How the COVID Vaccine Allocation Revealed Social Disparities:

A Nurse’s Perspective

TAINA M. BENJAMIN BSN, RN

“Woman receiving a vaccine in her arm” by SELF Magazine is licensed with CC BY 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/2.0/

The COVID-19 pandemic has revealed social disparities long present in New York City. COVID deaths have disproportionately affected communities of color, particularly Black and Latinx neighborhoods in the Bronx, Harlem, and Brooklyn. Yet, despite these disproportionate health burdens, vaccine allocations have not been prioritized for these communities.1 In my experience working as a public health nurse and administering these vaccines, I have also noticed these disparities in my everyday life. To better understand how Black and Latinx communities are not being effectively prioritized during the vaccine allocation, we need to look at the disproportionate rate of COVID infections within these communities as an example of the health disparities they face. 

According to the Centers for Disease Control and Prevention (CDC), communities of color, high-poverty neighborhoods, and the elderly population had the highest rate of COVID infections and hospitalizations in New York City from March to May 2020.2 The Bronx had the highest rate of COVID infections, while Manhattan had the lowest. Among all racial groups, Black/African Americans have experienced the highest rate of COVID infection in New York City, at 1,590 per 100,000 people. African Americans have also experienced the highest rates of hospitalization and death from COVID infection, followed by Latinx Americans.3 The high infection rates within these populations and much lower rates in white and Asian communities raises questions about the causes of these disparities. 

One argument has been that these disparities are the result of the high prevalence of chronic medical conditions within Black and Latinx communities, such as diabetes, hypertension, obesity, and asthma, making them more susceptible to COVID infection and COVID-related fatalities.4 Another argument is that Black and Latinx communities tend to distrust medical institutions due to historical discrimination, which makes them less likely to seek medical attention — even when the high prevalence of chronic illnesses within these populations puts them at higher risk for COVID infection and hospitalization.56 In my experience working at a Federally Qualified Health Center (FQHC) in East Harlem, I encountered many Black and Latinx patients who didn’t believe that the pandemic was real or thought that it was part of a conspiracy. As a result, they were noncompliant with safety precautions such as mask-wearing and maintaining a six-foot distance from others when necessary. In areas such as East Harlem, where there are high rates of obesity, diabetes, and hypertension among Black and Latinx residents, I had many patients tell me that they had a chronically ill parent, aunt, uncle, or other family member succumb to the virus. When I would question these patients further, they usually revealed to me that their family member did not adhere to public health measures such as wearing a mask because they didn’t understand the importance of these practices.                                                         

As a Black nurse who has received both vaccine doses, I often felt that I had to act an example “in the flesh,” to reassure my patients that receiving the vaccine would protect them or even save their lives.

With such high rates of infection and mortality among Black and Latinx populations, one might assume that these communities would be prioritized for COVID vaccine allocation. However, this has not necessarily been the case, as demonstrated by my research and first-hand experience as a registered nurse. One of the drivers of the lack of vaccine access for poor Black and Latinx NYC residents is insufficient or limited access to technology and other resources needed to book vaccine appointments.7 Signing up for a vaccination appointment in New York State and New York City relies upon a largely online system, which can be problematic for the 500,000 NYC households that lack internet access.8 These communities may also lack the transportation necessary to travel long distances to appointments in NYC suburbs in  Rockland and Westchester counties when appointments are unavailable in NYC.

Low-income Black and Latinx residents must compete with wealthy urban and suburban New Yorkers with greater access to the resources necessary to secure appointments. In some cases, wealthy, white urban and suburban residents have even booked appointments in lower-income neighborhood clinics before residents from those neighborhoods have had a chance to sign up.9 As of February 2021, 48% of people who received their first dose of the vaccine in NYC were white, while only 15% of Latinx people and 11% of the Black population had received their first dose.10

Targeted vaccine distribution efforts face obstacles. Some officials fear that isolating specific neighborhoods for vaccine allocation could lead to lawsuits that allege racial preference, since some local agencies may not have control over their vaccine allocation based on eligibility guidelines proposed by their supervising county or state authorities.11 In some cases, there were even penalties for breaking the rules of eligibility; as a result,  some agencies ended up with expired vaccines if there was a mismatch between eligibility requirements and the availability of eligible individuals.12 Additionally, community health centers in NYC have been sidelined in the vaccine rollout when supply was scare; there has been more focus on mass facilities like the Javits Center, city and private hospitals, and pharmacies. This further limited where  Black and Latinx populations could receive vaccines. In neighborhoods like Rosedale in the Bronx, 95% of  senior residents – a high-risk population – were Black, but less than 6% had received their first dose of the vaccine as of February 2021.13 

In my experience working as a public health nurse charged with administering the vaccine to patients from a variety of racial and socioeconomic backgrounds, I have noticed in my fieldwork that white residents tended to make up the majority of vaccine recipients. This was the case even when I was administering the vaccine in lower-income neighborhoods where we were targeting poor Black and Latinx residents. In one example, I was administering the vaccine during a field visit in Spring Valley, NY, a lower-income community in Rockland County with very large Black and Latinx populations. This initiative intended to increase vaccine availability in under-resourced communities. I noticed that we had a disproportionate number of white patients coming to get the vaccine who didn’t appear to be residents of the community. This left me in a state of confusion. When speaking to various Black and Latinx patients, they would often voice to me how difficult it was to obtain their appointment or how their family members were still having difficulty obtaining appointments. While some white patients also expressed to me how difficult it was to obtain the same appointments,  many also stated that they “knew someone,” such as someone at the Department of Health or at other medical locations, who helped them, their family members, and even their acquaintances get appointments. 

Additionally, I experienced some skepticism from Black patients when I was administering their vaccines, revealing their distrust of medical institutions. Common sentiments were, “I don’t know about this,” or “did YOU get it?” As a Black nurse who has received both vaccine doses, I often felt that I had to act as an example “in the flesh,” to reassure my patients that receiving the vaccine would protect them or even save their lives. It was almost as if they needed to hear it from someone who looked like them, rather than rely on the medical institutions that many have distrusted for decades. Often after I provided this reassurance and education about the vaccine, Black patients were more confident about receiving it.

With a substantial increase in supply of COVID vaccines available to communities in both New York City and New York State as of April 2021, there is hope that those in under-resourced  communities will be able to receive the vaccine without difficulty.14 Expanding eligibility to those aged 16 years and older has made 16 million New Yorkers eligible for the vaccine as of April 6th, 2021. There have also been efforts by Mayor De Blasio and Governor Cuomo to simplify registering for vaccine appointments for those who must navigate technological barriers.15 The vaccine allocation disparities experienced by Black and Latinx communities, who experienced the highest rates of COVID infections and deaths, reveals that more needs to be done by New York City’s public health system to provide better public health outreach. Doing so may aid in preventing high infection rates in these communities in future pandemics. Increasing the availability of vaccine appointments via online and in-person registrations would make future vaccines more accessible to all citizens and increase herd immunity, which is crucial to preventing pandemics.16 As vaccination efforts continue, there is still hope that all New Yorkers will have an equal opportunity to protect themselves from the virus that has devastated many, regardless of their racial identity and socioeconomic status.


Notes

1. Kristina Sgueglia, Brian Vitagliano, & Ganesh Setty, “New York officials plan to redouble efforts to fix racial disparities in vaccination rates”, CNN, February 1, 2021,  https://www.cnn.com/2021/02/01/us/racial-disparities-covid-19-vaccine-access-new-york/index.html.

2. Corinne N. Thompson, et al., “COVID-19 Outbreak- New York City, February 29- June 1, 2020,” Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report 69, no.46 (November 20, 2020): 1725- 1729. https://www.cdc.gov/mmwr/volumes/69/wr/mm6946a2.htm

3. Corinne N. Thompson, et al., “COVID-19 Outbreak- New York City, February 29- June 1, 2020.”

4. Aylin Woodward & Andy Kiersz. “An alarmingly disproportionate number of black Americans are dying from the coronavirus, more and more research shows,” Business Insider (May 6, 2020). https://www.businessinsider.com/black-americans-disproportionately-hospitalized-with-coronavirus-2020-4 .

5. J. Jaiswal, C. LoSchaivo, & D.C. Perlman, “Disinformation, Misinformation and Inequality- Driven Mistrust in the Time of COVID-19: Lessons Unlearned from AIDS Denialism”, AIDS and Behavior 24 (2020): 2776-2780, https://link.springer.com/article/10.1007/s10461-020-02925-y.

6. Benkert, Ramona et al. “Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust,” Behav Med 45, no. 2 (2019): 86-101, doi: 10.1080/08964289.2019.1588220

7. Editorial Board. “How New York’s Vaccine Program Missed Black and Hispanic Residents”, The New York Times, February 1, 2021, https://www.nytimes.com/2021/02/01/opinion/new-york-covid-vaccine.html.

8. Ibid.

9. Abby Goodnough & Jan Hoffman, “The Wealthy Are Getting More Vaccinations, Even in Poorer Neighborhoods”, The New York Times, February 2, 2021, https://www.nytimes.com/2021/02/02/health/white-people-covid-vaccines-minorities.html.

10. Editorial Board, “How New York’s Vaccine Program Missed Black and Hispanic Residents.”

11. Goodnough & Hoffman,  “The Wealthy Are Getting More Vaccinations.”

12. Megan J. Shen,  “The COVID vaccine system is unfair to those who need the shots most. This is predictable,”  USA Today, February 24, 2021, https://www.usatoday.com/story/opinion/2021/02/24/covid-vaccine-unfair-minorities-elderly-low-income-column/4556195001/.

13. Ann Choi & Josefa Velasquez, “Easy Vaccine Appointments Help Bridge Deadly Racial Gap for Elderly New Yorkers”, The City, February 24, 2021, https://www.thecity.nyc/coronavirus/2021/2/24/22300111/easy-vaccine-appointments-new-york-racial-gap.

14. Eyewitness News, “COVID Vaccine Supply Appears to Outpace Demand in New York City, Despite J & J pause: Coronavirus Update”,  ABC 7, April 16, 2021, https://abc7ny.com/covid-vaccine-nyc-covid-19-finder-appointment-update/10518926/.

15.  Faraz Toor, “Mayor Says City Will Work Towards Simplifying Process of Getting Vaccine Appointment”, Spectrum News, (March 29, 2021), https://www.ny1.com/nyc/all-boroughs/politics/2021/03/29/mondays-with-the-mayor-bill-de-blasio-nyc-covid-vaccine-eligibility-nyc-vaccine-eligibility-expanding

16. Ralph Ellis & Christina Maxouris, “Not reaching herd immunity by the fall could have dire consequences, expert says”, CNN. (May 3. 2021), https://www.cnn.com/2021/05/03/health/us-coronavirus-monday/index.html.


Taina M. Benjamin BSN, RN is a registered nurse currently pursuing a dual master’s degree in Nursing Administration and Urban Policy and Leadership at Hunter College. She currently works at the Rockland County Department of Health serving low-income and immigrant communities. She is interested in researching health disparities in urban communities.
Personal Blog: aruntsjourney.wordpress.com

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