While Washington University made vaccines available to all students, faculty and staff last week, campus medical experts say inefficiency and a lack of equity still plague Missouri vaccine distribution.

Missouri no longer ranks last in the percentage of residents who have received one dose of the vaccine, but the state has only used 75% of the doses it has been allocated, leaving it far behind a majority of other states. Not only has poor distribution planning led to wasted vaccines, but professors have also noted how it has exacerbated long-standing healthcare disparities.

Multiple professors noted how the geographic distribution of the vaccine causes areas of greater need to receive less vaccines than areas with lower demand.

“They initially wanted to be very fair,” Dr. William Powderly, Co-Director of the Division of Infectious Diseases at the School of Medicine said. “I don’t think they anticipated that the demand would be greater in the cities and less in some of the rural areas.”

While the demand for vaccines has outpaced supply in Missouri cities, vaccination sites in rural Missouri frequently end up wasting doses. In one case, Brown School of Social Work Professor Timothy McBride recalled, the state government sent thousands of shots to a town of 500 people. “Nobody showed up,” McBride said.

The vaccine distribution system in Missouri has created many barriers to access, particularly for older adults and people of color.

“We relied on people getting themselves registered, which meant that for most people they had to have access to the internet and be internet savvy,” Powderly said. “In particular, there are a lot of poorer people who do not have reliable access to the internet.”

“The reality is that if you don’t have reliable access to the internet, if you don’t have a smartphone, if you can’t be constantly searching for appointments,” Powderly said.

Along with the technological barriers that residents have faced, a lack of access to transportation and workplace restrictions makes getting to appointments burdensome.

Powderly said that many middle class adults were able to drive to rural areas with leftover vaccines. “But to do that,” he said, “you need transportation and a job where you can take off. Again, for poorer people who don’t have that sort of freedom, that was much more of a challenge. As you well know in the United States, individuals such as that are more likely to be minorities.”

Though physical access to the vaccine has been the main issue facing minority communities, people have also expressed concerns that individuals from marginalized backgrounds, and Black Americans in particular, would choose not to receive the vaccine due to systemic racism within the medical industry.

“I think the biggest worry… was the historic lack of trust in the healthcare system because of the Tuskegee experiments and historic tension between the healthcare system and African Americans,” McBride said.

But that has not been the story. “African Americans seem to be pretty much willing to take up the vaccine when it’s offered to them,” McBride said. “Most people now believe that disparity, if it exists, is due to lack of access.”

Powderly said community leaders, especially in communities of color, should help lead health messaging efforts, since having health guidance come from trusted leaders can address long-standing distrust of the medical profession.

“One of the things that is really critical to make this work and make sure that everyone gets vaccinated is to have a very clear plan to engage with marginalized communities, particularly communities of color,” Powderly said. “And the same thing is true in rural areas, where for different reasons they currently distrust authority.”

Washington University health economist Derek Brown noted that another issue in vaccine distribution has been both a lack of accurate information and the existence of inaccurate data.

“Data collection and data sharing has also not been good,” Brown said. “It has been difficult to track and actually get the state’s data on which racial and ethnic groups have received the vaccine. The state has had some inaccurate or faulty data that’s made it difficult to track.”

Yet there have been improvements to the system since rollout began, Brown added. “I think it’s easy to feel better—some reallocation has occurred but also just this national distribution and national supply has increased so much that I think you can feel fairly optimistic today that these problems are getting mended,” he said.

As supply increases and the distribution process in Missouri continues to work more efficiently, Powderly said he is hopeful. “I’m very optimistic that we will [vaccinate] everyone who wants to be vaccinated by the summer,” he said.