Eola Lokebol, a Marshallese interpreter, feels like she has déjà vu.

When the pandemic hit Hawaii last year, she was flooded with calls from families asking for her help in finding COVID-19 tests and figuring out how to quarantine. Now her phone is ringing with calls from Marshallese-speaking families who want to get vaccinated but don’t know how.

She tries to help people register online, talk to their doctors and reach out to community health centers. But she worries it’s not enough. “We can only help them so much.”

Now that Hawaii’s coronavirus vaccination effort is underway, advocates like Lokebol say the state should put Pacific Islanders on its priority list since the communities have suffered disproportionately from the coronavirus.

Hawaii’s vaccine prioritization doesn’t explicitly name hard-hit geographic or ethnic communities. Some critics argue it should. Department of Health

Instead, the state is relying on community health care centers and its own outreach to try to ensure those in the most affected communities are inoculated.

The question is whether that’s enough. As of Monday, state data says more than 151,000 vaccine doses have been administered, more than 170,000 have been received and over 200,000 have been allocated. But the state has not yet broken the data down by geography, race, ethnicity or other demographics.

The Health Department is still finalizing its vaccine distribution plan, and is expected to release it within the next two weeks. So far, the state is in the first two phases, 1a and 1b, in which vaccinations have largely been limited to health care workers, long-term care facility residents, other front-line essential workers and kupuna over the age of 75.

The state’s priorities are both intended to reduce COVID-19 deaths and preserve the overall functioning of society, Department of Health deputy director Danette Tomiyasu said in a Zoom interview last week.

But those priorities don’t acknowledge the fact that non-Hawaiian Pacific Islanders – particularly Chuukese, Marshallese and Samoan communities — make up 23% of Hawaii’s coronavirus cases, even though they’re just 4% of the population. The striking disparity is actually down from earlier in the pandemic. At one point the community comprised about a third of all COVID-19 cases statewide.

Filipinos are the only other ethnic community experiencing disproportionately high rates of COVID-19 cases in the islands.

Both communities are more at risk of getting COVID-19 in Hawaii in part because many hold front-line jobs and live in crowded households. State officials say by prioritizing certain occupations, these communities will by extension get priority access to the vaccine. But without better data, it’s not clear whether that’s happening.

The vaccine rollout in Hawaii began in mid-December and has been relatively slow. Officials have struggled with uncertainty over federal deliveries of more doses and other logistical issues.

The logistical challenges are part of what left community health center Kalihi Palama Health Center waiting until this week to start vaccinating patients.

Kalihi has been a hotspot for the virus, with more concentrated cases there per capita than almost any other neighborhood on Oahu.

Emanuel Kintu, chief executive officer of Kalihi Palama, said his staff got final guidance on vaccine logistics on Jan. 25 and have since been reaching out to encourage patients to get vaccinated. State data shows more than 280 people have been vaccinated across two Kalihi community health centers as of Sunday. Many were health care workers.

Kalihi Palama Health Center is just starting to vaccinate patients against COVID-19 this week. Cory Lum/Civil Beat/2020

Kintu said he understands why the state wants to vaccinate kupuna over the age of 75 first, but he wishes he could vaccinate patients over the age of 65 given how devastating the virus has been to his patients.

“I think it would be much, much better if we had a way of saying, let’s go for the vulnerable communities first,” he said.

Regardless, Kintu said he appreciates how the Department of Health has shifted to actively partner with community health centers, in contrast to the start of the pandemic when the organizations were largely ignored.

In October, the agency also increased its Pacific Islander contact tracing staff, after months of urging from community advocates.

Still, that partnership is limited. Health Department spokesman Brooks Baehr said some of the community health centers are just helping with outreach and not actually providing the vaccine to patients.

As of Monday, the state’s website listing places where kupuna could register for a vaccine did not include any names, phone numbers or websites of the state’s community health centers.

‘You Have To Be Computer Savvy’

The state set up a COVID-19 vaccine information webpage with links to various ways to register for the vaccine, and has translated a list of frequently asked questions into more than a dozen languages. But for now, all the vaccine registration pages are English-only.

“You have to be computer savvy, you have to know how to surf the net in order to learn what is the information and how to access it,” says Josie Howard, who leads the Pacific Islander-serving organization We Are Oceania.

Sheri Daniels from the nonprofit  Papa Ola Lokahi thinks the state’s vaccination plan should explicitly prioritize Native Hawaiians and other Pacific Islanders because of their high rates of pre-existing conditions such as diabetes.

During the same Zoom interview with Tomiyasu last week, Baehr, the health department spokesman, disagreed.

“It’s not the DNA that determines whether they’re more susceptible to being infected with the virus, it’s other factors,” he said. “That’s where it gets sensitive and tricky because we don’t want to identify along those lines.”

The state of Montana explicitly prioritizes Native Americans and communities of color hit hard by the pandemic in its vaccine rollout. 

Baehr said that Pacific Islanders would already fall under a subset of the 1b vaccination category, which lumps together “congregate living residents, disproportionately impacted groups.”

But he said that detailed subset of who’s included within each vaccination priority group won’t be finalized for another couple of weeks. So far the state has only publicly released the executive summary of the final vaccination plan.

“It’s a cop out,” Daniels said of the state’s explanation. “It’s just frustrating. I feel a lot for the Pacific Islanders because it’s like, here we go again.”

Other states and cities vary in whether they prioritize vaccinating certain communities. In Montana, Native Americans and people of color are included in the state’s 1b vaccination category. New York’s vaccination plan specifies certain ZIP codes based on high COVID-19 case rates.

But Dallas County got rid of a plan to prioritize certain ZIP codes for vaccination after the state of Texas threatened to pull funding in response. At least one scholar has said while giving the vaccine first to hard-hit communities may be a moral imperative, doing so may also raise legal questions.

Hawaii state officials didn’t cite legal concerns however.

Christopher Johnson, a program specialist at the Department of Health, said the agency preferred to reach Pacific Islanders and Filipinos through their occupations or other social determinants of catching COVID-19, and noted racial preference is challenging to do in Hawaii because of the state’s minority-majority status.

“Social determinants we think are a better way to get to the same results,” Johnson said. “Pacific Islanders aren’t genetically disposed to get COVID.”

Lack Of Data

Sarah Kemble, acting state epidemiologist, told Civil Beat the state hopes to release vaccinations by race within the next couple of weeks.

But the data will be based on federal race categories, in which Native Hawaiians are combined with other Pacific Islanders and Filipinos are combined with other Asian communities. So the data will lack the granularity to illuminate whether non-Hawaiian Pacific Islanders and Filipinos are actually getting vaccinated.

Kemble told Civil Beat the state is still standing up its vaccine registry and data that disaggregates Filipinos and non-Hawaiian Pacific Islanders is still a couple of months away.

Honolulu City Councilmember Radiant Cordero worries that without race and ethnicity data about vaccines, it’s hard to tell whether outreach efforts are effective.

“I would like to see that the targeting of the vaccine is working for my community. Are we doing enough?” she said.

Barbara Tom, who leads the Safe Haven Immigrant Resource Center in Waipahu, is eager to know as well.

“I’d love to see the data on how many of the Pacific Islanders they’re reaching,” Tom said. “Because they’re not reaching the community out in Waipahu. They’re not reaching the low-income community here.”

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