Over a year into widespread Covid vaccinations, an equity gap remains.

Remember the days, one year ago, when it was a race to get a spot in a Covid-19 vaccination clinic. Now we are moving on to a second round of boosters for some people, but there’s still outreach going on to increase the vaccination rate for people who are eligible for a first vaccine and still have not gotten one.

The official term in medical circles for holding out, despite the safety and effectiveness of vaccines is “vaccine hesitancy.” There’s a lot of research on this topic, and analysis from medical providers on how to talk to patients and understand their concerns, from lack of confidence in the medical system to a fear of side effects.

Dr. Vanessa Lopez-Littleton is interested in these personal reasons. She’s also interested in broader social and cultural forces that lead people to remain unvaccinated. As chair of the Health, Human Services, and Public Policy Department at CSU Monterey Bay, she is leading a survey on vaccine hesitancy and hosting a series of virtual community conversations, inviting people to talk directly to health care providers about their concerns.

Lopez-Littleton wants to boost the vaccination rate overall – just 83 percent of vaccine-eligible Monterey County residents, those ages 5 and up have received at least one dose, according to Health Department data. But she’s especially interested in addressing an alarming inequity.

Of the county’s Latino and Asian populations, 78 percent are vaccinated; 77 percent of the white population is vaccinated; a remarkable 100 percent of the Pacific Islander population is vaccinated. But of Indigenous residents, only 51 percent are vaccinated, and only 47 percent of the Black population.

With her CSUMB colleague John Olson, Lopez-Littleton is circulating a survey with questions about vaccination. “The results will be used to develop targeted strategies to increase the rate of vaccinations in our county,” they wrote. They’ve received about 260 responses so far, with a goal of 300, but frustratingly few responses from Black respondents, the group they’re most interested in. Lopez-Littleton is circulating the survey to mostly Black churches and restaurants, hoping to get more responses. “We are trying to get their voices represented in our sample,” she says.

Her interests are both immediate – how do we get more Black community members vaccinated? – and long-term. “I play the short game and I play the long game,” she says. “How do we build an equity infrastructure that actually builds systemic change? It’s not just the Covid vaccine. We have higher infant mortality rates, maternal mortality rates, HIV/AIDS [infection rates] – these are things that some populations have kind of moved on from, but the African American community is still struggling with.”

Along those lines, Lopez-Littleton is taking a multi-pronged approach to understanding the issues and looking for solutions. Some have to do with vaccine hesitancy. Others have to do with social factors that transcend personal choice.

“I heard someone say the other day that if we want to make a difference for our health care workers, we should just take better care of ourselves. But you are just discounting the social factors,” she says. “This is not just about one person – it’s about critical mass. How do we change behavior, and how do we make policy to support that?”

As an example, she looks at the federal government’s initiative to distribute at least one free Covid test kit to every address. Was that the best choice, given the range of incomes, household size and other factors?

Locally, Lopez-Littleton is hopeful about making systemic change. “Since I’ve been in Monterey County, I’ve seen more elected officials being responsive to social determinants of health than in a while. That is promising. It is up to us as scholars to meet them.”

There are three upcoming virtual community conversations with health care providers and public health professionals. The next is 6-7pm Tuesday, April 6. On Saturday, May 14 from 10-11am, there’s a Spanish-language session; and on Tuesday, June 14 from 6-7pm is a final session (structure TBD).

To attend a conversation, visit bit.ly/MontereyCountyCovidForum. To complete the survey, go to bit.ly/CSUMBvacccinesurvey.

Sara Rubin is the Weekly’s editor. Reach her at sara@mcweekly.com