Below is a joint letter written and organized by the Disability Justice League-Bay Area submitted as public comment to the Community Vaccine Advisory Committee, California Department of Public Health, on February 14, 2021. The Disability Justice League-Bay Area is QTIPOC disabled group committed to cross-movement organizing through direct action, engagement, and critical advocacy.
The letter responds to the new guidance regarding vaccine prioritization by the state that would allow certain high risk populations to be eligible for the COVID-19 vaccine starting March 15, 2021. The letter outlines several concerns such as implementation, timeline, and systemic barriers that will disproportionately harm multiply marginalized high risk people. The letter also includes recommendations such as access to vaccination from all sites (not exclusively from a healthcare provider) and the appointment of a representative from the disability justice community to the Community Vaccine Advisory Committee.
This is the third letter in a series by a coalition of groups. Here is the second letter submitted as public comment on December 22, 2020 from FatRose.org.
- If YOU have questions or concerns on vaccine equity, you can send your written public comments to the Community Vaccine Advisory Committee: COVID19VaccineOutreach@cdph.ca.gov
- You can attend their upcoming meetings on February 17, March 3, March 17, 2021 and review their past meetings’ presentations, agendas, and written public comments here: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Community-Vaccine-Advisory-Committee.aspx
- Send a message to the Governor and your local elected representatives.
- Share your story on social media with the hashtags #HighRiskCA and #NoBodyIsDisposable and tag @GavinNewsom and @CAPublicHealth
- Are you delaying important medical care, treatment, or testing while you wait for the vaccine? Participate in community surveys on delayed care or avoidable death by the No Body Is Disposable coalition and share with others.
Action Toolkit for Vaccine Equity, Senior Disability Action, No Body Is Disposable Coalition, the California Foundation for Independent Living Centers and others
Background on vaccine access in California, No Body Is Disposable Coalition
Whose Underlying Conditions Count for Priority in Getting the Vaccine? Liz Bowen, Scientific American
New Analysis of COVID-19 Mortality Risk for Californians with Disabilities Under Age 65, Dr. H. Stephen Kaye, DREDF
Community Vaccine Advisory Committee
California Department of Public Health
Dear California Department of Public Health and California Community Vaccine Advisory Committee Members and Staff:
1) We appreciate that California state leadership has finally provided a date when disabled people, fat people, and people with specific medical conditions can get vaccinated. However, the latest plan fails to communicate how it will meet the needs of our communities and must be further articulated.
2) Time is not on our side. March 15th marks more than a full year of delayed care for many people who are fat or have high risk disabilities and medical conditions, including many chronically ill and immunocompromised individuals, [hereafter called “people with high risk disabilities/conditions”] during which time critical routine care continues to be delayed such as cancer screenings and chemotherapy treatment.
- For people with high risk disabilities/conditions who have not been able to isolate, it is at minimum more than a month of additional exposure risk.
- People with high risk disabilities/conditions individuals are forced to wait another month or longer when veterinary staff and outdoor exercise instructors have been eligible for the vaccine, and people who work from home continue to be vaccinated.
- People with high risk disabilities/conditions continue to die, remain at higher risk than people without disabilities, and are susceptible to a permanent worsening of pre-existing conditions as a result of decisions made by the CA Department of Public Health’s to delay vaccine access for high risk Californians.
The Governor has repeatedly made decisions that have gone into effect immediately yet people with high risk disabilities/conditions are not being seriously considered.
3) Vaccinations for people with high risk disabilities/conditions can not be limited to provision by health care providers. An express statement clarifying that people with high risk disabilities/conditions can receive vaccinations at the site of their choosing should be clearly communicated.
- Populations who do not have a primary care provider may only receive their healthcare through emergency rooms/urgent care, or small or temporary clinics. These populations will continue to experience challenges in terms of access to the vaccine.
- Racial, class, weight, and gender biases within the healthcare industry are well known and documented. The current plan creates additional barriers for Black people and other communities of color, economically under resourced people, and higher weight people, all of whom already experience higher levels of bias and discrimination from health care providers, by forcing additional visits to healthcare providers in order to receive the vaccine.
- Furthermore, individuals who are heavily policed based on gender identity should likewise be free to choose the vaccination environment most friendly and accessible, which may not be a healthcare provider.
- People with high risk disabilities/conditions require access to the vaccine at accessible public sites per Section 504, Rehabilitation Act of 1973 and ADA requirements apply Refer to Section 794 “Nondiscrimination under Federal grants and programs.”
- In the State of CA, Majority of people with disabilities ages 18-64 live considerably below poverty level. West Virginia, opting out of a federal program partnering with CVS and Walgreens to vaccinate long-term care and assisted living, instead delivering its vaccine supply to small, independent pharmacies with established relationships in their communities, presents a model that can be used in underserved neighborhoods who may otherwise experience access barriers, for example if individuals aren’t tech savvy or do not have access to a computer.
- Relegating people with high risk disabilities/conditions to private health providers presents an additional obstacle because they may not always have the vaccine available, or may not make it available to all eligible groups promptly.
People with high risk disabilities/conditions must have access at all public facilities providing vaccinations, just like nondisabled people; separate is not equal.
4) The State’s guidance provides:
“Healthcare providers may use their clinical judgement [emphasis added] to vaccinate 16-64 who are deemed to be at the very highest risk…from COVID-19 as a direct result of one or more of the following severe health conditions…”
Inserting “clinical judgment” in this context does nothing but invite bias. Californians who meet the significantly narrowed CDC-list of conditions should automatically be eligible for vaccination. There should be no further requirement that a doctor deem them to be “at the very highest risk” and no invitation to screen them out via “clinical judgement.”
EXAMPLE: We are aware of a 40-year-old woman who meets the narrowed vaccination criteria due to weight and diabetes, and who is forced as an essential worker to interact with members of the public every day, but was told by a doctor that she does not need to worry about COVID because of her age.
5) Other states are guided by the CDC list, which is broader than California’s list. The California list of articulated conditions is extremely curtailed, which causes three problems:
- This puts more power into providers’ discretionary decisions. This, in turn, automatically disadvantages people of color, economically under resourced people, and fat people, all of whom tend to face systemic medical bias. This is not equity.
- Higher weight, diabetes, hypertension are all conditions that may be more prevalent among certain communities of color, but these conditions are all limited (BMI must be over 40, A1C must be over 7.5, hypertension is excluded) on California’s list. The result will impose further hurdles to vaccinating the most vulnerable Black, Brown, and Indigenous people in California. This is not equity.
- After taking much longer than other states, California should have a more comprehensive list of automatically qualifying conditions. This is not equity.
Notably, HIV/AIDS, autoimmune conditions, people delaying gender affirmation or other critical surgeries, and similar should be considered for automatic inclusion.
6) Nobody is disposable. Disabled people using in-home care through formal or informal service providers or through mutual aid provided by family/friends/community, people with high risk disabilities/conditions who would be in residential facilities but for the threat of COVID-19, as well as those in psychiatric facilities, group homes, board and cares, or other congregate settings including jails, prisons, and detention facilities, houseless individuals who are not a part of the shelter system should all be in the same category as people in nursing facilities, or at least moved into 1B Tier 1.
7) We continue to ask that a representative from the disability justice community be included on the advisory committee. Disability Justice principles take into account race, class, and other identity and systemic factors that impact people with disabilities. The interests of disabled and higher weight Black, Indigenous and brown viewpoints are not currently adequately represented in the advisory group or on the workgroup.
8) We object to the total lack of community and civil rights representation for fat individuals on the advisory board, despite the fact that approximately 1 in 4 Californians are higher weight, weight discrimination disproportionately impacts Black people and other communities of color, fat people face potential discrimination during crisis care, and they may be at heightened risk for severe COVID-19 illness.
The current plan sends a message about California’s priorities that is inconsistent with the State’s commitment to equity. If the Governor and the Working Group are truly committed to equity, the plan must be improved.