27 states are now reporting race and ethnicity data for their vaccinations. This week, New York joined that number. New York City also started reporting these data last Sunday, as we noted in that day’s issue. Despite promises from city and state leadership to prioritize equity in the vaccine rollout, the numbers so far are showing white New Yorkers getting vaccinated at much higher rates than their Black and Hispanic/Latino neighbors.
Here’s one way of visualizing the disparity: Black New Yorkers make up 25% of NYC’s population, but only 12% of those vaccinated. Latino New Yorkers make up 29% of the population, but only 15% of those vaccinated.
Here’s another way of visualizing the disparity: about 4.6% of white NYC residents have been vaccinated, compared to 2.2% of Latino New Yorkers and only 2% of Black New Yorkers. White New Yorkers are getting vaccinated twice as fast as their neighbors. This is particularly striking when you consider that Black and Latino New Yorkers disproportionately make up our essential workers—they constitute the majority of grocery workers, public transit workers, healthcare workers, childcare workers, and cleaning services workers, according to a March 2020 report by the NYC Comptroller’s office.
(Note: Asian American and Pacific Islanders make up a disproportionately large share of healthcare workers and Pacific Islanders have been particularly hard-hit by the pandemic; these two factors may help explain the high rate of vaccinations in the NYC Pacific Islander community.)
As someone who lived in NYC during the height of the city’s spring surge, I’ve seen how hard the pandemic has hit my neighbors of color. Sirens screamed through my north Brooklyn neighborhood at all hours, and hundreds of requests for aid came into my local mutual aid group. About 7,400 Black New Yorkers and 8,000 Latino New Yorkers have died of COVID-19 since the pandemic hit this city. In any version of an equitable vaccine rollout, these communities should be first in line.
So, what’s happening? Why are vaccinations for Black and Brown New Yorkers lagging? The answer is a combination of poor planning and poor access. The city didn’t set up appropriate systems to tell its most vulnerable communities about the vaccines or help them set up appointments. As a result, those NYC residents who have the time, know-how, and internet access to navigate a complex system are snapping up appointments—and you can guess which residents those are.
“What we’re going through now with the vaccine rollout reminds me of what we were going through at the beginning of the pandemic,” said Dr. Uché Blackstock, emergency physician and founder of the organization Advancing Health Equity, at a webinar with City Councilmember Mark Levine this past week. She described how she struggled to get enough tests and PPE to care for her patients—many of whom were Black and Latino essential workers—last spring.
Now, there’s both a supply gap and an information gap. In one example now infamous in the city, a vaccination site in Washington Heights (home to NYC’s Little Dominican Republic) was primarily catering to white patients from other parts of the city, the suburbs, and even New Jersey. Josefa Velasquez, a reporter at THE CITY who exposed the problems at this site, described how the vaccination center was ill-equipped to serve the population in its neighborhood:
At the door, most people entering appeared to be white and unfamiliar with the neighborhood. Some asked security guards where they could find parking. Nylon Longchamp handbags and Burberry scarves stood out.
Outside of the site, run by NewYork-Presbyterian Hospital near its Washington Heights medical center complex, Olga encountered another language barrier: None of the handful of guides and security guards outside directing people spoke Spanish.
Velasquez herself actually helped translate for some of the seniors trying to get vaccinated. After her reporting brought the vaccination center’s problems to light, the center limited all new appointments to NYC residents and reserved 60% of slots for Washington Heights residents. But the story is still indicative of larger issues: NYC data show that 23% of vaccinations in the city have gone to non-residents, and a significant majority of those non-residents are white.
Even when appointments are reserved for New Yorkers, barriers to vaccine access remain. Just this week, Yankee stadium opened as a vaccination site with all doses reserved for residents of the Bronx. Councilmember Levine posted on Friday that thousands of these appointments were still open, unreserved—while appointments elsewhere in the city get snapped up in minutes.
A reply to Levine’s Tweet reveals one reason: Bronx residents can’t access these Yankee stadium appointments through the NYC vaccination website, because this clinic is run by a network of private physicians. The city website is confusing enough already for many New Yorkers—and now that website doesn’t even encompass all available appointments.
Some residents of the Bronx also associate the stadium with invasions of their community:
At the same webinar that I cited earlier, Councilmember Levine announced a redesign of the official NYC vaccine appointment scheduler. The site’s design has been simplified and made more accessible. On the homepage, for example, users are provided with four options: Schedule First Dose, Schedule Second Dose, Reschedule Appointment, Cancel Appointment. But users still have to navigate through a checklist and input a lot of personal information in tiny boxes. And, while NYC does have a vaccine hotline, it “hasn’t been adequately staffed,” according to Levine—nor is there adequate translation.
In an ideal world, Dr. Blackstock suggests that doctors should call all their patients proactively to offer vaccine appointments. Community health workers should go door-to-door. Vaccination centers should be set up in every low-income housing development. NYC clearly dedicated nor the advance planning time nor the funding to such proactive measures. But the least we can do should be setting up an easy-to-use website and phone line, right?
(We also need more data on vaccinations by occupations, preexisting health conditions, and ZIP codes—but that’s a topic for another issue.)
- Booster shots exacerbate global vaccine inequityAt the end of last week’s post on booster shots, I wrote that these additional doses take up airtime in expert discussions and in the media, distracting from discussions of what it will take to vaccinate the world. But these shots do more harm than just taking over the media cycle. When the U.S. and other wealthy nations decide to give many residents third doses, they jump the vaccine supply line again—leaving low-income nations to wait even longer for first doses.
- Another COVID-19 endgame takeTrevor Bedford, computational virologist at the Fred Hutchinson Cancer Research Center—and widely regarded expert on coronavirus variants—wrote a useful Twitter thread this week. In the thread, Bedford provides his take on the “COVID-19 endgame.” In other words, what will happen once the virus reaches endemic levels?
- Unreliable population numbers hinder vaccination rate analysisAn excellent article in the Financial Times, published this past Monday, illuminates one major challenge of estimating a vaccine campaign’s success: population data are not always reliable. Health reporter Oliver Barnes and data reporter John Burn-Murdoch explain that, in several countries and smaller regions, inaccurate counts of how many people live in the region have led to vaccination rate estimates that make the area’s vaccine campaign look more successful—or less successful—than it really is.
- Booster shots: What we’ve learned—and what we still don’t knowThis week, the FDA’s vaccine advisory committee had a two-day meeting to discuss booster shots for Moderna’s and Johnson & Johnson’s COVID-19 vaccines. From the outside, these meetings may have appeared fairly straightforward: the committee voted unanimously to recommend booster shots for both vaccines. But in fact, the discussions on both days were wide-reaching and full of questions, touching on the many continued gaps in our knowledge about the need for additional vaccine doses.