Statement from Stephanie Enyart, Chief Public Policy and Research Officer, American Foundation for the Blind
WASHINGTON, D.C. (March 8, 2021)—Since COVID-19 vaccines first became available several months ago, logistics of the distribution have been murky at best. With recent announcements that some states may change their vaccine allocation strategies away from prioritizing high-risk/high-need populations, alarm bells about equitable vaccine access are ringing loudly – but is anyone listening?
Dr. L. Penny Rosenblum, Director of Research at the American Foundation for the Blind, has not driven a vehicle all her life due to her low vision. Unsurprisingly, the COVID-19 pandemic has increased her transportation challenges. “As primary caretaker for my 86-year-old mother, I recently secured her a slot for her COVID-19 vaccine,” she says. “Once I got her the appointment, my next challenge was transportation through the drive-through vaccination site. Did I want Mom to take an Uber? Did I want her to explore paratransit where she’d be exposed to one or more strangers for 45 minutes, or even hours? Would a friend take her and thus expose themselves and Mom as they sat in a car? In the end, I opted to ask my husband to take two hours off work and be Mom’s driver.”
Fortunately, Dr. Rosenblum could fill the transportation gap for her mother. Not everyone has that option. And she later found that paratransit would only take her to a building, not a drive-through appointment.
Providing an equitable distribution requires significant investment in time and resources to overcome the barriers that create inequities in the first place. Take transportation. Transporting the vaccine to the population has been a major consideration; largely lost in this is the role of transporting people to vaccine sites. People with vision loss are three times as likely as sighted people to live in a household without access to a vehicle, and the disparities worsen when considering other marginalized identities. For example, Black and indigenous people with vision loss are almost twice as likely as their white counterparts to live in a household without access to a vehicle. As the CDC’s Advisory Committee on Immunization Practices noted, when it comes to vaccinations, one of the primary ethical considerations is to remove unfair, unjust, and avoidable barriers.
In September, the American Foundation for the Blind released the Flatten Inaccessibility report that examined the early impact of COVID-19 on 1,921 adults with visual impairments. The findings on transportation were chilling: 68% of participants had concerns about restricted access to their usual transportation options (e.g. paratransit, public transit) and many feared they would be unable to safely get themselves or loved ones to COVID-19 test sites if needed.
As one participant commented, “I am not sure how I would get to a mobile testing site. I wouldn’t feel comfortable using public transportation or rideshare services for fear of backlash or spreading [COVID-19].” Testing facilities present significant challenges to individuals who cannot drive, may be infected, and do not have a household member willing or able to drive them.
Whether we’re talking drive-through testing, vaccinations, food banks, or other services, drive-through-only options discriminate against those who don’t drive due to a visual impairment or other reasons. States, counties, and local communities must adequately plan for accessible vaccine distribution. A coordinated effort is needed to ensure people without access to transportation can get the vaccine.
As the pandemic has progressed, paratransit service has been modified, rideshare options have become more limited and expensive, and bus lines have been cut. Atlanta, for example, suspended 70 of its 110 bus lines indefinitely. Even before the pandemic, not everyone had access to transportation. The need for super-cold storage for and limited supplies of the vaccine means fewer distribution sites, requiring even farther travel.
Black farming communities near Lake Okeechobee in Florida are 25 miles or more from the nearest Publix, which has sole vaccine distribution rights. In Coosa County, Alabama, having no doctors or county health department means the state must rely on a neighboring county for distribution. In Delaware County, New York, the average trip to a health care appointment is 30 miles one way. Lack of transportation is not limited to rural communities, though the problem is more obvious there.
Governments must take proactive steps to identify and publicize solutions to transportation barriers, such as providing supplemental transportation options. Simply, providing easy-to-navigate, accessible walk-in options expands access to existing sites. In areas with existing publicly funded transportation services, transit and other transportation providers can be reimbursed for the cost of providing expanded transportation to vaccine sites. Ideally, vaccinations and testing should be available within easy walking distance or accessible by transit even in rural areas, but if vaccines won’t be available locally, states and municipalities should consider offering safe rides or in-home services for those who need it. Deploying mobile vaccine units may also reduce the distance people need to travel. To address the fear of using existing shared transportation services, additional information about safety practices as well as access to non-shared rides for higher-risk people must be widely publicized through accessible formats.
The current piecemeal approach isn’t working. But with coordination and effort, options are available to ensure transportation is no barrier to receiving the vaccine and by extension to meeting our goals of an equitable distribution. As one survey participant wrote, “My concern runs deep relative to persons with disabilities being dismissed, disregarded, and or discarded as persons [who] lack in value when determining the level of attention/care to be given in health settings during the COVID-19 pandemic, especially when having to decide who receives use of limited resources.”
Let’s not let transportation remain one of the ways people with disabilities are disregarded.
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About the American Foundation for the Blind
Founded in 1921, the American Foundation for the Blind (AFB) is a national nonprofit that creates a world of no limits for people who are blind or visually impaired. AFB mobilizes leaders, advances understanding, and champions impactful policies and practices using research and data. AFB is proud to steward the Helen Keller Archive, maintain and expand the digital collection, and honor the more than 40 years that Helen Keller worked tirelessly with AFB. Visit: www.afb.org