New York State

How New York can distribute the vaccine more equitably

Vaccine distribution has been woefully unequal. Here’s how New York might start to fix it.

Dr. Jacqueline Delmont, Chief Medical Officer at Somos delivers the COVID-19 vaccine at St. Luke's church in the Bronx.

Dr. Jacqueline Delmont, Chief Medical Officer at Somos delivers the COVID-19 vaccine at St. Luke's church in the Bronx. Office of Governor Andrew M. Cuomo

Data breaking down how the coronavirus vaccine is being distributed across New York state is hard to come by, but from what is known – thanks to information provided by New York City and seen through anecdotal reporting – one thing is clear: some of the same inequities that have made low-income communities of color bear the brunt of this pandemic are making it more difficult for them to access the vaccine.

Last weekend, New York City released demographic data on its vaccinations, showing that among adults who received at least one dose and noted their race or ethnicity, 48% were white, while only 15% where Latino and 11% were Black, even though the city is 29% Latino and 24% Black. The takeaway? Black and brown New Yorkers are getting shorted again. 

Public health experts said that to achieve a more equitable rollout of the vaccine, New York state and local governments need to do a better job of bringing the vaccine to the people in those hard-hit neighborhoods, instead of expecting people to overcome the barriers to getting their jab. That requires making it easier for people to sign up for appointments, prioritizing residents of the hardest hit neighborhoods for appointments in those neighborhoods and bringing the vaccine directly to people. New York is already starting to take some of those steps. 

The release of that data followed reporting by The City showing that at a vaccination site in Washington Heights – a largely Hispanic neighborhood – most people in line appeared to be white suburbanites, and Spanish-speaking guides were hard to find at the site.

New York state has so far released only minimal demographic vaccine data – only releasing a racial breakdown for hospital workers vaccinated in the 1A eligibility group – despite calls to disclose data for the much wider group of New Yorkers who have now been vaccinated. Gov. Andrew Cuomo’s office has said that that data is being collected, and a larger dataset will be made available once state officials are comfortable with its accuracy. Meanwhile, a bill from Rep. Grace Meng calls for a national breakdown of demographic vaccination data.

Despite the dearth of information on just how inequitable the rollout of the vaccine has been, the early signs are not promising, reflecting stark disparities between white communities and Black and Latino communities. The latter represent the communities hardest hit by the pandemic. Across the country, Black and Hispanic Americans are dying from COVID-19 at roughly 2.8 times the rate of white people. 

New York is not alone here; many of the states and cities that have started to release demographic breakdowns show similar patterns, with people from white and wealthier communities having an easier time accessing the vaccine and taking up a greater share of appointments.

In New York, the inequitable distribution observed so far likely has a few explanations, public health experts said, but it’s hardly surprising. “New York took the equality approach – everyone has equal access to everything,” Melody Goodman, associate dean for research at the New York University School of Global Public Health, said of New York’s vaccine rollout. “But often, that means that some people are going to be more likely to take it up... Just putting it out there is not the same as getting it to where it needs to be.”

While part of the challenge New York confronts is in convincing disadvantaged communities that the vaccine is safe – especially because of a historical distrust of health care providers stemming from systemic bias against people of color in the healthcare system – hesitancy about getting the vaccine is just a part of the challenge. Public health experts said that not enough has been done to make it easy for people of color and low-income residents to learn about the vaccine, easily sign up for an appointment and eventually get vaccinated. 

Part of that has to do with New York not relying enough on its health departments in its rollout of the vaccine, Goodman said. As The New York Times reported earlier this week, the state health department has seen an exodus under Cuomo, as some health officials reportedly felt underutilized despite their expertise in public health. 

Rather than rely on the vaccination plans that the state health department had collaborated on with local health departments, Cuomo has relied mostly on hospitals for the rollout. “We often marginalize public health. Even in this public health crisis we've been marginalizing the experts. We've not been giving our public health departments the infrastructure to do the work that they've been doing this entire time,” Goodman said. “Instead we’ve been giving it to more commercial entities.” Reaching underserved communities and communicating essential information about the vaccine are functions local health departments are well-equipped, and in fact designed, to handle, she said. 

Facing the same problems as New York, some other states and localities have started to refocus their vaccination efforts on reaching disadvantaged communities. One North Carolina county is prioritizing vaccinating older people who live in ZIP codes with the highest rates of COVID-19. When releasing new appointments for vaccinations, Washington D.C. has started restricting the first day of reservations to residents of ZIP codes with the highest infection and fatality rates. Other cities are starting pop-up vaccination clinics in Black churches and community centers, and Baltimore is going door-to-door in housing complexes for seniors, The New York Times reports.

Similar efforts have started in New York. At vaccine sites located in 33 hard-hit neighborhoods, New York City will prioritize appointments for residents of those neighborhoods, Mayor Bill de Blasio announced on Sunday. New York state has also launched pop-up vaccination sites in public housing developments and churches, delivering vaccination kits to those sites and working with local partners such as the health network SOMOS to administer the vaccine. “In just over two weeks, we’ve deployed pop-up vaccination clinics to 27 public housing developments and churches statewide, which have administered shots to nearly 10,000 New Yorkers in communities of color,” Cuomo spokesperson Jack Sterne wrote in an email. Dozens more pop-ups are planned in the coming weeks, Sterne said, with the goal of setting up 300 sites in communities of color.

Actions like these are moving in the right direction, public health experts said, but there’s more that New York state and local governments can do. Here are a few of the steps New York could take to bring the vaccine to underserved communities and ensure that all New Yorkers – especially those hardest hit by the virus – are getting vaccinated:

Stop relying on an online system for signing up to get the vaccine

As COVID-19 vaccine eligibility expanded last month, sign-ups for vaccination appointments were largely relegated to online booking and information websites developed by the state and New York City, which have experienced glitches and have been frustrating and time-consuming to use. Just as importantly, they’re ill-suited to reach the very people that New York’s leaders have said it’s important to reach.“Think about the fact that part of who we said we wanted to vaccinate first was older adults, and then we rolled out an online system,” Goodman said. That’s not to say older adults can’t use the internet, she noted, but it’s insufficient as a primary tool for signing up to get vaccinated – especially when trying to sign up older adults with less education, wealth, free time or English language skills. The state and city each have phone lines too, but people have gotten stuck on hold on those or experienced calls dropping. These options not only disadvantage those without internet access, but those who don’t work from home or otherwise have a white-collar job that allows them to constantly check a website or call back in hopes of finding an available slot.

Instead, New York should be meeting people where they are to spread information about the vaccine and get them signed up for an appointment. Wafaa El-Sadr, a professor of epidemiology at Columbia University, suggested having workers devoted to helping older New Yorkers or those without internet access find and sign up for vaccine appointments. That includes making information about signing up available in all languages that New Yorkers speak, she said. 

Community centers, churches and schools could be used as sign-up hubs, too. The state has also said it’s working with nonprofits and community groups to register people at community vaccine hubs. A New York Times editorial also suggested sending public health workers door-to-door to help people book appointments. “The faith-based strategies make sense, as long as they’re safe. The door-to-door strategies make sense,” said Derek Griffith, a professor in the department of Medicine, Health & Society at Vanderbilt University. “Talking to folks from those communities and asking them, ‘What kind of things would reach people that are having difficulty accessing this kind of information?’”

Reserve spots for local residents at community vaccination sites

Cuomo has committed to creating more pop-up vaccination sites at public housing developments, churches and other community centers, and that is a first step in directly reaching unserved residents, experts said. But to take it a step further, vaccine sites in some of the hardest-hit neighborhoods should prioritize appointments for residents of that neighborhood – as New York City announced it would start doing. Guillermo Chacón, president of the Latino Commission on AIDS, founder of the Hispanic Health Network and a member of New York state’s Vaccine Equity Task Force, said that after The City reported on suburban New Yorkers flocking to a vaccine site in Washington Heights, he and other members of the vaccine task force put pressure on the city to start restricting who is able to get those appointments. Now, those kinds of restrictions have to be put in place statewide, he said. “If the intention is to bring a vaccination center to a Black or Latino neighborhood, we cannot allow people from outside those neighborhoods to just show up … and then get appointments,” Chacón said. 

Cuomo has said he’s open to this approach. “I do not have a problem with restricting the site when you are targeting a problematic community, by positivity (rate) or lack of coverage,” he said last week.

Of course, this would be an easier challenge to confront if New York weren’t faced with a scarcity of vaccines and a ticking clock on the doses themselves before they expire. “I would just say go door-to-door in communities and vaccinate people. But we don't have enough vaccines to even do that,” Goodman said. 

Still, there doesn’t necessarily have to be a choice made between making sure the vaccine gets to as many people as possible as quickly as possible, and making sure the most vulnerable New Yorkers have easy access to it. “You can achieve rapid enrollment, but you have to be attentive to who is rapidly enrolled,” El-Sadr said. “And by going to the community, by going out there and facilitating and situating vaccination sites, and facilitating people coming to these vaccine sites, we can achieve both.”

Collect and produce complete demographic data on vaccinations

Perhaps the easiest first step New York could take in achieving equitable vaccine distribution is ensuring the complete collection and timely publication of data about vaccinations broken down by categories including race, ethnicity and geography. “It is urgent to receive data on race and ethnicity at the state level,” Chacón said, noting that the state has yet to release that data. “That’s the other side of the coin to help us to be more responsible and focused about where to put energy.”

Goodman said it shouldn’t be hard to collect and report this data. While the minimal data we have now gives us an idea of how inequitable vaccinations have been so far, there’s still a lot we don’t know. “The fact that so much of the data is missing means that we have an idea of what the picture is, but we really don't know,” she said. “It could be better than what we think it is, but it actually could be a lot worse.”

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.