Almost every patient in our primary care practices is talking about the COVID vaccine. They describe feelings of fear, confusion, impatience and frustration. Whether for themselves or an elderly family member, people are waking up early to snag a fleeting appointment through an online portal, driving long distances to secure a dose, calling and re-calling automated phone numbers, and worrying about whether their name is really on a list or not.

Both locally and nationally there is intense scrutiny about who has received these first doses of vaccine and why. The systems created to vaccinate our elders are not delivering the high quality health care that we expect. Frustration with the vaccine rollout is well-founded — and it points us toward what is missing: health equity.

Equitable health care means that everyone has a fair and just opportunity to be as healthy as possible.

To date, our elders have not had equal opportunities to access the COVID vaccine. Some fortunate Mainers have already received a dose, but older people who live alone, without internet access, reliable transportation or nearby family may not yet be aware of how to begin.

We care for patients who are too hard of hearing to use a telephone, whose primary language is not English or who are illiterate. Sometimes these individuals are grouped together and labelled “vulnerable” or “disadvantaged,” but in reality they are also our neighbors, friends and family, left behind by systems that are not designed to meet their needs. We should all feel frustrated on their behalf.

What would an equitable vaccine rollout look like? Vaccine registration would be available through multiple means and locations: phone, internet, paper, in-person conversations. One size almost never fits all.

Information would be available in the primary language of all patients, including those who are vision or hearing impaired. The needs of people at greatest risk would be prioritized, even in the face of intense pressure to deliver vaccine to the vocal majority. Community partners who already have relationships with target groups (isolated elders, people facing food or housing insecurity, immigrant communities) would be consulted proactively to address the unique challenges facing their clients.

Vaccine would be allotted not only to high volume health care systems but also to organizations that can effectively connect vaccine those who need it most.

Six qualities define high-quality health care: safe, timely, effective, patient-centered, efficient and equitable. We think about most of these qualities in our day-to-day health-care decisions: Is this new medicine safe? Will it actually help my symptoms? Is this treatment worth the cost? How long will I wait to see a specialist? Do I feel heard and respected by my provider?

Now is the time to start thinking about equity as we evaluate and participate in our health-care systems. Is this treatment, program or service equally available to all people? If not, what can I do to help?

We can each advocate for equitable systems and we can also take responsibility for creating opportunities for our neighbors to be as healthy as possible. Seek out informal networks (growing now) that assist elders with vaccine navigation. Donate your time or money to social service organizations that are already in place to help older people; Spectrum Generations is the Central Maine Area Agency on Aging that serves the Kennebec Valley. Let us shift our attention from how quickly we get to the front of the line to making sure that everyone has a seat at the table.

We are grateful for the complex and time consuming work of the Maine Centers for Disease Control and Prevention and all our regional health systems who are responding to the pandemic and now also coordinating vaccination.

We urge everyone — systems, health care teams and patients — to learn from this pivotal moment and prioritize equity in the delivery of high quality health care in our communities.

Signed, Cheryl K. Seymour, M.D.; Julia L. McDonald, D.O., M.P.H.; Kathy Wistar, M.D.; Connie Adler, M.D.; Scott Schiff-Slater, M.D.; Caroline LaFave, D.O.; Steve Bien, M.D.; Amy Madden, M.D.; Kiran Mangalam, D.O.; Kohar Der Simonian, M.D.; Alicia Mancuso, D.O.; Hoai-nam Hoang, M.D.; Katharine M.K. Anderson, M.D.; Megan Barker, M.D.; Kathryn Hoffman, D.O.; and Kathleen D. Polonchek, M.D.


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