts to reach out to Latinos, some county health departments say. In
Kern County, Latinos make up 53% of the population and 57% of covid cases, but
got only 36% of the vaccines administered as of April 15. Confusion over the
essential-worker eligibility tiers caused many to think it wasn’t their “turn,”
said Brynn Carrigan, the county public health director.
Dr. Tomás Aragón, state
public health officer and director of the California Department of Public
Health, defended the state’s initial age-based approach and said it was a
strategy to make sure Latinos were prioritized. He noted that, while Latinos
accounted for 48% of the state’s covid deaths, the majority of those deaths
occurred in people over 65.
“We are in a
significantly better place today than many states, not just because our vaccine
strategy saved lives and kept people out of hospitals, but also because we
focused on proven public health interventions, such as masking, distancing,
hand washing and tracing,” Aragón said in an emailed statement.
Vaccine hesitancy among
racial and ethnic minorities has faded as educational outreach has ramped up,
access has improved, and more people see friends and neighbors safely get the
shot. Vaccine hesitancy instead appears high among Republicans, particularly
white evangelicals, according to several polls.
But confidence in
vaccines is growing even among Republicans, according to a poll recently
conducted by Frank Luntz and released by the de Beaumont
Foundation. It showed that 38% of Trump voters and 48% of Biden
voters were more likely to get vaccinated than they were in March.
While some experts said
consistent messaging from politicians would be helpful, time and experience
watching friends and family safely receive vaccinations as well as
communication with trusted individuals — particularly personal doctors — is the
most effective way to overcome lingering concerns about the shots.
“What’s going to change
that is getting vaccine more readily available to primary care providers … who
they trust and get their questions answered, because I think they are
vaccine-hesitant versus anti-vaccination,” said Dr. David Lakey, chief medical officer at the
University of Texas System.
This story was produced
by KHN (Kaiser
Health News), a national newsroom that produces in-depth journalism about
health issues. Together with Policy Analysis and Polling, KHN is one of the
three major operating programs at KFF (Kaiser
Family Foundation). KFF is an endowed nonprofit organization providing
information on health issues to the nation.
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