Inequality in the COVID Recovery, from Infection Rates to Vaccine Access

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Rudayna Bahubeshi

June 15, 2021

The first wave of COVID-19 coincided with the massive protests around the world. Anti-Blackness, and systemic racism broadly, were in the public eye to a degree unprecedented in recent decades.

In the city of Toronto in August 2020, Black people made up 34 percent of COVID-19 cases, despite comprising only 9 percent of Toronto’s population. Overall, Black and racialized people in Toronto made up 83 percent of COVID-19 cases. It is important to note that the city did not publish numbers on Indigenous people due to lacking a data gathering system. More recent data from the University of Toronto indicates that Indigenous people in Toronto were hospitalized for COVID-19 at three times the rate of the general population, contracting the virus 23 percent more than the general population.

When the second wave came in the fall, some hotspot neighbourhoods —with long histories of being underserved— reported feeling as though they had never emerged from the first wave. By the third wave, after nearly a year of organizing in the name of racial justice, health inequities and systemic racism starkly played out again. This time in vaccine distribution: it was like amnesia and making the same wrong choices.

Inequitable patterns also extended beyond who was most affected by the virus. Poor policy making through the spring exacerbated unsafety, with a call for increased policing (that was eventually retracted), strong resistance to paid sick leave, and inordinately tough restrictions on outdoor gathering. In this way, and against the advice of science advisers, new policies doubled down on the asymmetrical impact of the pandemic by creating dangerous conditions for communities already targeted by police, for low-waged workers, and for households that may have many people living in a small space now unable to be outside. But the worst of the discriminatory policy making was observed in how vaccines were distributed.

In April 2021, The Wellesley Institute, a policy and research think tank focused on population health, found that in Ontario, areas with the highest cumulative incidence of COVID-19 were the areas with the lowest levels of vaccination. This was most evident in Toronto. One of the city’s neighbourhoods with the highest COVID-19 rates was Jane and Finch, a community also experiencing the highest concentration of poverty and the highest number of multigenerational households, where the rate of the virus was 5.06 per 1,000 people. Jane and Finch had the lowest reported vaccination rate in April at 5.5 percent, and residents of the community could access only six pharmacies and clinics with vaccines in a three-kilometre radius. Meanwhile, Moore Park, one of the city’s wealthier neighbourhoods with 0.59 cases of COVID-19 per 1,000 had a vaccination rate of 22.4 percent. Residents of this neighbourhood, one quarter the size of the Jane and Finch population, could access 29 pharmacies with the vaccine in a 3-kilometre radius. This is not an anomaly. The top five postal codes for first-dose vaccine rates were among the wealthiest in the city. This trend was also observed in Hamilton.

When we emerge from this pandemic, we must demand a review of how these decisions were made and how particular communities were consistently and repeatedly left behind.

Some commendable efforts began in Toronto last March to recognize the need for more equitable access, including multilingual outreach campaigns and transportation support. But it is difficult to understand why plans were not drawn up and services planned for an equitable roll- out while the province waited on vaccines at the end of 2020 and the beginning of 2021. After significant advocacy from medical professionals, communities, and advocates, the province activated a hotspot strategy in mid-April, allocating 50 percent of the vaccine supply to 114 hard-hit communities. It is a strategy that was clearly working. But while the Ontario COVID-19 Science Advisory Table’s original recommendation was for a strategy focused on 75 hotspot communities for 25 days, Premier Doug Ford’s strategy serving 114 communities ceased in two weeks.

In Ontario, we see the light at the end of the tunnel of this pandemic, but the missteps have been significant, and the discriminatory outcomes have been a testament to the fact that we were not, unlike was often said, all in this together.

Nor was it really a case of amnesia. It was not a matter of forgetting, but a commitment to ignoring ongoing advice, expertise, and community feedback. We must now respond with the opposite. When we emerge from this pandemic, we must demand a review of how these decisions were made and how particular communities were consistently and repeatedly left behind. Even when the pandemic is behind us, the inequities in our health systems —that were not new— will continue. The lasting impact and the problems of the COVID-19 pandemic will not go away simply because governments choose to stop looking at them.

Rudayna Bahubeshi is a graduate student at the Max Bell School of Public Policy at McGill University.