In New York City, location is everything. It matters for schools, homes and hot-dog carts. Now, it defines access to Covid-19 vaccines.
Among the starkest divides is a swath of Manhattan that starts on the Upper East Side, where 36% of adults had received at least one dose as of Tuesday. Blocks north in Harlem, that number is just 17%. In general, the parts of Harlem that are less wealthy and White are also less likely to have vaccinated residents, city data show.
“The fact that we knew where the hardest-hit communities were and didn't set aside shots for them or prepare for that is just frustrating and mind-boggling,” said Diana Ayala, a City Council member representing East Harlem and the South Bronx who hasn’t been able to secure a vaccine herself despite being eligible.
Mayor Bill de Blasio and Governor Andrew Cuomo pledged the nation’s most equitable distribution, but shots are going to White New Yorkers at a much greater rate than minority, poor and immigrant communities.
“We're among the most cases and deaths. How does it happen that we're so many weeks into this and it's still such a grueling process to get a vaccine?” said Ayala, who's been walking door to door to sign up senior citizens. “The city says to be patient, that we need more supply. But it's really difficult to explain away.”
De Blasio got elected with a pledge to make New York “the fairest big city in America.” Months into the pandemic, it was clear he hadn’t achieved his goal. Covid hospitalizations and deaths were disproportionate in lower-income neighborhoods, and remain so. Job losses followed.
When vaccines arrived in December, de Blasio pledged to direct them to the neediest places first. But the nation’s largest city still lags behind other parts of the U.S. in equitably distributing the vaccine. At least a dozen states, including Oregon, Rhode Island and Kansas, are reaching a relatively more equal share of people of different races and ethnicities, according to the Bloomberg Vaccine Tracker.
Vaccine Mismatch
New York City Health Commissioner Dave Chokshi said the city disclosed ZIP code data to highlight efforts to remedy inequities. It's a “road map,” he said, noting a majority of city vaccine sites are in 33 vulnerable neighborhoods.
“Equity is at the heart of the city’s vaccination effort,” said de Blasio spokesman Bill Neidhardt.
Some disparities can be chalked up to higher proportions of older residents, or concentrations of health-care workers and first responders. But some of the least-vaccinated ZIP codes, including in Harlem, have some of the highest rates for diabetes, obesity and and other underlying health conditions that qualify residents for shots.
More than half of adults in the Queens enclave of Breezy Point, which is 91% White, had received at least one dose by Tuesday, the city’s highest rate. That compares with just 9% in Corona, Queens, and Brownsville, Brooklyn, which include New York’s least-vaccinated ZIP codes — and some of the highest Covid death tolls.
City and state officials have blamed disparities on the hesitancy of some people to take the shot. But council members, community leaders and health-care workers say refusal numbers, which are declining, don’t tell the whole story.
“It is absolutely about access,” said Sheena Wright, chief executive officer of United Way of New York City, who is working to provide testing and vaccine awareness. “Black people are showing up at the hospital at the end stage of the disease, and that’s the first time they’ve even gotten a test. The same is true with the vaccine.”
Racial Divide
Initial vaccine shipments went to health workers via hospitals and health-care systems. When eligibility expanded, more sites opened, but because hospitals remained a primary dispenser, New Yorkers with their own doctors went to the front of the line. Many without insurance don’t have that luxury.
Only 4% of Upper East Side residents are uninsured, compared with 12% in East Harlem, according to the city’s health department.
“When you get sick, you go to the clinic and see who’s available, or you go to the emergency room if it’s really bad,” said Wright. “They’re not connected to a health home where they actually have their doctor.”
Public-hospital leaders said reserving appointments for existing patients served their minority clientele: “We're actively calling people,” Mitchell Katz, head of the city system, said last month.
But the same practice was happening at prominent private institutions on the affluent Upper East Side: Lenox Hill, New York-Presbyterian/Weill Cornell and Mount Sinai. “Having a doctor that's affiliated with a medical institution is an incredible privilege,” said Councilman Ben Kallos, who represents parts of the neighborhood.
Scheduling websites remain a major hurdle: Nearly a fifth of Harlem residents lack internet service, according to U.S. Census data. That leaves wealthier residents with strong connections to their physicians at an advantage. Upper East Side residents Tipp and Gloria Gilbert, 78 and 70, were grateful when their primary-care doctor booked them an appointment at a state-run site at the Fort Washington Armory in Manhattan’s Washington Heights, where Covid positivity rates hit 10% in January.
Shot of Wealth
That same month, Cuomo hailed the armory as a way to combat inequality. “We are making sure New Yorkers of color aren’t left behind,” he said. But it quickly became a magnet for people from richer neighborhoods as well as elsewhere in New York state and even New Jersey. “They're very well organized inside,” Gloria Gilbert said. “They move you right through.”
Friction quickly built as people from outside Washington Heights flooded in. “The majority of people being vaccinated were not from the low-income predominantly Latino neighborhood,” Susana Bejar, a doctor who volunteered at the site, wrote on Twitter. “I've never seen so many White people in Washington Heights.”
The mayor investigated. Weeks later, the armory began reserving 60% of new appointments for neighborhood residents. Other vaccine sites have followed suit.
Across New York, more than a fifth of vaccine recipients are nonresidents, who are younger and more likely to be White, according to city data. As of Tuesday, 59% of out-of-towners were White and 7% were Black.
Outside Manhattan, the most-vaccinated neighborhoods are majority White, affluent communities where most residents have Internet access. In Breezy Point, a neighborhood of 2,300 people, there's a large population of police and first responders. In City Island, a Bronx community with 4,500 residents, city council members and community groups are active in the vaccine program. “When the vaccine came around, there was no hesitancy,” said Paul Klein, president of the City Island Chamber of Commerce.
Jim Livingston, 67, a retired police detective, said residents post available vaccine slots on the island’s Facebook page and “we can gather people and take them to the site.”
The siting of clinics also has contributed to inequities. Manhattan, the highest-vaccinated borough — and home to some of the world’s most affluent people — also has the most sites. There are 10 per 100,000 adults in Manhattan versus five in Brooklyn, the least vaccinated.
Uneven Vaccinations
In Queens, which has six sites per 100,000, 70-year-old Marta Munoz, a house cleaner, rode the subway to the Citi Field vaccine station last month without an appointment. She wandered around the gates for half an hour before a Spanish-speaking worker helped her call a scheduling hotline.
“I don’t have a computer, I don’t know how to say most things in English," she said. “I have no one to help me at home. It's just me.”
-With assistance from Maria Elena Vizcaino, Jeremy Cf Lin and Angelica LaVito.
This article was provided by Bloomberg News.
