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Is the current COVID-19 surge a "pandemic of the unvaccinated?" No, according to Rhea Boyd, MD, MPH, pediatrician and co-developer of the "The Conversation: Between Us, About Us" project to encourage more people of color to get vaccinated.

"This is not a pandemic of the unvaccinated," Boyd said Wednesday at a virtual event sponsored by the Alliance for Health Policy. Instead, "what we really exposed during the vaccination distribution effort is just how unequal the United States is" when it comes to getting access to COVID-19 vaccines. She presented data from the New York Times and the Kaiser Family Foundation showing that vaccine distribution was worse in Southern states, which also are where more Black and Latinx people live (the conversation is a joint project of the Kaiser Family Foundation and the Black Coalition Against COVID).

In addition to the vaccine distribution problem, "we also know this is an area of the country where access to insurance is not evenly distributed because these are states who have disproportionately been less likely to expand Medicaid," she said. "So what that means is now 97% of adults in this country who live in the coverage gap, which means their income is too high to qualify for Medicaid, but too low to be eligible for the [Affordable Care Act] marketplace or premium tax credits -- those folks who then just simply lack coverage -- mostly live in the South," particularly in states like Texas and Florida "which are states where we're all seeing surges and we're seeing lower rates of vaccination."

Boyd noted that CDC data released Monday showed that a smaller percentage of Black and Latinx individuals in the U.S. have been fully vaccinated compared with whites. One barrier for many of these unvaccinated people is cost: although they know that the vaccine itself is free, "getting to that vaccination site requires gas in your tank, it requires bus fare. It might require a parking fee if you go to a public site in the community," she said. "Getting to and from healthcare always costs money, and that is a concern for people who are low-income, and we've seen that people who are low-income are more likely to be disproportionately unvaccinated."

Taking time off of work is another barrier, especially when it comes to getting children vaccinated, she continued; one poll found that 25% of all parents who had unvaccinated children, ages 12 to 17, said they would be more likely to get their children vaccinated if they were given paid time off to do so, she said. They would also be more likely to get vaccinated themselves "if their medical provider could come to their workplace to do it," Boyd added.

The information gap is another problem for lower-income people. "We are also facing an information gap in communities that mirrors the health literacy gap that has existed in this country for decades, if not centuries," she said. "People who have access to resources and healthcare tend to have access to credible information about health, and other communities do not. On top of that information gap, we are obviously also facing a disinformation campaign that's been targeting communities of color, particularly Black folks, since the beginning of the vaccine rollout."

"Our nation's unvaccinated are not a monstrous monolith," Boyd said. "This is not a group who is adverse to science, or medical care. We have seen that this is a group who is more likely to be our nation's working poor; they're more likely to lack the resources to actually access any type of healthcare, let alone a vaccination. And so if we're going to vaccinate them, we have to talk about what we're going to do to address access barriers both to the vaccines and other types of medical care, but also to information about vaccines."

For instance, "we need to talk about universal healthcare, so that the cost of vaccination truly is free for folks," she continued. "We need to talk about paid sick leave ...We need to acknowledge that disinformation is rarely behind a paywall, but credible science often is, and so we need to make sure that -- particularly around COVID and health in general -- that we provide free access to everybody to have that information online and in their community."

Boyd also urged people to stop using the term "vaccine hesitancy." "People don't have a kind of amorphous hesitation or reluctance to get vaccinated or to receive medical care," she said. "Most of those who are unvaccinated in our country are not 'anti-vaxxers' -- that is a tiny minority of the folks who are unvaccinated." Many of the unvaccinated are actually children, which "obviously blows open the idea that the folks who are unvaccinated just hate medical care and vaccines. So if we're not going to talk about hesitancy, it means you have to do the extra work to actually understand why folks aren't vaccinated."

Also during the event, Henry Fernandez, CEO of the African American Research Collaborative, which more than 12,000 people regarding their attitudes on vaccination, was asked whether he thought that the FDA's granting of full approval to the Pfizer/BioNTech COVID-19 vaccine was likely to result in more people being vaccinated. Fernandez said he didn't see that approval per se would convince people, but that the employer and government mandates that are likely to follow full approval would have an impact.

"About a third of the unvaccinated said just even a request from their employer would lead them to get vaccinated," he said. "We also saw that larger financial incentives actually had quite a significant impact ... and there's probably no more significant financial incentive than the loss of a job."

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