COVID

Vaccine honor system may be harming vulnerable communities, say MGH researchers

“Why are we creating policies that have the most potential for harm on communities that need the most protection?”

By Mihiro Shimano

August 12, 2021

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When new mask guidelines were released by the Centers for Disease Control and Prevention, or CDC, mid-May, fully vaccinated individuals were told it was safe to gather indoors without masking or social distancing. The long-awaited removal of masks showed the return of a sense of normalcy.

But removing masks required an “honor system,” where individuals trusted one another that unmasked people were fully vaccinated and there was no need to show proof of vaccination. Simar Singh Bajaj, a research fellow at Mass. General Hospital, and director of equity in MGH’s endocrinology division Fatima Cody Stanford argued that this honor system threatened the Black and minority community by potentially increasing the risk of transmission.

The commentary, published Wednesday in the Journal of General Internal Medicine, said that the mask guidance by the CDC in May ignored the health inequities and vulnerabilities the Black community would be exposed to. 

“Health equity is premised on a recognition of various levels of privilege and appropriately nuanced responses, not a one-size-fits-all guidance as the CDC endorsed,” the commentary said. “Why are we creating policies that have the most potential for harm on communities that need the most protection?”

The CDC mask guidance in May left those who are unvaccinated more vulnerable to getting infected. As people began to unmask and socialize, it left Black communities most vulnerable and susceptible to transmitting and catching COVID-19 due to their low vaccination numbers, according to the commentary.

As of May 17, close to when the guidance was released, only 28% of Black Americans had received the first dose of the COVID-19 vaccine, as opposed to 42% of white Americans and 52% of Asian Americans. Despite the CDC’s hope that the new mask guidance would incentivize more individuals to get vaccinated, they did not consider the distrust and hesitancy toward the vaccine that the Black community holds from “historical traumas and everyday racism,” Bajaj wrote. 

Instead, the CDC should have changed their mask policy for each state based on their own quantitative benchmarks, similar to what they had used in May 2020, they wrote. This could also be catered toward certain ethnic or racial groups, staggering the modification of their mask guidance. The commentary also called for the establishment of a “standardized national mechanism” for verifying vaccination statuses. 

“If we continue the current state of affairs, it will be a tale of two pandemics—one in the highly vaccinated, majority-white, suburban areas, and another ripping through and devastating minority communities,” Bajaj said. “I think that’s an unacceptable proposition.”

Since May, the CDC mask guidance has changed accordingly with the increase in cases from the Delta variant. Individuals, even those who are vaccinated, are now highly recommended to “wear a mask indoors in public if you are in an area of substantial or high transmission.” Bajaj says that using benchmarks by looking at areas of high transmission is a much better way to implement mask policies. 

The next move, according to Bajaj, is for public health authorities to focus on increasing the rate of COVID-19 vaccines, including in minority communities, and through that, promoting greater health equity among those communities.

Read the full commentary here.