Arab Americans: Disproportionate Impact of COVID-19 and Vaccine Inequity
Raed Al-Naser / Arab America Contributing Writer
From the onset of the COVID-19 pandemic, it was indisputable that racial and ethnic minority groups would be disproportionately affected. The Center for Disease Control and Prevention (CDC) has long documented the number of cases and mortality rates in the Latinx, African American, Asian, Alaskan/Native American, and Native Hawaiians/Pacific Islanders communities. The data shows that Latinx, Native Americans and black and brown Americans are at least twice as more likely to die from the virus compared to white Americans. Unfortunately, we are now seeing this pattern of disparate impact persist with regard to vaccine distribution among Arab Americans.
Lack of Arab American Ethnic Recognition
The CDC recently published demographic data on people receiving the COVID-19 vaccines at the national level. There is a lack of a dedicated racial or ethnic identifier for Arab Americans and other Middle Easterners. Thus, these groups are labeled as “white” in health data collection of the CDC. Arab Americans would have a better chance of recognition if the Census Bureau adopted its own 2015 study to add a Middle Eastern/North African (MENA) Category. Unfortunately, in 2018, the Census Bureau delivered a severe blow to the efforts of Arab Americans advocacy groups. Their reasoning for the rejection was that more research and testing was needed!
Unlike their “white” counterparts, however, MENA people suffer from a host of economic, immigration, physical and mental health effects unique to their group. The process of supplying and administering the COVID-19 vaccine has yet again emphasized to health care professionals the need for data collection to narrowly focus on race and ethnicity as an essential factor for epidemiological decisions. Such information is vital for health care organizations, public health agencies and policy makers. In turn, they can better understand prioritize their focus of care and subsequently allocate resources to those communities.
Personal Testimony
Here at the local level, the County of San Diego recently released geographic data on vaccine distribution based on zip code. Again, the same woeful and agonizing patterns emerge. Poorer neighborhoods resided by racial minorities which COVID-19 had devastated are the same neighborhoods that are getting less vaccines. The center of the city of El Cajon, an Arab American enclave, is one of the top five zip codes in COVID-19 numbers, hospitalizations, and mortality in the county. Incredibly, El Cajon, however, is not even in the top 10 zip codes with reference to vaccination uptake.
As a pulmonary and critical care physician serving this community, I am familiar with the disproportionate number of Arab Americans admitted to the intensive care unit with COVID-19 complications. Each COVID-19 victim is more than a number to me. Each sad story of a life lost has touched me deeply on a personal level. The disease has inflicted inordinate pain on this community. I am extremely concerned that attention and aid will be late or inadequate.
Hindrances to Vaccinations
A multitude of factors contribute to the low rates of vaccination in the Arab American community. Arab Americans tend to receive their health information about the COVID-19 vaccine from news outlets in the Middle East and on social media. For most first-generation Arab Americans and new immigrants, language literacy poses a significant hindrance in obtaining evidence-based information from reputable health publications.
Moreover, the abundance of false information and conspiracy theories, the lack of knowledge about vaccine recommendations and the perceived risks about their safety create the most attitudinal barriers in the willingness to take the vaccine. Surprisingly, older people tend to have more positive attitudes and women are more reluctant than men. People with lower levels of education and family income express wider skepticism. Sadly, personal family experience with COVID-19 related illness seems to be the most persuasive factor in accepting the vaccine.
Vaccine hesitancy commonly exists in Middle Eastern and other minority communities. However, it is imperative not to regard such trepidation as the sole barrier to the vaccine accessibility and distribution. Cyber technology and digital infrastructure may be effective and plausible ways to promote easy access to vaccines. Such health services are already available in certain wealthier communities.
What Needs to Happen
The online platforms for booking vaccine appointments have presented tremendous obstacles for people with limited technical resources and education. Theses systems were set up by the State of California and the County of San Diego. Low income, older, and English literacy challenged Arab Americans have little help and resources to overcome this frustrating process. The ever-present digital divide has added insult to injury and further exacerbated health inequities for lower income Arab Americans.
To achieve a successful and effective vaccination program, government officials, policymakers and health institutions must accept the uncomfortable truth. This is that the current U.S. health care system, consciously or not, enforces structural racism and inequity. Arab Americans are subject to discrimination and xenophobia on many different levels. The system often ignores or suppresses these concerns. The widest possible uptake of vaccines in these communities is the obvious step which our health care system must take. It needs to address the disproportionate impact of the virus on Arab Americans. This will help prevent the widening of racial health disparities. Eventually, we can attain population immunity and defeat the deadly virus.
Raed Al-Naser, M.D., F.C.C.P., is a pulmonologist and critical care physician, practicing primarily at Sharp Grossmont Hospital, La Mesa California, and the president of San Diego Chapter of National Arab American Medical Association (NAAMA).
The reproduction of this article is permissible with proper credit to Arab America and the author.
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