Minnesota has strayed from its commitment to distribute the COVID-19 vaccine to communities that are among the highest risk for severe disease and death, according to three members of the state's vaccine allocation advisory panel.
They are joined by 350 clinicians, researchers and organizations that sent a letter to state officials this week raising concerns that the state has not prioritized vaccines for Black, Indigenous, Hispanic and Asian Minnesotans.
Minnesota's racial and ethnic minorities are dying at rates two to four times higher than the white population, according to data compiled by the Minnesota Department of Health. For hospitalizations, rates are three to five times higher.
Critics of the state's COVID-19 vaccination policy acknowledge that the limited supply of doses forces officials to make difficult decisions. The Department of Health has often turned to outside advisers who help guide the ethical allocation of scarce public health resources.
But some on the vaccine panel were surprised when state leaders took the rollout in an unexpected direction, expanding eligibility to seniors 65 and older, as well as school and child-care workers.
Two members of the vaccine advisory panel said in a recent letter to Health Commissioner Jan Malcolm that they were "frustrated and disappointed."
"Prioritization based on ethical and equitable methods is what was promised to us in the advisory group, and more importantly, to the people of Minnesota," wrote pediatrician Nathan Chomilo and Nneka Sederstrom, chief health equity officer at Hennepin Healthcare. "There has been no transparency with the advisory group or the public to how decisions are being made on the methods of vaccine allocation."
Chomilo, who also serves as the medical director for the Minnesota Medicaid program, is a board member of Minnesota Doctors for Health Equity, which released its letter on Monday.
"Vaccine distribution phases must recognize that prioritization by age alone exacerbates disparities and misrepresents the disproportionate toll of COVID-19 among Black, Native American, Asian, and Hispanic populations who are younger on average yet face higher risk of exposure and death," the group said.
A third vaccine advisory group member, Debra DeBruin, interim director of the Center for Bioethics at the University of Minnesota, said that the state is passing over more difficult to reach vulnerable groups in its efforts to accelerate the vaccine rollout.
"If we focus only on speed and not on fairness and equity, we will fail to protect people at greater risk of serious illness and death," she said. "We should not tolerate that outcome."
Gov. Tim Walz and Malcolm said Tuesday that vaccine inequities were legitimate concerns, given that data from other states show that nonwhites are being vaccinated at lower rates.
In Minnesota, statewide data are not yet available, although Malcolm said an effort has been launched to improve data reporting.
But preliminary numbers indicate that there are disparities, she said.
"It is a very, very important point and a very fair critique," Malcolm said in response to a question about inequities. "So far it looks as though, and our data confirm it, that we are not yet reaching that proportionality that we need."
The Department of Health on Wednesday announced that 677 new COVID-19 infections and 11 deaths, bringing the pandemic total to at least 469,905 cases and 6,319 fatalities.
Among the deceased was a child in the 5 to 9 age range from Chippewa County. State death records indicate that the girl had a congenital neurological disorder that was exacerbated by COVID-19.
She was the state's second COVID-19 death involving someone younger than 10.
Last month, the Health Department began shipping vaccine doses to the state's 17 federally funded community health centers as part of an effort to reach racial and ethnic minorities.
St. Paul-based Minnesota Community Care announced Wednesday that it will offer shots to anyone in the community who is older than 64.
Clinic CEO Reuben Moore said the vaccine is needed because clinic patients are testing positive for the coronavirus at high rates.
"It is a high percentage of COVID within the community," he said. Many of the clinic's patients are front-line essential workers who live in close quarters.
"There should be a reimagination of how we consider [vaccination] priorities," Moore said. "I think that this is an opportunity for our state to bet on equity. That doesn't mean that other folks won't have access to the vaccine."
Minnesota, like most other states, prioritized the first doses it received for health care workers, who play a lifesaving role in the pandemic, and long-term care facilities, where deaths among residents account for 63% of the state's COVID-19 fatalities.
Federal guidance on who would be next in line shifted a few times since, but when the state's vaccine advisory group met in late December, the plan was to vaccinate seniors 75 and older, as well as front-line essential workers who are not in health care professions.
Manufacturing workers, who are considered essential to help keep the economy moving, account for 22% of coronavirus infections among those who are employed, according to an analysis of more than 25,000 Minnesota cases conducted by University of Minnesota researcher JP Leider. By comparison, health care practitioners made up 9% of infections.
Leider told the advisory panel that infection rates among nonwhite essential workers showed disparities that were "profound, consistent, and worsening," according to his presentation.
Because of that, "different groups should be prioritized differently, based on their risks of bad outcomes, like hospitalizations or deaths," he told the Star Tribune.
After federal officials urged states to include those 65 and older, Minnesota changed its plans too, including all seniors and the school and child-care workers, a move they've characterized as fulfilling some of the priorities that were set for the second phase of the rollout.
Some who attended the advisory group meetings were concerned that seniors 75 and older have a much higher risk than the 65-74 age group.
"I am especially worried about opening it to everyone 65+ because of the profound racial and ethnic disparities we've seen in COVID-19 and excess mortality," Leider said in an e-mail.
State leaders have said that they are "vaccinating for impact" and they have enlisted a string of trusted community-based organizations and hired vaccine outreach coordinators who will address equity issues.
But some in the community want a more direct approach.
"We need more than the education," said Shirlynn LaChapelle, a nurse who works with racially and ethnically diverse communities about vaccine safety. "While we are in the church doing education we can do the shots.
"We'd love to sit down and have a meeting with whoever is in charge so we can get some of the vaccines to distribute within the community," she said.
Hennepin Healthcare's Sederstrom said the state's recent vaccine allocation decision will leave it playing "catch-up."
"Equity is not something to do just when things are convenient," she said. "The normal response is to put it on the shelf for a better date and when you do that you are just continuing to perpetuate the inequities."
Staff writer Jeremy Olson contributed to this report.