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Multnomah County submits COVID-19 equity plan Friday, asks for lower risk designation

OHSU employees Pam Starr, left, and Nichole McCaffrey prepare COVID-19 vaccines at a mass vaccination clinic at Portland International Airport, April 9, 2021.
Kristyna Wentz-Graff/ OPB
OHSU employees Pam Starr, left, and Nichole McCaffrey prepare COVID-19 vaccines at a mass vaccination clinic at Portland International Airport, April 9, 2021.

As COVID-19 vaccination rates increase and numbers of infections and deaths decrease, the Oregon Health Authority is lowering the designated risk levels for some counties. Last week it announced that if counties had a 65 percent vaccination rate and a plan to close vaccine equity gaps, they would be eligible for the lower risk designation. That would mean significantly fewer restrictions on masking, indoor gatherings and social distancing. Multnomah county chose to wait to submit its equity plan until Friday, so the lower risk designation is not likely to come until sometime next week. We talk with Multnomah County chair Deborah Kafoury about the details of the equity plan and more about the county’s overall COVID-19 strategy.

Dave Miller: This is Think Out Loud on O. P. B. I’m Dave Miller. This morning, Multnomah County sent state officials their request to be able to enter the low risk category. That would mean fewer restrictions on local businesses. Five other counties were granted low risk status. As of today, Multnomah County’s application is based on two criteria: more than 65% of residents, 16 and over have now received at least one COVID 19 vaccine dose and the county has provided the state a plan to address the racial equity gap in vaccinations. For more on what that plan is, I’m joined once again by Deborah Kafoury. She is the chair of the Multnomah County Commission. Chair Kafoury, welcome back to Think Out Loud.

Deborah Kafoury: Thank you so much, Dave.

Dave Miller: So let’s start with the disparities. According to the latest data from the state, the three demographic groups with the lowest vaccination rates, and this is by total population, as opposed to 16 and over. They are native Americans, blacks and Latinos. That is the case both in Multnomah County and it also tracks with statewide numbers. Just to put the numbers in perspective: the vaccination rates for these groups hover in the mid-30s, for white people in Multnomah County, the rate is about 53%. So in the big picture, how do you explain these disparities?

Deborah Kafoury: Well we know that the health care system in our country and actually, the government over the decades, has systematically failed to protect the health of people of color. And we can even see it for where the vaccination sites were located: in areas that are more difficult for people who live in the parts of our county where, where people of color live.

Dave Miller:So there was one at the Portland Airport, one big one, another big one at the Convention Center, in the close-in east side.

Deborah Kafoury: Right. And there’s a map that shows very distinctively, that 82nd is a breakdown, the east side of 82nd, the vaccination rates are drastically lower than they are on the west side of 82nd.  And it coincides with where people of color live in our community.

Dave Miller: It’s not like a focus on addressing racial equity in vaccination rates is new.  We’ve been talking about efforts in Multnomah County and other counties to reach various communities of color for months now. Can you remind us in Multnomah County what those existing efforts, that these prior efforts have been?

Deborah Kafoury: Well, Multnomah County as the Public Health Authority has had an equity plan for addressing Covid since the start of this pandemic, because we knew that communities of color would be most heavily impacted by the disease, both getting the disease and then, and then dying from the disease. And so we had an equity plan from the start. I wouldn’t say that with the vaccine efforts, Multnomah County received as again as the public health authority, really a small percentage of all the vaccines that have been distributed throughout our county. The majority of them have gone, the majority of vaccines have gone to the major health systems and now to pharmacies.

Dave Miller: Something like 90%, right?

Deborah Kafoury: Correct.

Dave Miller: So I mean, does that limit what you can even do at the county level? The state said, Hey, if you want to enter the low risk category, show us your plan for addressing the racial equity gap in terms of vaccination rates. But how much power do you actually have given the way vaccine allocation works.

Deborah Kafoury: Well, I can just give you an example. As the public, our public health team at Multnomah County, we’ve reached 20,000 people, we’ve vaccinated 20,000 people, 75% of whom identify as people of color. In our health clinics, we run federally qualified health centers as well. We’ve reached and vaccinated nearly 8000 people. About 70 %of those identify as people of color. And half of those requested an interpreter to be able to participate in the vaccination program. So if you compare that to the to the numbers that you mentioned earlier, you see that Multnomah County, although we’re doing a great job using our values, we we can’t do it, but we can’t do it alone.

Dave Miller: So. But what does that mean in terms of the plan? I mean, if the state says, show us your plan to address this, do you have any authority for example, to to decide how, you know, say Kaiser or OHSU or any other hospital system, let alone say Walgreens, how they are going to distribute the vast number of the vaccines that actually are in Multnomah County?

Deborah Kafoury: No, we don’t have the authority to dictate how others use their vaccine or how they, the plans that they use. But we do believe in leading by example. And I think that’s one of the reasons why we put so much time and effort into our equity plan because we truly believe in it and because we want to show other people that it can be done, it just takes intention.

Dave Miller: Early on disparities in vaccination rates were tied to the states eligibility schedule. Obviously, now that’s all out the window because anybody can go without even an appointment. But early on, teachers and health care workers who were more likely to be white were prioritized ahead of many other groups. That schedule came from the state itself. Is it fair to say that at least to some extent, you are now being asked by the state to come up with a plan to address racial gaps and vaccinations that the state helped to create.

Deborah Kafoury: I think that hindsight is 2020 and I would imagine the state, if they could go, look back at the way that they did things, they would want to make some changes. I believe that we have a moment in time now where we need to look forward. And I hope that the plan that we’ve, that we’ve developed and that we’ve put forward will show other systems, other entities how they too can, and should. They have, they really have the moral imperative to focus on getting all of our community members vaccinated. And it’s not just, I’m hearing, actually been getting a lot of emails from people saying what even is an equity plan? Why is it important? And I believe that people need to understand that the health of each of our communities supports the health of our whole community.

Dave Miller: So let’s get to some of the specifics about what this plan going forward is. Can you give us, you know, the 30,000 ft overview of the plan going forward?

Deborah Kafoury: Sure. And in some ways it’s not dramatically different from the plan that we have been implementing from the start and that is the way to work with our communities of color is to listen to them. So our plan is about developing this plan in partnership with community so that when we are trying to figure out why aren’t our Latin X, why aren’t folks in Latin X community getting vaccinated? We need to talk to them, we need to listen to them and we need to hear from them what is going to help? And we’ve been doing that from the beginning. Obviously now it’s different because we are trying to reach people who, who haven’t jumped at the chance and and haven’t had the access. So how do we get the harder to reach folks? And that is, that’s what this plan is focused on. It’s continuing to listen to communities about how they believe the best way to get their folks vaccinated.

Dave Miller: One of the phrases that I’ve seen in recent days, in terms of the county’s plan is a hub and spokes model. What is that?

Deborah Kafoury: It’s some really good government jargon. That’s what it is. It’s the latest, the latest thing.

Dave Miller: Break it down for us.

Deborah Kafoury: Well, and it’s again, it depends which context you are using, but I’ll use it in the vaccine context. So the vaccine, the beauty of those big vac sites is that you have a lot of vaccine. It’s hard to store, so you can keep it in specialty lock freezers. And then people just come through bam, bam bam. But if you’re trying to vaccinate people who are, who have mobility issues, say, and they can’t get out of their homes, you have to bring the vaccine to them. That means one person vaccinated, one person at a time. It can be slow going. So if you have the hub, you have a facility, we’re locating a new site out in East Portland and that’s going to be the hub where we will store the vaccine and volunteers and staff can work out of that. But then they can do the spokes, they go out to a community center or they go out to an adult care foster home or they go out, you know, somewhere out away and then they come back. So that’s the hubs to the spoke. The spokes to the hub.

Dave Miller: I should remind folks, maybe just tuning in. We’re talking right now with Deborah Kafoury, the Multnomah County chair. It is worth pointing out. There has been one very clear notable success in terms of demographic groups and vaccinations. Native Hawaiians and Pacific Islanders have by far the highest vaccination rate in Multnomah County and actually the highest in the state as a whole. How do you explain that? I mean, what went right and is there some kind of lesson there for the county’s approach to other demographic groups?

Deborah Kafoury: That’s a great question, Dave. And unfortunately I don’t have a great answer for you at this time, but I, now that you’ve mentioned that I’m very curious myself and I would have to talk to the folks in our public Health Department who works specifically with that community.

Dave Miller: Well, what about this one? This is almost the opposite version of that question. Because if we’re talking about demographic groups with the lowest vaccination rates, the nationwide white conservatives are among the lowest in the country. Does Multnomah County have a plan in this equity plan to boost vaccinations, specifically among white conservatives?

Deborah Kafoury: No, I don’t believe that we do have a plan. I don’t think we’ve seen that data here. I don’t know that they, that we collect data based on people’s political preference. So we’re looking just at race and ethnicity in the data that I’ve seen,

Dave Miller: As I noted in my introduction, five other counties are actually entering into low risk, the low risk category today. That’s because they actually sent in their applications to the state, including their equity plans before Multnomah County did. Did you wait a little bit saying it was going to take you more time to do this right? Why did it take more time? And I should note that two of those, Washington and Deschutes Counties also have sizable populations. Washington,

you know, in many ways is a smaller version of a very diverse county like Multnomah County. Why was Multnomah County different?

Deborah Kafoury: Well, I’m going to push back a little bit on the implication there that it took us a long time. It really didn’t take that long. We got the guidelines and the 13 questions that the state wanted answered last Wednesday and we submitted the plan today. And the reason that we submitted it today, as opposed to any other day this week is because that’s when the deadline was. We either could have turned it in last Friday or this Friday. And, we have, as I’ve said, we believe that the equity component of this new framework from the state deserves the same consideration that we have paid to equity throughout our Covid response. And I think you can see that in the document that we submitted. It’s detailed and it was built in partnership with community, which takes a little longer to do than just, you know, throwing spaghetti on the wall. But it’s important. It’s what we believe in and, and that’s why we wanted to take the time to do it right.

Dave Miller: Are you suggesting that the five other counties threw spaghetti at the wall because they did this in two days?

Deborah Kafoury: Of course not. No. I’m just, I’m just saying for us, you know, we could have thrown something together quickly, but it wouldn’t have been it would not have been real. No, I believe that each, each of the counties in in Oregon that you mentioned have worked really hard and have done a really good job and that’s why they are able to move into the low risk category because they worked hard in building trust with their community members so that they are able to vaccinate a large number of people.

Dave Miller: And just briefly, the initial thinking, my initial thought was it would take the state a week to actually grant this and that this meaning that if they approve your plan, Multnomah County would move into low risk a week from today, next Friday. But in the press release, it says you actually are hoping for that earlier. What’s the timeline that is actually possible from the state?

Deborah Kafoury: Well, the state set up, they’ve had many different criteria and matrixes over the, over this past year, but the most recent one is a warning week and then a movement week. And that’s why I was talking earlier about Friday was the deadline to turn in the plan and then they would let you, on Tuesday they tell you if you meet the metrics and then they move you on Friday and I understand that they set that in place several months ago. It’s really arbitrary to be honest. And if we’re ready to go, which I believe we are and once they approve our plan, we should, we believe that we should be able to move into the low risk as soon as they’ve signed up on our plan.

Dave Miller: Meaning potentially Tuesday or Wednesday.

Deborah Kafoury: Correct.

Dave Miller: Deborah Kafoury, thanks very much for joining us today.

Deborah Kafoury: Thank you.

Dave Miller: Deborah Kafoury is the chair of the Multnomah County Commission.

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Allison Frost