COVID-19 Data Dispatch

Category: Vaccines

  • The volunteers working to make NYC vaccinations more accessible

    The volunteers working to make NYC vaccinations more accessible

    Screenshot of the NYC Vaccine List homepage.

    When faced with entrenched disparities and a local government that doesn’t want to confront them, it can be difficult for singular individuals to step in and fill gaps. But the founders of NYC Vaccine List knew they could fill one specific gap: they built a better website for finding vaccination appointments.

    The NYC Vaccine List website is simple—simpler than the official city site. Just go to the homepage, scroll past the instructions, and you’ll find a list of vaccine locations. For each location, the site clearly marks available appointments or, where this information can’t be automatically pulled in, provides a link to the location’s website and a note from the last NYC Vaccine List volunteer who checked it. When I checked it at about midnight this morning, Yankee Stadium appointments (for Bronx residents only) were at the top of the list.

    I talked to Dan Benamy and Michael Kuznetsov, two of the founders of this project, over email last week; they told me more about how the NYC Vaccine List website works and their efforts to improve its functionality for all New Yorkers. This interview has been lightly edited and condensed for clarity.

    Betsy Ladyzhets: I know the basics of the project’s methodology—you’re scraping the websites of different vaccination sites and compiling all the info in one place. But I’d like to know more about what running this site actually looks like on a day-to-day basis. What parts of the project are manual vs. automated?  Are there regular hours that you work on updates?

    NYC Vaccine List: The project is managed through a Discord chat server, which makes it possible for volunteers to communicate about certain topics in a group chat, as well as one-on-one when needed. Various responsibilities have been parcelled out to different volunteers based on their ability to help in different areas: maintaining the crawlers, calling to verify information that cannot be crawled, and reaching out to local organizations and press to help spread the word about the project. There are no fixed hours—as this is an all-volunteer effort, we fit this work in between our responsibilities to work and family. This means that it’s not that unusual for there to be work done well into the early hours of the morning! 

    BL: I saw on Twitter that you’re working on providing translations to make the site accessible in languages other than English. How is that going so far?  Have you noticed any changes in the people using the site thanks to this change?

    NYC VL: As of this week, the site can be translated on-demand using the “Language” button in the upper right hand corner of the site. We use the Google Translate widget, which is the same technology used by NYC.gov. The Google Translate widget is provided free-of-charge to COVID-related efforts. Our volunteers have reached out to friends and family to validate the translations, and received positive feedback that the translations make the site easier to use for a non-English speaker. 

    BL: So far, white New Yorkers are getting vaccinated at disproportionately high rates while Black and Latino New Yorkers are getting vaccinated at disproportionately low rates. What can the city do to make vaccination appointments more accessible for these groups?  What role do you see your project playing in addressing this issue?

    NYC VL: The social and epidemiological questions that come along with a mass vaccination effort are complex, and although we have volunteers that have experience in this realm, our organization is not in a position to make recommendations to the city. We hope to increase access to the vaccine by removing the burden of navigating dozens of websites and waiting for hours on hold in order to find a vaccine. 

    We have two simultaneous efforts that strive to make the site more equitable to all residents: First, we’ve prioritized technical fixes that make the site usable for non-English speakers, those with slow internet, those that cannot easily travel across the city, and those relying on screen-readers. Second, we’ve reached out to organizations around the city that directly work with underserved communities. In that outreach, we’ve made sure that the organizations are aware of our site, as well as that they have a direct line of communication back to us in case there is a way to improve the site for their communities and constituents. 

    BL: The city revamped its own vaccine portal recently; the updated site at least appears to be easier to use. Has this update impacted your project?

    NYC VL: The new site is a big step in the right direction, and we’re thrilled to see it because it means more New Yorkers can easily find an appointment. First and foremost, the site should be usable for New Yorkers that visit it directly. Any challenges that we encounter while trying to visit it automatically are secondary, so we don’t have any gripes related to how the page is coded. We’re continuing our efforts to build a site that encompasses all available vaccine locations and appointments available to New Yorkers, which the new site does not yet do, and remain hopeful that the city will continue to make progress in this domain.

    BL: What are your future plans for the project?  Do you see yourselves keeping this going through future phases of vaccination?

    NYC VL: At this point, we haven’t made future plans for the project. We’re energized by the short-term impact we’ve been able to make, and are hopeful that our project won’t be needed for much longer. 

    BL: What has been your favorite story so far of someone using the website to find an appointment?

    NYC VL: We have a new favorite story every day, but one that came in a few minutes ago is top of mind: “Thank you. Thank you. Thank you. A lung transplant makes me a high-risk individual but the ways things are set up, my doctors could not help me get the vaccine. … NYC Vaccine List might literally be my lifesaver. I got my first shot yesterday, Feb. 3, after I spotted an opening on your site at 1:20 a.m. that morning. Thank you. Thank you. Thank you.”

    Related posts

    • Sources and updates, November 12
      Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
    • How is the CDC tracking the latest round of COVID-19 vaccines?
      Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
    • Sources and updates, October 8
      Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
    • COVID source shout-out: Novavax’s booster is now available
      This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
  • Access barriers lead to vaccination disparity in NYC

    Access barriers lead to vaccination disparity in NYC

    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.) 

    Related posts

    • Sources and updates, November 12
      Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
    • How is the CDC tracking the latest round of COVID-19 vaccines?
      Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
    • Sources and updates, October 8
      Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
    • COVID source shout-out: Novavax’s booster is now available
      This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
  • Vaccinations so far are perpetuating existing inequity

    Vaccinations so far are perpetuating existing inequity

    Two weeks ago, I wrote that only 19 states were reporting vaccinations by race and/or ethnicity. This demographic information is key to evaluating the vaccine rollout: both government officials and watchdogs should be able to see how well this process is serving vulnerable populations. Without good data, we can’t see the true picture—making it harder to advocate for a more equitable system.

    Demographic vaccine data has improved since then, but not by much. The federal government is still not reporting these data on a national level. 23 states are reporting some form of vaccinations by race and ethnicity—but the data are difficult to standardize, as every state is reporting slightly different demographic categories. Several states are reporting in percentages, rather than whole numbers, which makes the data less precise.

    And a lack of federal standards for these data means it’s easy for states to change things up: Indiana, which started reporting vaccinations by race/ethnicity early in January, is now only reporting vaccinations by age and gender. New York City also reported demographic data for vaccinations in December, then removed the figures after disparities were revealed, according to Gothamist. (NYC’s demographic data are back, as of this morning, but they still show white residents getting vaccinated at disproportionately high rates compared to the city’s population.)

    (For more detail on which states these are and how to navigate their vaccination data, see the COVID-19 Data Dispatch’s annotations.)

    Meanwhile, the data we have so far continue to show significant disparities. In 23 states with available data, white Americans are being vaccinated at higher rates than Black Americans, a recent analysis by Kaiser Health News’ Hannah Recht and Lauren Weber found. This analysis followed a similar study that I cited two weeks ago—Recht and Weber write that “disparities haven’t significantly changed” with two more weeks and several more states reporting.

    Chart by Hannah Recht/KHN.

    In all but six of the states Recht and Weber analysed, white residents had been vaccinated at double (or more) the rate of Black residents. In Pennsylvania, this rate rises to 4.2 times. Indiana reported white residents vaccinated at 2.6 times the rate of Black residents—before the state took these data off its dashboard. Polling from the Kaiser Family Foundation continues to show that Black Americans are more hesitant; 42% of those surveyed said they want to “wait and see” how the vaccines are working for others before getting a shot.

    This vaccination news builds on the continued, deep strain that COVID-19 has placed on Black communities. Alice Goldfarb provided an update this week in an analysis post for the COVID Tracking Project. While the piece maps out disparities in COVID-19 cases for Black, Hispanic or Latino, and Indigenous populations in every state, Goldfarb also provides a stark comparison for the toll this pandemic has taken:

    More Black Americans have died of COVID-19 since the pandemic began than there are names on the Vietnam Memorial. More Black or Latinx people have died than the number of people commemorated on the AIDS Memorial Quilt.

    The urgency of fixing our vaccine system is clear. And politicians are starting to take note: Massachusetts Representative Ayanna Pressley and Senators Elizabeth Warren and Edward Markey called for better demographic data in a letter to the Department of Health and Human Services this week. They urged the department to better work with states, local public health departments, and labs to collect more data and publish it publicly.

    In a statement to the Associated Press, Pressley says:

    That which gets measured gets done, and the first step towards ensuring we are able to effectively address these disparities and direct lifesaving resources to our hardest-hit communities is for our government to collect and publish anonymized demographic data, including race and ethnicity, of vaccine recipients.

    White Massachusetts residents are getting vaccinated at 1.4 times the rate of Black residents, according to KHN.

    Dr. Marcella Nunez-Smith, the chair of Biden’s new COVID-19 equity task force, similarly discussed the need for better data and equitable vaccination at briefings this week. She mentioned leveraging existing data sources, removing barriers to vaccination in underserved communities, sharing ideas between states, and generally making vaccines more accessible, along with a vaccine communications campaign. But she didn’t go into many specifics.

    The federal government may be able to make vaccine distribution more equitable, if it can provide the funding that state and local public health departments—along with health clinics, community centers, churches, and so many other possible vaccine providers—need right now. But one thing it can do is require race and ethnicity data, and make it standardized. We need that, like, a month ago.

    More vaccination data updates

    There were a couple of great features this week on problems with America’s vaccine data system(s), as well as updates to major sources. Here are the highlights:

    • STAT’s Nicholas St. Fleur wrote about the struggle to find a vaccine appointment, highlighting a viral Twitter thread from intensive care physician Dr. Arghavan Salles. Convoluted online systems are simply not working for seniors and many other vulnerable populations.
    • In another STAT piece, Mario Aguilar described vaccination data challenges in Utah as a microcosm of similar issues across the country. Even within this single state, he writes, some counties with robust IT already in place were able to adapt their tech for COVID-19 vaccination, while in others, exhausted healthcare workers must enter every data point by hand.
    • KHN’s Rachana Pradhan and Fred Schulte describe how a lack of standards for race and ethnicity data collection have led some states to leave this field optional, while others aren’t tracking it at all. Similar problems persist for occupation data, which should be crucial when we’re supposedly prioritizing essential workers for earlier vaccination!
    • Cat Ferguson at MIT Technology Review gives the full picture of Vaccine Administration Management System, or VAMS, a brand-new vaccine data system that the CDC commissioned for COVID-19 vaccination—and that is completely failing to do its job. Most states in the country have chosen not to use this free system, as it is difficult to use, arbitrarily cancels appointments, and confuses patients.
    • A team from POLITICO laid out Biden’s journey to locate 20 million vaccine doses. The White House briefings were “short on details,” these authors claim, because behind the scenes, the Biden team was still struggling to get their hands on basic information that should’ve been communicated during the transition. Once doses are delivered to states, the state public health systems are fully responsible for tracking these doses until they are officially recorded as “administered”; this makes it difficult for the federal government to track the overall vaccine rollout.
    • KFF has a new dashboard for its COVID-19 Vaccine Monitor, which is tracking public opinions of and responses to vaccines. The organization is also running a dashboard of state COVID-19 vaccine priorities, which makes it easy to compare strategies across states.
    • Vaccine Finder, a tool developed at Boston Children’s Hospital which makes it easy for Americans to find vaccine providers in their communities, is partnering with Google Maps to “bring wider awareness and access to COVID-19 vaccines,” according to John Brownstein, Chief Innovation Officer at the hospital.

    Related posts

    • Sources and updates, November 12
      Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
    • How is the CDC tracking the latest round of COVID-19 vaccines?
      Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
    • Sources and updates, October 8
      Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
    • COVID source shout-out: Novavax’s booster is now available
      This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.

  • Featured sources, Jan. 24

    We have two featured sources this week, both related to vaccination data:

    • US COVID-19 Vaccination Tracking: This is a new vaccination dashboard focused on demographics, developed by researchers at Georgetown University’s Bansal Lab. The dashboard compiles data on vaccination by race, ethnicity, sex, and gender from state reporting. Users can also hover over counties to see what share of the county’s population has been vaccinated, based on county or state data. Here’s a Twitter thread from lead researcher Shweta Bansal on the dashboard’s methodology and findings so far.
    • COVIDcast vaccination survey results: I’ve featured COVIDcast, a project by the Delphi Group at Carnegie Mellon University, before. The project’s dashboard interactive maps for a variety of COVID-19 indicators ranging from movement trends to antigen tests. But I’m featuring the source again this week because recently, the Delphi Group collected survey data on vaccine acceptance. You can download the data and compare vaccine hesitancy across counties; read more about the release in MIT Technology Review.
    All featured sources

  • Vaccination is a logistics problem

    Earlier this week, I got a frantic email from my grandma. She wanted my help in finding a vaccination appointment. She’d talked to her primary care provider and looked at her state public health agency’s website, but wasn’t sure how to actually secure her own spot in line. She lives in California, which is still officially in Phase 1A (vaccinating healthcare workers and long-term care facility residents), but is allowing some providers to start vaccinating seniors and essential workers based on “available supply.”

    My uncle did help my grandma get an appointment—one month from now and an hour’s drive away. Despite living in Berkeley, near several research universities, she’ll be heading to Palo Alto for her shots. I told her to keep a close eye on her county public health department’s website in case something becomes available there (which would be my advice to anyone else in this position), but I couldn’t guarantee that she’d be able to find an appointment any closer than the one she has now.

    And she’s not alone: a lot of grandmas are having trouble getting vaccination appointments. In fact, recent survey data from the Kaiser Family Foundation suggests that the majority of American seniors “do not have enough information about when and where they will be able to get the vaccine.” Black, Hispanic, and low income adults also report not having enough information about vaccinations, according to KFF. The minority communities that continue to be heavily impacted by the pandemic are supposed to be first in line for vaccines, but barriers to information and technology—particularly to vaccine registration portals—are leaving them behind once again.

    It would be easy to say the problem here is a lack of vaccine doses. But that’s not exactly it. The federal government is distributing millions of doses each week, and many of those doses are making it into arms: according to Bloomberg’s vaccine tracker, an average of 1.1 million shots were reported each day this past week. By sheer numbers, we are already on track to meet President Biden’s 100 million vaccinations in 100 days goal.

    Our current problem is, in fact, a logistics one. It’s a build up of infrastructure failures, with all the weight falling on those underfunded local public health departments I mentioned in the previous section. Right now, these public health workers are trying to set up vaccination appointments, while also dealing with constantly-changing information from their state on how many doses they will get, while also stretching out a depleted budget, while also probably short on personnel because half of their staff quit or got COVID-19 in 2020, while also dealing with backlash from their communities, while also fielding endless calls from confused grandmas… and all of this while still testing, contact tracing, and communicating basic pandemic safety measures. Whew. I got tired just writing that sentence.

    Some dimensions of this problem, such as the funding and lack of community trust, are years in the making. But there’s one piece the federal government may be able to solve soon, and it’s a data issue. The federal government is not giving states—and by extension, local public health agencies—enough lead time to coordinate their vaccine distribution. ProPublica reporters Caroline Chen, Isaac Arnsdorf and Ryan Gabrielson explained the situation in a detailed feature this week: unpredictable shipments at the national level mean that vaccine providers are unable to use up all of their shots in some weeks and cancelling appointments in others. The whole piece is worth reading, but I want to highlight the one quotation near the end:

    Starting Wednesday, it will be up to the Biden administration to provide clear visibility for states, according to a member of the president-elect’s COVID-19 team, who asked not to be identified because he wasn’t authorized to speak on behalf of the new administration.

    “The government can point at the manufacturer, but it’s like asking the [Defense Department], ‘How many planes do you have?’ and them saying, ‘I don’t know, ask Boeing,’” the person said.

    Reporters at POLITICO similarly found that public health workers simply don’t trust the dose allocation system. While the Biden administration may want to ramp up vaccine production in order to vaccinate more Americans, this goal may be more easily achieved by ensuring vaccines are properly tracked. At every part of the vaccination pipeline, stakeholders should know how many doses they’re getting and when. Shipments should be predictable, and appointments should be easily managed, freeing up public health workers’ time to take on the important task of actually vaccinating people.

    And there are still holes in our data on who’s getting vaccinated, too. Only 23 states are reporting vaccinations by race and ethnicity; this is an improvement from last week, but still a far cry from comprehensive data collection. Another ProPublica investigation, meanwhile, found that many states aren’t requiring providers to report vaccine doses that go wasted, making it difficult to see a comprehensive picture of the shots that get spoiled or thrown in the trash.

    It also bears mentioning that Pfizer will now be shipping out fewer vaccine vials to account for the “surprise 6th dose” that providers are often able to get out of each vial—since Pfizer charges by the dose. It is unclear whether this reduction in dose availability will affect the rollout.

    One piece of good news, on the vaccination data front: the CDC vaccination tracker stepped up its reporting to include weekend updates, as of yesterday. But the agency still isn’t reporting demographic data, comprehensive data on long-term care facilities, or even a time series of doses administered per day. Vaccination tracking has a long way to go.

    Related posts

    • Sources and updates, November 12
      Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
    • How is the CDC tracking the latest round of COVID-19 vaccines?
      Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
    • Sources and updates, October 8
      Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
    • COVID source shout-out: Novavax’s booster is now available
      This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
  • Only 19 states report vaccinations by race/ethnicity

    Only 19 states report vaccinations by race/ethnicity

    Every week, I come into your inbox and I say, the vaccine rollout is going badly.  And you’re probably like, yeah, Betsy, I know, it’s on the news every single day.

    You probably don’t need me to tell you about the announcement this past Tuesday, from Health and Human Services Secretary Alex Azar, telling states to stop saving their second doses and start prioritizing all adults over the age of 65… or the Washington Post scoop this past Friday, revealing that states couldn’t actually vaccinate more people because the federal vaccine reserve was already used up. (I salute all the policy reporters following this madness. Seriously.)

    So instead, today, I’m focusing on a vaccination issue that hasn’t gotten as much press: who is actually getting vaccinated? On the national level, we largely can’t answer this question, thanks to a lack of demographic data.

    While the CDC’s vaccination tracker has seen some upgrades recently (such as the inclusion of people receiving two doses and downloadable data), it does not report any information on the race, ethnicity, age, gender, or occupation of those Americans who have gotten shots. And the data aren’t much better at the state level, according to recent analysis from the COVID Tracking Project. 

    The COVID Tracking Project analysis discusses 17 states which report race and/or ethnicity data for vaccine recipients. Since the post was published, two more states—Missouri and West Virginia—have started reporting such data. Still, just reporting these data isn’t sufficient. Alice Goldfarb, Kara Schechtman, Charlotte Minsky, and other Project volunteers who compiled detailed annotations on the vaccine metrics reported by each state found that, even when states do report demographic data, each state uses vastly different categories, making it difficult to compare or combine this state-level information into a useful national dataset.

    See the CDD’s updated annotations on both state and national vaccine data sources here.

    Using the limited data that are available, though, we can still see that the vaccination effort thus far is incredibly inequitable—despite government promises to prioritize vulnerable populations.

    White Americans are getting vaccinated at much higher rates than Black Americans, according to a Kaiser Health News analysis of state data published yesterday. Reporters Hannah Recht and Lauren Weber discuss access issues and mistrust of the healthcare system—tied to systematic racism against Black Americans seeking healthcare—as reasons why Black Americans may be left behind.

    But the disparities so far, at a stage of the vaccine rollout that has largely prioritized healthcare workers, means that both national and local public health agencies have a lot of work to do:

    “My concern now is if we don’t vaccinate the population that’s highest-risk, we’re going to see even more disproportional deaths in Black and brown communities,” said Dr. Fola May, a UCLA physician and health equity researcher. “It breaks my heart.”

    In New York—a state which finally released a vaccine dashboard today, but is not yet reporting demographic data—vaccination trends by hospital suggest a similar pattern. The hospitals with the highest shares of vaccinated workers are, by and large, private hospitals located in Manhattan. The hospitals with fewer vaccinated workers, on the other hand, include those located in Harlem, Brooklyn, and other working-class neighborhoods.

    Data are also lacking for long-term care facilities. The CDC reports total vaccine doses administered in these facilities (which include nursing homes, assisted living facilities, and other care homes). But a national total is unhelpful in analyzing where states have been most successful at getting vaccines to this high-priority population. A COVID Tracking Project analysis, published on Thursday, found vaccine data for LTCs in only seven states. South Carolina is the only state releasing detailed data on individual facilities.

    Meanwhile, CVS has published a state-by-state dataset of LTC vaccinations administered by this pharmacy chain. The COVID Tracking Project reports that Walgreens may release a similar dataset. It seems pretty wild that independent pharmacy chains are reporting more detailed vaccine data than the federal government itself—until you remember, well, how data reporting has gone this entire pandemic.

    Vaccination data, right now, are about as messy as testing data were back in spring 2020. Every state is doing its own thing, and the federal government has yet to provide sufficiently detailed information for meaningful analysis. Readers: I urge you to push for better vaccine demographic data, both in your own region and nationally.

    A few more vaccine data updates:

    • Sources and updates, November 12
      Sources and updates for the week of November 12 include new vaccination data, a rapid test receiving FDA approval, treatment guidelines, and more.
    • How is the CDC tracking the latest round of COVID-19 vaccines?
      Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
    • Sources and updates, October 8
      Sources and updates for the week of October 8 include new papers about booster shot uptake, at-home tests, and Long COVID symptoms.
    • COVID source shout-out: Novavax’s booster is now available
      This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
  • Vaccine confusion abounds—and this is the easy stage

    Vaccine confusion abounds—and this is the easy stage

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    It’s been one month since the Pfizer/BioNTech vaccine was authorized for use in the U.S. Since then, about 22 million Pfizer and Moderna doses have been distributed—and at least 6.7 million of those have actually made it into people’s arms, according to the CDC. (The CDC is not yet tracking second doses.)

    Despite the federal government’s intense push to get vaccines through safety trials, that “last mile” step—from the Pfizer and Moderna factories to people’s arms—has been under-planned and underfunded. In the past month, we’ve been shocked by news stories ranging from a Wisconsin medical employee “intentionally removing” doses from a refrigerator to a local journalist in Florida individually helping over 150 seniors register for vaccination appointments. 

    State public health departments, already overwhelmed from ten months of running every other aspect of pandemic response, needed more money and resources to simultaneously coordinate millions of vaccinations and communicate their importance. The needed money didn’t come until this month, and recommendations from the federal government have left a lot of room for interpretation—leaving state and local health agencies scrambling.

    And this first month was supposed to be the easy part! As The Atlantic’s Sarah Zhang explains, early U.S. vaccination efforts were aimed at easy-to-reach people: those in hospitals, nursing homes, and other long-term care facilities. In these locations, it’s easy to quickly identify the most vulnerable patients and get them registered for vaccination appointments. The next groups of eligible Americans will not be so easy to reach. Doctors’ offices, pharmacies, and many other businesses will need to figure out vaccine logistics while also ramping up campaigns to convince people to even get vaccinated in the first place.

    (For a plain-language explanation of this issue that you can send to confused friends and relatives, I highly recommend the latest episode of the Sawbones podcast with Dr. Sydnee McElroy and Justin McElroy.)

    When I updated my vaccine data annotations yesterday, I added notes on how the vaccine rollout is progressing in each state. For the 38 states (and D.C.) now reporting vaccinations, you’ll find two new fields: the state’s vaccination phase (1A, 1B, etc.; 31 states are reporting this) and any prominently featured information on how residents can get vaccinated, such as a registration portal or contact information for local public health departments (at least 12 states are doing this).

    Please note that, while most states do not yet have state-wide vaccine registration portals, many local public health departments are setting up such portals at the regional and county level. I highly recommend searching for your local public health agency to see what they have available. Also, New Mexico, which has a registration portal but no vaccine data dashboard, is not included in the annotations.

    State data availability (as of Jan. 9)

    • 39 jurisdictions are reporting some form of COVID-19 vaccination data on a dedicated page or dashboard
    • 16 states are reporting race and ethnicity of vaccinated residents
    • 20 states are reporting age of vaccinated residents
    • 17 states are reporting gender or sex of vaccinated residents
    • 20 states are reporting vaccinations by county or a similar local jurisdiction
    • 31 states are reporting their vaccination phase (1A, 1B, etc.)
    • 12 states are prominently featuring information on how residents can get vaccinated, such as a registration portal or contact information for local public health departments

    More vaccine data news

    • Jurisdictions with new vaccine dashboards or pages include: Arkansas, Arizona, California, Washington D.C., Kansas, Nebraska, and South Carolina.
    • The CDC’s vaccination data are now available for download, via a table beneath the interactive dashboard. The agency updated its state-by-state data every weekday this past week—an improvement from the past two holiday weeks. A time series isn’t yet available, though.
    • Bloomberg’s vaccine tracker now has time series for both individual states and several countries which have begun administering vaccines. The states currently leading the pack for vaccinations per capita in the U.S. are West Virginia, the Dakotas, and Maine.
    • KFF has updated its COVID-19 Vaccination Monitor with polling data on vaccine hesitancy in rural America. Compared to urban and suburban residents, the foundation found, rural residents are significantly more hesitant. 31% of the rural residents sampled said they would “definitely get” a vaccine, compared to over 40% in other categories. Rural residents are also more likely to say they’re “not worried” that they or someone in their family will get sick with COVID-19.
    • NPR’s Selena Simmons-Duffin and Pien Huang surveyed experts to determine several major ways the U.S. could “jump start its sluggish vaccine rollout.” These include: more money for state and local health departments, more vaccine types (hopefully some easier-to-transport brands), massive administration sites, more regular supplies from the federal government, and public awareness campaigns.
    • The Trump administration is speeding up at least one thing: a plan to help pharmacies administer COVID-19 vaccines. According to POLITICO’s Rachel Roubein, almost 40,000 pharmacies are involved in the federal program, including those part of the Costco, Rite Aid, and Walmart chains. Pharmacies which are already used to administering flu vaccines each year—and already have huge patient databases—are strong candidates for the next phase of vaccine rollout.  
    • After some classic infighting from Governor Andrew Cuomo and Mayor Bill de Blasio, New York state is moving to Phase 1B—meaning seniors and essential workers will start to see vaccinations. However, as City Councilmember Mark Levine pointed out on Twitter, the city has: “One website for H+H sites, another for DOHMH sites, another for Costco. For community clinics, 7 have their own different websites, 4 require calling, and 1 is by email.” (I want to get vaccinated at Costco, personally, if the opportunity arises.)
    • A Twitter thread from KFF Senior Vice President Jen Kates points out more of the methods states and counties are using to get residents signed up for vaccination appointments. They range from the expected online portals to SurveyMonkey and Eventbrite.

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  • Vaccination data update, Jan. 3

    Despite the holidays, several more states began reporting vaccination data in the past week. The Centers for Disease Control and Prevention (CDC) also made a huge update: this national dashboard is now posting vaccination counts at the state level.

    Here are the notable updates:

    • I launched a vaccination data page on the CDD site which includes annotations on ten major national sources and every state’s vaccination reporting. I’ll be updating it weekly—the most recent update was yesterday.
    • Five states have started regularly reporting vaccination data since December 27: Alabama, Alaska, Indiana, Mississippi, and Wisconsin. 32 total states are now reporting these data; 15 states are reporting race and ethnicity of vaccinated residents. See more details on the resource page.
    • On December 30, the CDC started reporting state-level vaccination data on its national COVID-19 dashboard. For every state, the CDC is reporting total vaccine doses distributed and total people who have received their first dose. The dashboard also includes national counts—both for the U.S. as a whole and for long-term care facilities. Data are not yet available for download. According to the most recent update (yesterday, January 2), 4.2 million Americans have received their first dose.
    • Drew Armstrong, the Bloomberg reporter who runs the publication’s vaccination dashboard, posted a vaccine data user guide on Twitter. While the Tweet thread primarily describes the methodology and design choices behind Bloomberg’s dashboard, it also provides useful context for vaccination data overall. Two notable details: all vaccination data lag (the CDC’s data lag by about 50 hours, according to Armstrong), and Bloomberg is working on making the underlying data behind their dashboard public.
    • Benjy Renton halted updates for the “Doses Administered” tracker on his Vaccine Allocation Dashboard. As the CDC is now providing standardized state counts—and Renton is a one-person tracking operation—he’s switching to focus on analyzing vaccination trends and accessibility.  
    • Distribution delays: Operation Warp Speed promised that, if the Pfizer and Moderna vaccines received Emergency Use Authorization from the FDA, 20 million Americans would get vaccine doses by the end of 2020. That clearly didn’t happen. What went wrong? To answer that question, I recommend two articles: this STAT News story and this CNN story. Both articles suggest that a lag in data reporting may be one reason why the current vaccination counts look so low. Still, there’s a big difference between 4.2 million and 20 million.
    • Vaccination and the new COVID-19 strain: As the B.1.1.7 coronavirus variant, identified in the U.K., becomes an increasingly ominous threat to America’s COVID-19 containment, vaccination becomes increasingly urgent. Zeynep Tufekci’s latest piece in The Atlantic explains the issue. One piece that stuck out to me: the U.S. doesn’t have good genomic surveillance—or, a system to systematically sequence the virus genomes for people infected with SARS-CoV-2—which makes us less equipped to see where the new strain is actually spreading. As Tufekci puts it: “we are flying without a map.”
    • One dose or two? Scientists and public health leaders have been debating changing our vaccination protocol. Should the U.S. stick to the script, so to speak, and reserve enough vaccine doses that everyone who receives one dose can receive a second in the prescribed time window? Or should we give as many people first doses as we can, accepting that some may not get a second dose for months—or at all? (The U.K. opted for the latter earlier this week.) University of Washington professor Carl Bergstrom has compiled some Twitter threads that explain the debate. Dr. Fauci said on Friday that the U.S. will stick to the official two-dose regimen, but the scientific discourse will likely continue.

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    • How is the CDC tracking the latest round of COVID-19 vaccines?
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    • Sources and updates, October 8
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  • CDC now reporting a vaccination count (and other updates)

    CDC now reporting a vaccination count (and other updates)

    Screenshot of Bloomberg’s COVID-19 Vaccine Tracker, taken on December 26.

    Despite the holiday, many jurisdictions have begun reporting COVID-19 vaccination data since my last issue. Here are the major updates:

    • CDC added vaccinations to its dashboard: Mere hours after I published last week’s newsletter questioning when the federal government would release a national count of how many Americans had been vaccinated, the CDC began posting just that. The CDC COVID Data Tracker now includes both a count of how many vaccine doses have been distributed and a count of how many people have received their first dose—1.9 million as of Saturday, December 26. The count includes both Pfizer and Moderna’s vaccines, and incorporates reporting from states, local public health agencies, and federal entities including the Bureau of Prisons, Veterans Administration, and Indian Health Services. More detailed geographic and demographic data are not yet available from the CDC.
    • 27 states are now reporting COVID-19 vaccination data: While the COVID Tracking Project is not tracking vaccinations, the Project is keeping a running list of states that are reporting vaccine-related metrics. As of December 25, 27 states are reporting vaccine doses administered or another similar metric. Of the states reporting vaccinations, nine are reporting race and ethnicity of the residents vaccinated—that’s a huge jump from last Sunday, when only Florida was reporting this information. In other demographic metrics: 14 states are reporting age of those vaccinated, 10 are reporting sex or gender, and 14 are reporting county.
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    • How the COVID Tracking Project hopes vaccines will be tracked: In addition to its state dashboard annotations, the Project released a blog post last week detailing key information that Project leads believe should be prioritized by state and federal public health departments, as well as what states are reporting so far. Key metrics include: the number of people fully vaccinated (not just the number of doses administered), demographic data reported in absolute numbers (not percentages), county-level data, and data on vaccinations in long-term care facilities.
    • New Mexico will notify residents when they qualify for vaccination: This past Wednesday, the New Mexico Department of Health launched a website where state residents can sign up to learn when they will be eligible to receive a COVID-19 vaccine. The sign-up form is currently somewhat confusing to use, as a new user must click “Schedule a New Appointment” to put in their contact details—even if they aren’t eligible for vaccination yet. Still, this effort to provide transparency about vaccination progress on such an individual level is unique among states thus far.
    • Our World in Data is tracking COVID-19 vaccinations worldwide: As of December 26, the open-source data repository Our World in Data is compiling vaccination counts from 10 countries: the U.S., the U.K., China, Russia, Israel, Canada, Bahrain, Chile, Mexico, and Costa Rica. So far, the U.S. has administered the most doses at 1.9 million, while Bahrain has administered the most doses when adjusted for population, at 3 doses for every 100 people.
    • Initial COVID-19 vaccine data in North Carolina reveals racial disparities: Samantha Kummerer, reporter for ABC11 in Raleigh-Durham, North Carolina, used the state’s early demographic data to draw attention to healthcare disparity. “When compared to the overall population of North Carolina, both Black and Latino communities are severely underrepresented in COVID-19 vaccination data,” Kummerer writes. She goes on to explain that these data reflect the hospital workforce in North Carolina, which was the first group to be vaccinated—and which is overwhelmingly white. This story reflects why it is so important for states to be transparent about their vaccination demographics, even at such an early stage of vaccine deployment.
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  • 15 states are reporting COVID-19 vaccination data—federal government lags behind

    15 states are reporting COVID-19 vaccination data—federal government lags behind

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    Back in September, I read the Interim COVID-19 Vaccination Playbook released by the Centers for Disease Control and Prevention—the first national plan for how vaccination was supposed to proceed. Here’s an excerpt from my newsletter issue covering this playbook:

    Once COVID-19 vaccination begins, the CDC will report national vaccination data on a dashboard similar to the agency’s existing flu vaccination dashboard. According to the playbook, this dashboard will include estimates of the critical populations that will be prioritized for vaccination, locations of CDC-approved vaccine providers and their available supplies, and counts of how many vaccines have been administered.

    This past week, the first COVID-19 vaccine doses were administered to frontline healthcare workers across the country. The FDA issued Emergency Use Authorization to a second vaccine. But I haven’t seen a vaccination dashboard from the CDC; the closest we’ve come so far is a dataset listing initial allocations of Pfizer doses for every state. This federal agency is lagging behind several states that are making their vaccination counts public, as well as journalists who have already begun to compile the limited information that’s available.

    Here’s how the reporting of vaccination data is supposed to work. When someone goes in to get their COVID-19 shot, the provider of that shot will enter their name and other personal information to a state registry called an Immunization Information System, or IIS. Vaccine providers that issue shots and send data may include hospitals, clinics, pharmacies, pop-up vaccination sites, and any other institution that is giving shots.

    Most states and several large cities, like New York City, have these immunization registries; New Hampshire is still getting its registry ready to track COVID-19 vaccines. The registries stay private, with data only available for the people who ship, administer, and manage vaccines. A data system called the IZ gateway will help different state immunization systems link up with each other and with the CDC, which has asked all states to formally agree to share their data with this federal agency. (The CDC has asked states to share a pretty extensive list of data points for each vaccine patient, including names and addresses, which some states are not willing to send.)

    The CDC has also developed a system to help vaccine providers manage supplies and patients, a public-facing website that will help Americans see where they can get vaccinated, and a new software that will pull all vaccine-related information into one place for Operation Warp Speed officials to use. Finally, an HHS data system called the Vaccine Adverse Event Reporting System will collect information on patient reactions to the vaccines, such as headaches and fatigue—both of which are expected reactions to the Pfizer and Moderna vaccines.

    For more detail on these data systems, see this article by USA TODAY’s Aleszu Bajak and Janet Loehrke, which I drew upon to write this part of the newsletter.

    Theoretically, the CDC should have precise counts of how many people have received vaccine doses in every state, as well as personal identifying information for all of those people. So far, however, it appears that many states are beginning to make these data public, while the federal government has yet to release national numbers.

    According to ongoing analysis by the COVID Tracking Project, 15 states are reporting some form of vaccination data as of December 19. Here’s the breakdown:

    • Five states have added a count of vaccine doses administered as a single metric on their dashboards: Alaska, Colorado, Idaho, Oklahoma, and Rhode Island.
    • Two states have added vaccination-specific pages to their dashboards: South Dakota and Utah.
    • Three states have built entirely new dashboards for vaccination: Michigan, Ohio, and Texas.
    • Florida is releasing daily vaccination reports.
    • Four states are reporting vaccine-related metrics (such as counts of approved providers and doses delivered) that don’t yet include actual counts of the doses administered: Minnesota, Pennsylvania, North Dakota, and Tennessee.
    • Five states are reporting some form of demographic data: Michigan reports vaccinations by age; Texas reports by county; Utah reports by local health jurisdiction; Ohio reports by age and county; South Dakota reports by age, gender, and county; and Florida reports by race, age, gender, and county.

    For links to all of these states’ dashboards and reports, see the COVID Tracking Project’s annotations.

    Florida is the only state to report vaccination counts broken down by race so far, though the state has not yet reported such counts for different ethnicities. Public health experts have widely agreed that people of color—especially Black Americans, Native Americans, and Hispanic/Latino Americans—should be prioritized in COVID-19 vaccination because these communities have been disproportionately impacted by the pandemic. But without knowing vaccination rates in these vulnerable communities, it will be impossible to determine whether they are receiving the medical treatment they deserve.

    A recent article by ProPublica’s Caroline Chen, Ryan Gabrielson, and Topher Sanders calls attention to the lack of standardization that currently exists for state collection of race and ethnicity data:

    In state vaccination registries, race and ethnicity fields are simply considered “nice to have,” explained Mitchel Rothholz, chief of governance and state affiliates for the American Pharmacists Association. While other fields are mandatory, such as the patient’s contact information and date of birth, leaving race and ethnicity blank “won’t keep a provider from submitting the data if they don’t have it.”

    In other words, if a Black woman gets the Moderna vaccine at a Walgreens in Brooklyn, she could feel uncomfortable disclosing her race on the pharmacy’s form—and little action would be taken to explain to her why such disclosure is important and how her information would be used. The “race” checkbox on her form would be left blank. She would likely go uncounted by researchers and journalists trying to hold the government accountable to its promises of equity.

    The federal government should be both more rigorous in requiring race and ethnicity data and more transparent in disclosing these data—but I’d take a simple, national count of how many people in America have received COVID-19 shots to start. Recent data releases from the HHS have made me pretty optimistic about the federal public health agency’s ability to be transparent (see: the next two sections of this issue.) But the lack of a federal dataset so far means that key COVID-19 information is once again scattered.

    In a Poynter webinar last week, Al Thompkins asked a panel of top infectious disease experts—including scientists on both the FDA’s and the CDC’s vaccine advisory panels—a simple question: Will the public be able to see counts of how many people are getting vaccinated? None of those experts had a clear answer. There may be a dashboard in the works behind the scenes of which the panelists hadn’t been informed, but their responses still did not inspire confidence.

    Of course, journalists are once again stepping in to cobble together vaccination counts from all the public sources they can find. Bloomberg has counted 211,000 Pfizer doses in the U.S., as of December 19, by compiling numbers from state websites, press conferences, and interviews. The New York Times has surveyed state public health departments. Benjy Renton continues to update a Tableau dashboard that compares planned Pfizer and Moderna shipments to state populations.

    And the Kaiser Family Foundation released its COVID-19 Vaccine Monitor, an ongoing project to track public perception of and experiences with vaccination. The latest survey from this monitor shows that 71% of Americans would “definitely or probably” get a vaccine for COVID-19 if it was determined to be safe and freely available.

    This week, as I’ve seen the vaccination numbers—and the photos of frontline healthcare workers getting these well-deserved shots—I’ve felt something strange. Something hopeful. For the first time since March, I’m looking at numbers that I actually want to see go up. Now, if we could just get more comprehensive numbers, and get them more standardized, and get them reported with a priority on racial justice…

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