After weeks of flagging covid vaccine rates, ongoing racial disparities among the vaccinated, and the troubling spread of the Delta variant, Mayor Bill de Blasio is taking his first steps to impose more coercive vaccine policies in New York City. The mayor announced on Monday an upcoming mandate for all city workers to be vaccinated or subject to weekly covid testing, while encouraging private sector actors to institute their own mandates.

As the city continues its precarious reopening, there are questions about the efficacy of the city’s vaccination initiatives in getting a large enough percentage of the population inoculated against COVID-19. But while some prominent local lawmakers have called for more aggressive vaccine policies, over the last half-year the City Council has rarely used its oversight powers to publicly examine the city's behemoth vaccination effort, which is key to saving lives and the city’s broader future.

A spokesperson for Speaker Corey Johnson claims the Council is working closely with the de Blasio administration behind the scenes, but the body hasn't held an oversight hearing on the vaccine rollout since February, two months after the first doses arrived in New York. Council Member Mark Levine, who chairs the Council’s health committee, has pushed a number of measures to improve the effort without convening his committee for oversight of the city's health department since February. A spokesperson for Council Member Carlina Rivera, chair of the Council’s hospitals committee, told Gotham Gazette she focused on vaccination during city budget negotiations and helped secure an additional $9 million for community-based vaccine education. It has been five months since her committee held an oversight hearing outside the budget.

"The Council has had two hearings on the city's vaccination efforts this year, and passed two pieces of legislation to increase access to vaccines," said Jennifer Fermino, a Council spokesperson, in a statement. A third hearing took place last December, just before the vaccines became available.

The Council's committees on health and hospitals held a joint oversight hearing on January 12 after a rocky rollout of the first tranches of the coveted vaccine and initial city data showing racial disparities in inoculation. The next and most recent oversight hearing, run jointly by the committees on health, aging, and technology, was on February 17. It focused on vaccinations for homebound seniors and snafus with the city's disjointed vaccine scheduling system. The Council passed two bills requiring the New York City Department of Health and Mental Hygiene to submit to the Speaker a plan for reaching seniors at home and to create a unified scheduling system. They went into effect in March and April, respectively.

"We are proud of our efforts, and believe they helped save lives. Unfortunately, we as a city are dealing with a new and more difficult problem in regards to vaccines, namely hesitancy," Fermino said. The Council is working with community groups to overcome that. Staff also communicate "near daily" with the city health department and public hospital network, Health + Hospitals, "on what's working and what isn't," she said.

Since a covid vaccine first became available to limited groups on December 14, almost 8,700 New Yorkers have died of COVID-19, according to a Gotham Gazette analysis of city data (with 4,630 of those deaths since the last City Council oversight hearing on February 17).

While the city has administered more than 4.9 million covid vaccine doses, with 59% of New Yorkers fully vaccinated, many zip codes fall below the citywide average, particularly in predominantly Black and Latino areas. The city has also had a hard time reaching 12- to 17-year-olds, the youngest eligible residents who became eligible well after adults. Last week, de Blasio announced new vaccine sites at 25 “Summer Rising” education program locations.

Advocates say more needs to be done to facilitate access to the vaccine, including more public input and analysis of the rollout's successes and failures. City Council oversight hearings often spur action from the mayoral administration, expose problems, and lead to pledges for additional steps or the public sharing of new information.

"The city has the right instincts, being mindful about reaching hard-to-reach groups," said Dr. Stella Safo, executive director of Just Equity for Health, a healthcare education and advocacy group, in an interview. "The challenge the city has had, unfortunately, and that a lot of places have had, is that there isn't really a great understanding of how to operationalize that."

"I think [public oversight] is really needed because when you have those types of hearings what you often do is you get to hear from the people who are most impacted by this. It is definitely a failure not to have it," she said.

The hearings shed light on the administration's vaccine efforts and give experts and members of the public a chance to raise concerns and suggestions that could improve conditions on the ground. They can be used to elevate innovative vaccine approaches. The hearing in January led to renewed commitments from city health officials to look after communities underserved by the healthcare system.

"We've done many oversight hearings throughout the pandemic and they are important," Levine told Gotham Gazette by phone on Friday, when asked if another oversight hearing was needed. "The speed with which the pandemic moves means that often we have to act faster and so I am frequently just picking up the phone and calling people in the relevant city agencies," he added, noting that he has used his platform on social media and elsewhere to push good policy and, at times, sound the alarm. Levine was a vocal proponent of releasing vaccination and other data by zip code, and broken down demographically, which "has been an incredibly important tool of accountability," he said.

Jeremy Tillunger, a spokesperson for Council Member Rivera said she "has been a leader in pushing the de Blasio administration for an effective COVID-19 vaccine campaign," including through the budget process. "These efforts and efforts throughout the pandemic resulted in the City expanding funding for community based organizations to do critical vaccine outreach in communities where they are trusted voices," he wrote by email. Tillunger said Rivera and hospital committee staff have had weekly calls with Health + Hospitals and the city's Test and Trace Corps throughout the pandemic, and have toured several public hospitals to see vaccine and testing operations.

At the time of the last joint oversight hearing of the City Council’s health and hospitals committees in January, lawmakers were concerned about low inoculation rates in Black and Latino communities. "Why are we doomed to repeat the same number of deaths in communities of color with no access to the vaccine that may save their lives," Council Member Adrienne Adams asked de Blasio administration officials.

Those disparities have persisted even after eligibility opened to virtually all New Yorkers and supply far exceeded demand. Only 31% of Black residents are fully vaccinated compared with 41% of Latino, 45% of white, and 70% of Asian New Yorkers, according to city data.

The city health department has made efforts to reach unvaccinated New Yorkers, deploying targeted resources and tapping local providers, with mixed results. Mobile vaccination sites, which de Blasio and city health officials touted as a way to reach residents in transit and healthcare deserts, have administered roughly 100,000 doses, or about 1% of the citywide total, as of July 14. Only about 17,000 New Yorkers have been vaccinated at home since the door-to-door program for seniors began in early March, though vaccinations of Black residents over the age of 65 continue to trail other racial groups and the city average.

The gap in formal Council oversight coincides with the height of a rigorous primary election season in which the term-limited Johnson and Levine were part of competitive races in their respective bids for city comptroller and Manhattan borough president (Johnson lost, Levine won). Seeking reelection, Rivera also had a primary challenger, who she beat by a wide margin. Johnson has been noticeably absent from public government activities this year but for a handful of major Council events, and he has issued few statements on the city’s covid-related policies.

Citywide vaccination rates began to slow in May but had always been low in Black communities, particularly in the Bronx and parts of Brooklyn and Queens. In the last four weeks, cases in New York City have increased sharply, with a seven-day average surpassing 900 by the third week of July, according to the city health department. The Delta variant became the predominant strain around the same time as the uptick and now accounts for 75% of new cases, the city's testing data shows. "That's a concern," de Blasio told reporters last week. "We've got to really push hard on vaccination in every conceivable way.”

"When you're in a supermarket, store, subway car, movie theater etc, assume someone there may have the virus (and—especially if you're unvax'd—it may be you)," Levine tweeted Sunday.

Recent attention from the mayor and the Council has focused on overcoming vaccine hesitancy, especially as so many doses have been administered safely. "You're going to see a lot of people who have been a little bit slow, a little bit hesitant, now feeling more urgency," de Blasio said at a recent press briefing, noting the then-roughly 4.8 million New Yorkers already vaccinated. “We have reached the limits of a purely voluntary system. It's time for more mandates," he said at a press briefing on July 23.

On Wednesday de Blasio announced the city will give $100 to each New Yorker who gets vaccinated at a city-run site, starting Friday July 30.

"Vaccine hesitancy stems from a lot of different reasons, and addressing it is complex and labor intensive," wrote Fermino, in response to an inquiry about the gap between oversight hearings. "There are no easy solutions, but the Council is focused on overcoming these obstacles to reach New Yorkers in all communities."

But the inequities in vaccination are not only the result of hesitancy or lack of information -- they are also a symptom of poor representation in public health discourse, according to Safo. "We wouldn't have this challenge if we already had structures in places where the people who are most impacted by these policies are already tapped to be able to speak about it," she said, naming government oversight hearings as one such structure.

The city has given over $50 million to faith groups and other community-based organizations for education and outreach, according to Health Commissioner Dr. Dave Chokshi. Health department canvassers have knocked on over 280,000 doors, Chokshi tweeted in mid-July.

Levine said he wants to see more vaccinations in doctors’ offices, sites in every public school, and a more robust community-based outreach network. "We still haven't done something comparable to what was done in the Census, where we hired 150 community groups," he told Gotham Gazette. It’s a sentiment that has been shared and echoed for months by a number of officials and advocates, including the city’s 2020 Census director, Julie Menin, who just won a City Council primary on the Upper East Side, and groups like the New York Immigration Coalition.

"The disparity is very plain. It has to be addressed forcefully," de Blasio said at a January 31 press briefing, when the city began regularly releasing demographic data on covid vaccinations. "Clearly part of the solution is a lot more outreach and communication in multiple languages."

In June, Governor Andrew Cuomo began closing state-run mass vaccination sites, in New York City and elsewhere, to redirect resources to zip codes with low vaccine uptake, including many of the same communities city and state health officials warned would be hard to reach without concerted public health efforts.

The city's latest plan to require proof of vaccine or a weekly test for all city employees is in part a response to trailing rates among health workers and other professionals. "There's a lot more to do," Mayor de Blasio told WNYC radio’s Brian Lehrer on Friday, before he expanded the requirement to all city workers. "Our goal is to be very aggressive."

When he announced the policy last week for health department and public hospital employees, Rivera and Levine each called for more. Rivera, who joined the mayor at the briefing where he made the announcement, used her speaking time to call for more vigorous mandates, saying, "far more New Yorkers should be able to follow the same rules."

"Requiring that hospital workers get vaccinated or regularly tested is the bare minimum if we want to get through this," she tweeted later that day.

"Increasingly we need to focus on requiring vaccination in sensitive workplaces and in discretionary entertainment venues," said Levine, who criticized de Blasio's initial decision not to require proof of vaccination at the city's upcoming summer concert series, which the mayor announced last week to celebrate reopening.

"I think that is a huge mistake. This is an opportunity to push people to get vaccinated, let's use the city's own concerts to do that," Levine told Gotham Gazette last week, lamenting the squandered chance. On Tuesday, de Blasio announced that proof of at least one covid vaccine dose would be required for entry to the marquee concert in Central Park on August 21.

Reposted from Gotham Gazette, written by Ethan Geringer-Sameth, reporter.