FQHCs Remain Instrumental in Health Equity, COVID-19 Efforts

Federally qualified health centers continue to prove pivotal at supporting health equity, with the latest data from the Boston University School of Public Health showing FQHCs were disproportionately responsible for getting populations of color vaccinated against COVID-19.

Overall, FQHCs allocated about 61 percent of their COVID-19 vaccine doses to people of color, compared to the about 40 percent administered to racial and ethnic minorities in traditional clinics, the researchers wrote in JAMA Network Open.

“FQHCs have played a critical role in enabling equitable access to COVID-19 vaccines in marginalized communities that are otherwise often least likely to receive the vaccine,” study lead author Megan Cole Brahim, PhD, MPH, an assistant professor of health law, policy & management at BUSPH, said in a press release.

Low-income people, people of color, members of the LGBTQ+ community, individuals with disabilities, and others who are traditionally marginalized by the healthcare system often face social determinants of health that make it hard for to access medical care. Without adequate transportation, the option to take time off from work, or the ability to pay for healthcare, it is challenging for these underserved groups to get the medical attention they need.

FQHCs, which are usually located in underserved communities, make it easier for marginalized populations to engage in healthcare.

“These populations may not otherwise have easy access to a vaccine clinic, or may not trust other types of institutions with histories of racism or that have systematically failed them,” Cole explained.

And this latest study corroborated that. According to Cole and colleagues, FQHCs supported more than their share of underserved patients during the COVID-19 vaccine rollout period.

Using FQHC administrative data and cumulative CDC vaccine data, the researchers determined that FQHCs administered more of their vaccine doses to people of color than other clinics.

By study’s end, 61.4 percent of all vaccine doses given at one of the more than 1,000 FQHCs went to a patient self-identifying as American Indian/Alaska Native (AI/AN), Asian, Black, Hispanic, or “other.”

This compares to about 40 percent of doses given to populations of color at other clinics. Said otherwise, FQHCs did significant legwork in making sure populations of color got their COVID-19 vaccines.

What’s more, the data showed that any existing vaccine inequities closed over time at FQHCs. Although at the start of the study, AI/AN, Asian, and non-Hispanic White people were more likely to get a COVID-19 shot than Black and Hispanic people, that gap got smaller by study’s end.

“Persistent COVID vaccine inequities among Black communities is likely shaped by greater structural barriers to accessing the vaccine, combined with medical mistrust stemming from decades of systemic racism in the medical community,” Cole pointed out.

“FQHCs can help to further mitigate these drivers through continued partnerships with community organizations, targeted outreach, mobile and pop-up clinics with extended hours, and by provided culturally competent and linguistically appropriate information to all patients.”

Importantly, the researchers said FQHCs equitably distributed their COVID-19 vaccines; they did not prioritize communities of color when administering the shots. Rather, the researchers indicated the FQHCs serve a greater proportion of communities of color and are therefore instrumental in the nation’s overall goal for health equity.

Future public health efforts should continue to center FQHCs, while federal and state funding should support keeping these safety-net clinics open, Cole said.

“As we continue to see lower COVID vaccination rates in many low-income communities of color, particularly within Black communities and among children, continued investment in FQHCs from federal and state governments will be critical in improving vaccine equity,” Cole recommended.