COVID-19 Vaccine Inequality

The first wave of the COVID-19 pandemic devastated Black, Latino, and immigrant communities across New York City at disproportionate levels last spring and since. Some lawmakers are now asking why the same populations were not included in vaccine priority plans crafted by the state and city.

At a January 12 City Council oversight hearing on the de Blasio administration's roll-out of the first batches of the covid vaccine, members of the Council’s committees on hospitals and health asked the city's top health department officials why the city wasn't doing more to inoculate underserved and hardest hit Black, Latino and Asian communities.

"We know that communities of color experienced the highest death rate during the onset of COVID-19," said Council Member Adrienne Adams, a Queens Democrat, in her questioning of administration officials. "Why are they not prioritized? 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?"

Adams' district includes Richmond Hill, which contains zip codes with the highest covid positivity rates in the city. In that section of Queens, a predominantly Latino and South Asian neighborhood, the seven-day average positivity rate was 16.3% as of Wednesday, nearly double the citywide rate of 8.4%. Adams was talking about the availability of the vaccine to her constituents -- a question of state-designated eligibility as much as it is city-designed access -- and the dearth of data collected on inoculating members of communities of color, a fatal repetition of the carnage wrought in the spring and throughout the pandemic.

The groups most deeply impacted by the outbreak -- in terms of loss of life, infection, and the loss of livelihood due to the accompanying economic crisis -- live in the city's predominantly Black, Latino, and immigrant neighborhoods. Neighborhoods like Elmhurst, in Queens, and Mott Haven, in the Bronx, saw their hospitals reach capacity and on the verge of collapse last spring. Even before the first wave broke over New York City, epidemiologists worldwide were discussing the heightened risk to seniors and people with comorbidities, the latter group also disproportionately represented in the city's historically neglected neighborhoods.

Rather than slicing the population by the categories most likely to contract, spread, or die from the disease, the New York State Department of Health has followed a different arithmetic, one that factors in the preservation of what have come to be defined as essential workers and the services they provide.

The state's vaccine distribution plan -- created under the close control of Governor Andrew Cuomo based on federal guidance and in consultation with local health departments, including New York City's -- has been to prioritize potential recipients by their occupation in the health-care sector (with the exception of nursing home residents, who’ve also been prioritized by federal decree), beginning with hospital employees and paramedics with patient contact, and expanding to other types of doctors and medical staff. On Monday, after the urging of Mayor Bill de Blasio and other local leaders, Cuomo opened vaccination to people over 75 and other types of essential employees, like police, firefighters, transit workers and teachers.

"Here's where we are," said Dr. Torian Easterling, first deputy commissioner and chief equity officer at the city Department of Health and Mental Hygiene, at the City Council hearing Tuesday. "We do have to keep in mind that we're following the federal and state guidelines as it relates to eligibility criteria."

"Certainly equity and ethical principles being taken into consideration, thinking about the categories that have borne the brunt and we want to save lives, but also those categories where we want to continue to preserve functions," he said.

When asked for clarity or elaboration on this point by Gotham Gazette, a department spokesperson only reiterated that the state set the eligibility criteria, not the city.

With a trickling supply of the vaccine scheduled by the federal government, Cuomo has repeatedly expressed concern over hospital staffing levels as the number of cases and hospitalizations have risen in recent months, echoing some of the most dire alarms raised during the state's first brush with inundated ERs and ICUs last spring.

Even after bowing to pressure from de Blasio and others to widen vaccine eligibility last week, those alarms have only heightened with the presence of a new more contagious covid strain connected to the United Kingdom, and more strains likely to be detected before enough of the population is vaccinated.

"The biggest capacity element in the hospital system is we're losing staff," the governor said on a call with members of the press Tuesday, after opening vaccinations up to people 65 and older in accordance with new CDC guidance. "We're losing staff because the staff is getting sick from covid. That's why continued prioritization of the hospital staff is key and in the webinar we said hospitals must continue to prioritize hospital staff."

Physicians and nurses in New York are less racially diverse than the population of the state, according to research released in 2017 by the Center for Health Workforce Studies. A report published by City Comptroller Scott Stringer last March showed that 54% of frontline workers in the city's health-care sector were Black or Latino, compared with 62% working in public transit. (Across industries, white employees made up roughly between a fifth and a quarter of the frontline personnel, according to the report.) The emphasis on preserving doctors over bus drivers further exposes the gruesome calculus of expendability in a pandemic crisis, with the training of health-care workers equating them to least expendable, while the transit workers getting some of them to their shifts, typically equipped with less PPE, are more expendable.

“New York State has followed the priority categories as outlined by ACIP & CDC,” wrote a state Department of Health spokesperson in an email to Gotham Gazette, referring to the federal Centers for Disease Control's Advisory Committee on Immunization Practices.

That guidance, which is national and not specifically tailored to New York, suggests that the right distribution of the vaccine within the broad category of health-care personnel (HPC) would mitigate inequities. "Vaccination of HCP across all occupations and work settings addresses the disproportionate representation of racial and ethnic minority groups in low-wage HCP," reads a supplement to the federal recommendations.

"Effort will need to be applied throughout the vaccination program to ensure equitable access," the document states.

It notes that health-care personnel in long-term care facilities, like nursing homes, are at risk of transmitting the virus to medically vulnerable patients, but does not cite any study or evidence related to hospital facilities or staff.

Fewer than 1 in every 300 confirmed COVID-19 deaths nationwide has been of a health-care professional, according to CDC data.

The vaccine roll-out has been plagued by infighting between Cuomo and de Blasio, often leaving the public in the dark about what may come next. Both have been reluctant to share data at various points since the state of emergency began last March, which now extends to vaccination rates by race and ethnicity.

City Council Member I. Daneek Miller and Brooklyn Borough President Eric Adams, who is running for mayor this year, plan to introduce a resolution to the City Council calling on the city and state to improve "coordination in distributing and administering COVID-19 vaccines, prioritizing vaccinations for essential workers - especially home health care, food delivery, supermarket, and transit workers – immigrants, and other high-risk populations in our hardest-hit communities of color," according to a statement from the Black, Latino, and Asian Caucus, of which Miller and Adrienne Adams are co-chairs.

The resolution, which has not yet been introduced, will also call for a real-time vaccine tracking system with demographic data, according to the statement, which Council Member Adams presented at Tuesday's oversight hearing.

The statement reads: "One of the most painful lessons drawn from this crisis was that a failure to provide timely reporting of racial demographic data at the onset of the pandemic resulted in a disproportionate number of dead Black and Brown New Yorkers that otherwise could have resulted in more aggressive mitigation measures employed in these communities."

The mayor has been criticized for not having taken better advantage of the months before the vaccine arrived to prepare vaccination sites in lower income communities and communities of color. "Let me be clear, we have been building out sites constantly and we're building out the hours of sites," de Blasio told reporters Wednesday when asked why there were no city-run vaccination hubs in Inwood and Washington Heights, neighborhoods with some of the highest positivity rates in Manhattan. Figures like City Council Member Ydanis Rodriguez, who represents the area, have called for more.

On Friday, Cuomo announced the state would be setting up five vaccination sites on NYCHA campuses for public housing residents, predominantly people of color. An official press release does not say when they will become operational.

The city, through de Blasio’s Racial Equity and Inclusion Task Force, has made efforts to "tailor our resources" using data to target testing and outreach, said Dr. Easterling, of the city Health Department, at the City Council oversight hearing, "and certainly we're thinking about this as the vaccine distribution plan rolls out."

"We know that Black and Latino communities bore the brunt of this COVID-19 pandemic and the data was very clear during wave one," Easterling said in response to the BLA Caucus statement and Adams' question. "And, as you laid out, we continue to see cases go up and we continue to see disproportionate impact even today."

"Now that we have more data, [we are] looking at not only COVID-19 data but also being able to really understand some of the inequity that really contributed to high exposure, thinking about overcrowding, overcrowding in housing, multi-generational homes. Also thinking about being a frontline worker, and really being able to map those neighborhoods," he said.

The city was limited by the plan outlined by Cuomo and state health officials, which takes into consideration the city's essential operations, highest among them the hospital and health-care systems. But the mayor made no public push for any changes to vaccine categorization and availability based on the most medically-vulnerable communities other than his call for the state to allow those over 75 to become eligible sooner.

A spokesperson for DOHMH said the health department doesn't track positivity or mortality rates by occupation or eligibility criteria, indicating it is not collected by the state nor a significant factor in the vaccine distribution scheme. A spokesperson for the state Department of Health did not say whether the officials are tracking infection and mortality rates within eligibility groups and did not provide data to justify the breakdown of eligibility categories, though it is consistent with CDC guidance.

On January 12, the state opened vaccination to people living and working in shelters and to grocery store employees. De Blasio has since called for eligibility to include delivery workers, and bodega and deli staff.

In an initial roll-out plan released in October, before the first vaccines received federal approval, the state was concerned with addressing the highest risk groups and most essential workforce, with an eye toward geographically targeting eligible recipients in the hardest hit areas.

"In anticipation of limited numbers of vaccine initially available coupled with current knowledge of COVID-19 morbidity and mortality, public health concerns, and the need to maintain essential services, one of New York’s prioritization strategies for vaccine distribution is designed to ensure early vaccination of the most vulnerable New Yorkers as well as essential frontline workers, with distribution potentially directed to these populations who reside or work within communities with highest prevalence of COVID-19," reads the report, prepared by the New York State Department of Health.

Much of that seems to have been shelved as the state has adhered closely to CDC guidance.

As the vaccine roll-out has come closer to utilizing the supply -- and, as de Blasio and Cuomo warn, will soon exhaust it -- the number of new daily covid cases and hospitalizations has continued to rise. For the last few days new hospital admissions in New York City have come close to 300 per day, and new reported daily cases have topped 5,000. In the second week of January, close to 60 people in New York City have died from covid per day.

At the January 12 oversight hearing, city Health Commissioner Dr. Dave Chokshi said the city was working to reach lower-income neighborhoods and communities of color through "trusted messengers," such as faith leaders and local representatives. As for the grief of loss, especially in New York's Black and Latino communities, "we have to ensure that we turn that into our motivation to better serve people today as well as going forward," he said.

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by Ethan Geringer-Sameth, reporter, Gotham Gazette Read more by this writer.

Reposted with permission.