Pacific Islanders in Hawaii, excluding Native Hawaiians, have by far the highest rate of coronavirus cases and related deaths, but it’s still unclear how many have been vaccinated.

The prospects are not encouraging, however: when combined with Native Hawaiians, only 8.8% of the community received at least one dose of the vaccine thus far, even though together they currently make up 41% of COVID-19 cases statewide.

The Hawaii Department of Health Tuesday released racial breakdowns of coronavirus vaccinations as well as a new report on racial and ethnic inequities in Hawaii’s coronavirus pandemic. The statistics were presented in a virtual press conference a week after community leaders criticized the state for a delay in releasing racial breakdowns of vaccinations.

The new data shows that Hawaii residents who identify as white or Asian are far more likely to have been vaccinated at this point in the pandemic than Native Hawaiians, Pacific Islanders or Black people.

About a quarter of Hawaii’s Asian population has received at least one coronavirus vaccine dose along with 19.2% of Hawaii’s white community. Just 6.4% of Hawaii’s Black population has started the vaccination process, the new state data dashboard says.

Registered Nurse Alexis Lagasca from Kalihi Palama Health Center gives COVID-19 vaccinations at St. Elizabeth Church.
Registered nurse Alexis Lagasca from Kalihi Palama Health Center gives COVID-19 vaccinations at St. Elizabeth Church. The state Department of Health has been conducting outreach to hard-hit communities to help improve their access to the vaccine. Cory Lum/Civil Beat/2021

Non-Hawaiian Pacific Islanders and Filipinos have experienced disproportionately high rates of COVID-19.

At least 7.5% of the Pacific Islander population in Hawaii had been diagnosed with COVID-19 as of Jan. 31, the Department of Health wrote in its new COVID-19 equity report released Tuesday.

The cumulative risk “is four times greater than the next most impacted population (Filipinos) and 12 times that of the least impacted population (Japanese),” it said. The report found 1.7% of the Filipino community in Hawaii had been infected with the virus.

The state doesn’t yet have disaggregated vaccination data that separates Native Hawaiians from other Pacific Islanders or Filipinos from other Asians.

State epidemiologist Sarah Kemble told reporters Tuesday that she hopes to release such data in the coming weeks.

The state has requested that the Centers for Disease Control and Prevention collect these more detailed race groups in the federal vaccine data management system and federal officials recently agreed to do so, she said.

Hawaii is the only state that currently separates Native Hawaiians from other Pacific Islanders in its COVID-19 cases.

The agency’s new equity report reveals that Pacific Islanders, excluding Hawaiians, have an age-adjusted mortality rate of 319.6 per 100,000 people in Hawaii, more than eight times higher than any other racial or ethnic community and 14 times higher than the state average.

A graph showing disparities in coronavirus mortality by race and ethnicity in Hawaii from the state’s new report on equity and the pandemic. 

The report noted that as of January, the national mortality rate for the pandemic hovered around 153 deaths per 100,000. Hawaii had the lowest overall mortality rate in the United States with 22 deaths per 100,000 but the picture for non-Hawaiian Pacific Islanders was far different.

“If compared with other parts of the country, Pacific Islanders in Hawaii have the highest mortality rate in the country,” the report said.

Barriers To Vaccine Access

Acting state epidemiologist Sarah Kemble said that the relative lack of vaccinations among Hawaii’s Indigenous community and other Pacific Islanders living in the state was not unexpected.

Last November, a University of Hawaii survey found just 29% of Native Hawaiians said they were willing to get vaccinated, compared with 44% of all state residents. Limited English proficiency and computer literacy are also barriers for some Pacific Islanders.

Still, advocates say they know many in the Native Hawaiian, Pacific Islander and Filipino communities who are eager to get the vaccine but aren’t yet eligible.

The state created vaccine prioritization categories aimed at minimizing mortality and preserving the overall functioning of society based on federal guidance, but the system also made it less likely that Pacific communities would get early access to the vaccine.

Health care workers got vaccines first, and Native Hawaiians and other Pacific Islanders are underrepresented in that industry, Kemble said.

Prioritizing vaccines for people aged 75 and older first also limited access to Native Hawaiians and other Pacific Islanders who have shorter life expectancy than other communities, Kemble said. Hawaii only lowered the age of vaccine eligibility to 65 this week.

This graph from the DOH’s new pandemic equity report shows how different communities were sickened by age and race group. 

Kim Birnie, spokeswoman for the nonprofit Papa Ola Lokahi, said the average lifespan of a Native Hawaiian person in Hawaii is around 76 years, and the average lifespan of a Native Hawaiian man is 73.

One study found that the average lifespan in Hawaii is 82 years, with white people living until they’re 80; people of Filipino and Japanese descent until they’re 84; and residents of Chinese ancestry up to 87 on average.

“That ineligibility is really another tool of institutional racism because they set it at 75,” Birnie said, adding that she’s glad people over 65 are now eligible for vaccinations.

Hawaii vaccine disparities by race shift considerably once age is factored in. Eight percent of Native Hawaiians or other Pacific Islanders age 70 and up have received vaccines, and they make up 11% of the 70 and up population in Hawaii, the state data dashboard says.

Sixty-three percent of Hawaii’s over-70 residents are Asian and 59% of the over-70 Asian community in Hawaii has received a vaccine.

Meanwhile, 32% of white people who are at least 70 have received a shot, although they make up less than a quarter of the state’s 70-plus population.

Unlike some other states, Hawaii has not explicitly prioritized vaccines for its Indigenous community or groups like other Pacific Islanders who have borne the brunt of the virus here.

State officials noted community health centers in Hawaii received federally funded vaccines and were allowed to vaccinate patients from disadvantaged communities even if they didn’t meet the state’s age and occupancy prioritization categories.

Chantelle Matagi, who co-leads the Department of Health’s Pacific Islander contact tracing team, highlighted how the state has been hiring more staff who speak Pacific Islander and Filipino languages and supporting community organizations. She herself is part Samoan.

“Rather than placing the burden of pandemic response on communities,” she said, “these initiatives empowered them.”

Disparities Within Pacific Islanders

The state’s new equity report revealed that even within the Pacific Islander community, the pandemic’s impacts have been unequally felt. More than half of the COVID-19 deaths among Pacific Islanders in Hawaii affected Micronesians; a quarter were Samoans and the remaining were Marshallese.

More than 1,200 Samoans in Hawaii, more than 1,000 Chuukese and more than 900 Marshallese people in Hawaii have gotten COVID-19. Race data is missing for 27% of Hawaii COVID-19 cases.

The report emphasized how the pandemic reflects long-standing health disparities including high rates of chronic diseases among Native Hawaiians, Pacific Islanders and Filipinos compared with other ethnic groups in the state.

This table from the DOH pandemic equity report shows how cases by race and ethnicity varied over time. 

The report found 30% of non-Hawaiian Pacific Islanders lack a personal physician in Hawaii, and 10% of Native Hawaiians and Filipinos don’t have one either. Thirty percent of Native Hawaiians and other Pacific Islanders combined are either uninsured or underinsured, the report found.

The report listed numerous grassroots efforts to respond to the pandemic and cited the “tremendous efforts and investments of community groups across the state, many of whom made these contributions with limited resources.”

“Additional investment in these impacted communities is needed in order to turn the tide of this pandemic, and to build the resilience to meet the challenges of future and emerging health threats,” the report concluded.

Recommendations included advocating for standardized data collection; encouraging collaboration with community organizations; and improving “representation of historically marginalized communities in government leadership positions, committees, workgroups, and task forces.”

Click here to read the full report. 

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