AURORA | This year, health officials set aside a chunk of the state’s COVID-19 vaccine supply to inoculate residents in poor and mostly-minority neighborhoods, like areas of north Aurora, where locals have proved more at-risk for contracting and succumbing to the virus.
But officials said they may cut off a prominent doctor’s vaccine supply over his policy of reserving shots only for refugees and low-income residents along East Colfax Avenue.
The Sentinel reported last month that doctor PJ Parmar would deny the vaccine to someone who admitted to living outside of the 80010 zip code, which includes his clinic, Ardas Family Medicine. The clinic has long been a trusted source of medical help for refugees and immigrants, and it’s an integral part of efforts to instill local trust in vaccines.
Parmar insists that his plan funnels vaccines to those who most need them. Hispanic and Black people account for an outsized share of virus cases in Colorado because of more crowded living and working conditions. But he’s routinely turned away more wealthy people seeking the vaccine, who tend to be white, he said.
“Our purpose indeed was to create a barrier, to exclude those that don’t live here (80010 the poorest zip code), so that we can prioritize those disproportionately affected by the virus,” Parmar told the Sentinel in an email. “Only by creating a barrier to the privileged, can you focus on the less privileged.”
Since last week, state vaccine officials have told Parmar he’s violating a Colorado Department of Public Health and Environment rule that providers can’t turn away eligible Coloradans because of where they live or other factors.
A spokesperson for CDPHE told the Sentinel that officials expect vaccine providers like Parmar “to follow our guidance…. Providers who fail to do (so) risk having their doses reallocated.”
Shelby Wieman, a spokesperson for Gov. Jared Polis’ office, said that Parmar and state vaccine officials share the same goal to funnel the vaccine to low-income and minority neighborhoods.
It’s a strategy officials have used in most U.S. states, in light of the racial and socio-economic divisions shaping who suffers most during the pandemic.
But Wieman said Parmar’s discretion is a slippery slope. If other providers began denying the vaccine based on where someone lives or whether they’re a patient in a hospital’s network, that would hamstring the state’s goal to get as many people vaccinated as possible — and quickly.
“Who’s to prevent other providers from doing the same thing? Which is a concern,” Wieman said of Parmar’s policy.
Parmar said he won’t budge. He’ll continue to allow walk-in vaccinations for eligible locals, but he’ll put outsiders on a waitlist that’s likely to become long, he said.
“I have to. That’s the whole reason I do the work I do. That’s health equity, that’s vaccine equity,” he said.
Parmar said his staff at Ardas, located at 10180 E. Colfax Ave., have administered “thousands” of vaccines mostly to refugees and immigrants who live in the area.
He says he’s chipping away at the reality that north Aurorans still have lower vaccination rates than the rest of the city, according to Tri-County Health’s data platform. That’s in part because some immigrant communities generally don’t trust the vaccines, and partially because the state’s vaccination roll-out so far has prioritized residents who tend to be white and wealthier: Healthcare workers, nursing home residences, the elderly and teachers.
But the disparities are also likely fueled by barriers to access.
As in all of their day-to-day operations, Ardas doesn’t require appointments for a shot, unlike other vaccination clinics in the area also targeting low-income people and racial minorities.
But Parmar said that makes his clinic vulnerable to swarms of white and wealthier people from outside of the neighborhood, or even outside of Aurora, who will snatch up the vaccine supply if offered.
He saw that firsthand during a brief stint when word of Ardas’ no-appointment-needed policy spread through the metroplex last month.
“When we started giving the (COVID-19) vaccine like 6 weeks ago, we did open up to everyone as state orders commanded, and my Black and brown waiting room was immediately thoroughly (and predictably to any of us actually doing this work for years) replaced by rich white people,” Parmar told a National Guard vaccine official in an email this week. “That is a problem.”
So Parmar decided to deny vaccinations to people who weren’t from the neighborhood.
He also advertised that patients would have to arrive at Ardas with an ID or proof of residency to get the shot. But that’s not actually enforced, he said.
So it’s possible that “someone can show up from Highlands Ranch and pretend they have no ID,” he said. He added that, if someone says they’re from the neighborhood, “we take their word for it.”
In fact, if someone shows up without an ID, staff assume they’re undocumented immigrants, Parmar said.
With the policy, Parmar is adamant that he’s actually reducing barriers to access for immigrants and refugees — populations that typically struggle with phones, appointment times and internet connections, who might not be able to get the shot at nearby STRIDE or Salud clinics. Like most providers, those clinics require appointments via phone or computer.
Wieman and CDPHE officials affirmed that they support Parmar’s intentions but not his methods.
However, the jury’s still out whether the state’s open approach to vaccine equity will see success.
There’s some hope among providers that, as more “essential” workers — who tend to not be white — receive the vaccine in the months to come, the vaccination rate disparities benefitting white and wealthier Coloradans will slim down.
Plus, the state’s supply of vaccinations is expected to swell with the arrival of the new Johnson & Johnson shots. That will likely reduce the trade-offs that officials have had to make between various populations.
Polis pledged last month to set aside 15% of the state’s vaccine supply for residents in low-income and minority census tracts. On the ground, that’s funneled 60,000 doses so far into some of the state’s poorest neighborhoods and fueled some one-time vaccination drives in north Aurora.
Parmar says that’s not enough. It’s a question of vaccine “equality” versus “equity,” he said: to distribute the vaccine equitably, the state will have to exclude wealthier residents from Ardas and in some other cases.
Public health experts are largely behind the idea that vaccinating locals of low socio-economic neighborhoods is critically important to the bigger public health goal of creating herd immunity. Harald Schmidt, a vaccine distribution expert and assistant professor of medical ethics and health policy at the University of Pennsylvania, told the Sentinel they’re “two sides of the same coin.”
But he said it’s not clear whether excluding vaccines based on income, race or residency would be constitutional. If states like Colorado emulated Parmar’s idea, it may make the whole vaccine roll-out vulnerable to lawsuits, he said, reiterating a point he and colleagues made in an academic opinion piece.
“That’s a recipe for legal challenges, and that’s the last thing we need at this point,” Schmidt said. “And we’ve seen that play out in other states.”
Schmidt recommended that state health officials continually “retool” their equity efforts as more people get the shot.
Direct outreach to hard-to-reach residents is key, he said, and so is deliberately delivering shots within poor neighborhoods. Those have been focal points for local health officials in recent weeks.
As of March 11, about 4% of all Hispanic residents in Arapahoe County had received at least one vaccine dose, according to Tri-County. That’s compared with 22% of white people and 12% of Black people.