Mary Altaffer/AP Photo
Dr. Jacqueline Delmont, Chief Medical Officer at Somos, gives Helen Washington, 76, the first dose of the COVID-19 vaccine at a pop-up vaccination site at St. Luke's Episcopal Church in the Bronx.
Mary Altaffer/AP Photo
The center of D.C.'s first documented outbreak of the coronavirus last spring was a church in Georgetown, in wealthy and majority-white Ward 2. But once the virus started spreading rapidly across the city, its devastating effects fell hardest on Black and Latino residents. Ward 8, which is 92% Black, has seen the highest per-capita death rate from the virus in the District. And citywide, 74% of residents who have died from the coronavirus are Black, even though Black people make up 46% of the city's population.
Now, as the city begins to distribute vaccines, early data show that racial and geographic disparities are continuing to beleaguer the process. Appointments for eligible seniors are going quickly, and largely to residents in the whiter, wealthier parts of the city—instead of to the majority-Black wards that have seen the most residents die from the virus. And while vaccine hesitancy does persist among some residents, the issue of limited vaccine supply seems to be the larger problem right now: Many Black D.C. seniors say they want the vaccine—but they just haven't been able to get it.
Residents, community leaders and elected officials say there are clear steps that officials should have taken—and could still take—to ensure that the residents who have been most likely to die from the coronavirus are prioritized more effectively in the vaccine's distribution, and to bolster communication with residents in the wards hardest-hit by COVID-19. Several D.C. councilmembers sent a letter to the Deputy Mayor for Health and Human Services on Monday, asking the city to implement changes to address the wide racial and socioeconomic gaps in vaccine distribution.
"This makes it painfully clear that any distribution process cannot be blind to the technological challenges that our most vulnerable residents face," the letter reads.
Mary Cuthbert, a 76-year-old Congress Heights resident, is among those who say the sign-up process alone has been daunting.
"Where do I go to get the vaccine? How do I sign up? I have to sign up on the computer or call and wait on the phone for three hours? That ain't gone work," said Cuthbert, adding that "many of our seniors don't have computers." Cuthbert also doesn't drive, doesn't have any family in the District, and would need a friend to pick her up to take her to a vaccine site.
Supply has emerged as the most significant constraint so far during the rollout: The city simply does not have enough vaccines to meet overwhelming demand. Officials, in turn, have been forced to prioritize certain groups and wards, drawing criticism for some of those decisions. As of Jan. 23, the city has administered 51,421 doses of the vaccine — a number that does not cover the 85,000 health care employees who work in the District, let alone the city's other eligible seniors and essential workers.
On Wednesday, D.C. officials announced that the Biden administration would increase the city's vaccine allotment by 15% for the next three weeks—a sign they called a "promising indicator" of the federal government's commitment to vaccinate more people. But officials will likely face an ongoing battle to overcome the District's distribution hurdles.
When the city moved into the first tier of the Phase 1B distribution earlier this month, opening vaccine appointments online to residents ages 65 and older, the move was beset with technical challenges and inequitable distribution. The appointments filled up within hours of opening, and residents of the wealthiest wards obtained a sizable portion of those vaccine doses. Residents in Ward 3, home to some of the city's wealthiest neighborhoods, snagged the most spots of any ward that week, at 2,465 appointments. Meanwhile, in Ward 7 and Ward 8, that number plummeted to 197 and 94 vaccine appointments, respectively.
A map of D.C. residents over 65 who have received their first vaccine dose as of Jan. 23.
Following a meeting later that week with D.C. councilmembers, who advocated for a rollout prioritizing majority-Black and low-income wards, DC Health opened additional appointments for residents in wards that secured the least amount of vaccine doses. Now, vaccine appointments will open every Thursday at 9 a.m. for residents in "priority zip codes," with any remaining doses opening to all wards every Friday. And on Wednesday, DC Health announced additional changes to the portal that they say will streamline the process and make booking appointments easier.
The move to reserve appointments for residents of certain wards was "a step in the right direction," said Ward 5 Coucilmember Kenyan McDuffie.
But McDuffie said that he's been contacted by residents who believe the process still isn't accommodating some who need it most. Even with the new sign-up system, the weekly appointments continue to fill within an hour — sometimes even minutes — of opening. There's also no geographic restriction for booking appointments: if all appointments fill up at sites in Ward 3, for example, residents who have means of transportation can book an appointment at a site elsewhere in the city.
A lack of geographic restrictions recently raised equity issues in nearby Prince George's County where officials moved this week to restrict vaccine appointments to county residents exclusively. In Prince George's County, about 50% of vaccine appointments booked through February went to residents in other counties, including neighboring Montgomery County— where officials say they are not receiving enough doses from the state to meet demand. Black residents make up more than 50% of the population in Prince George's County, compared to 20% in Montgomery County.
D.C. officials and residents have also pushed for more staffing on the vaccine appointment phone lines so that residents without access to computers have a fair shot at securing appointments. This week, DC Health responded by quadrupling the number of call-takers to more than 200, starting this Thursday (The health department still recommends that residents use the online portal if they are able to, though).
McDuffie said the phone registration process had been particularly frustrating for his constituents.
"You've got residents ... who don't have the Internet access to register online, and they are dialing the line to try to schedule appointments and are waiting, in some cases for an hour, only to be told that the appointments have all been reserved," he said. "I get concerned about whether these residents are going to continue to attempt to schedule appointments to get the vaccine."
The District also has other means of distributing vaccines.
DC Health allocates doses specifically to certain groups and providers, including in-school staff at DC Public Schools and public charter schools, residents of intermediate care facilities and group homes, certain people experiencing homelessness, and some eligible seniors living in public housing. A spokesperson for the D.C. Housing Authority said that starting this week, DCHA will work with health care partners to offer vaccines onsite at public housing properties where approximately 1,527 seniors aged 62 and over reside. DC Health said last week that 975 vaccine doses would be set aside for seniors in public housing this week as part of its efforts to get the vaccine to residents who have limited access to transportation.
But as the rollout pushes forward, critics worry the disparities will continue unaddressed.
The Washington Post reported last week that starting as early as February, appointments will open to a broad swath of residents with chronic health conditions, including smokers and people who have a body mass index over 25. This means that more than half of adults in the District would be eligible for the vaccine, likely overloading the online portal that's already contributed to large gaps in access. The revelation drew confusion from residents and officials about how such a broad swath of the city would be vaccinated—and four days later, a spokesperson for DC Health clarified the city would prioritize older people and those with more severe health risks first in this phase of the vaccine rollout.
D.C. isn't alone in its hiccups — or in inequities of vaccine distribution. Across the U.S., seniors reported running into difficulties with online sign-up portals. Nationally, six out of 10 adults 65 and older who have not received a vaccine said they do not have enough information on the process, according to a Kaiser Family Foundation survey.
Only 17 states are currently publishing race and ethnicity data for vaccine distribution — Virginia and Maryland among them. (Although, Virginia has only published that data for about 50% of the doses administered thus far). In Maryland, 17% of vaccines have gone to Black residents, who make up 36% of deaths from the virus.
In D.C., officials have not yet published race and ethnicity data. During a press conference on Monday, DC Health director LaQuandra Nesbitt said that the data was still too incomplete. Fifty-six percent of reported doses were listed as "unknown" or "other," while 28% have gone to white residents, and 15% to Black residents, according to Nesbitt.
Ambrose Lane Jr., founder and chair of the Ward 7-based Health Alliance Network and co-founder of the Black Coalition Against COVID, said he thinks the federal government "failed the District in terms of vaccine distribution." Localities across the country say fluctuations in vaccine shipments from the federal government have been difficult to plan for, and many governments in the D.C. region say they are receiving a fraction of the doses they need to vaccinate priority groups.
But Lane thinks despite limited supply, DC Health could have partnered more extensively with providers to identify seniors with chronic conditions and a higher risk of becoming seriously ill with COVID-19 — a disproportionate number of whom are Black — to make sure they were prioritized for vaccine doses.
According to DC Health, seven Medicare-accepting health centers or hospitals have started outreach for patients 65 and older to schedule vaccines through the hospitals, instead of relying on the city's online portal. Expanding more doses to private providers will depend on vaccine supply, according to DC Health, and right now the city just doesn't have it. Daycare workers and advocates have also taken issue with the phase of distribution that began on Monday for teachers. It notably excludes childcare workers — the majority of whom are Black women.
Others point out that they want to see a broader diversity of vaccination sites, particularly for residents who live east of the Anacostia River. Currently, there are six vaccination sites east of the Anacostia River: They are located at the Alabama Ave. Safeway and the Alabama Ave. Giant, along with Community of Hope's Conway Resource Center, the Washington Seniors Wellness Center, the Elaine Ellis Center, and the Kenilworth Recreation Center. Across the city, Ward 3 and Ward 8 have the fewest vaccination sites, with one and two respectively, and Ward 5 has the most sites, at seven.
"I think that they need to bring the vaccine to the community to make it accessible with no appointment," said Linda Greene, owner of Anacostia Organics in Ward 8. Greene suggested walk-up vaccination sites or a vaccination on wheels van. "I mean they do it for everything else," she said.
Kendrick Curry, pastor of Pennsylvania Avenue Baptist Church in Ward 7's Dupont Park, suggested that churches and other existing coronavirus testing locations in Southeast (like firehouses) become vaccination sites. His church, which also serves as a COVID-19 testing site, has administered 2,000 COVID-19 tests since June through partnerships with health care providers.
"Everyone can't go to CVS, Walgreens, Safeway, or Giant," he said. "...Certain benefits should not be assumed when you're dealing with folk that are marginalized, vulnerable, or at risk."
There are just three grocery stores for the 150,000 residents who live east of the Anacostia River. But many churches, Curry said, are close and easily accessible to residents. Southeast also has a single hospital, United Medical Center, which has been designated as a vaccination site
Curry said there are other barriers to access that need to be addressed not only for seniors, but also for those with busy work schedules.
"What about those who work two, three, and four jobs, when are they gonna have time to take a vaccine?" he said adding that work situations vary and people may not have sick leave or benefits that allow them to take time off.
Ward 7 Councilmember Vincent Gray, who chairs the council's health committee, said he is hopeful that prioritizing zip codes will improve the District's vaccination process. Gray will lead a public oversight hearing on Friday, Jan. 29, and Monday, Feb. 1, offering residents an opportunity to weigh in on the process and identify areas for improvement.
Gray wants the city to create a waitlist for seniors who sign up in the online portal to be vaccinated, to give people a "reasonable expectation" of when they will be assigned an appointment. But D.C. Mayor Muriel Bowser pushed back on the notion that a waitlist could help alleviate anxiety for residents seeking vaccine appointments during a press conference on Monday.
"You can have anxiety for one week or you can have anxiety waiting for months with a waitlist or date," Bowser said. "I wouldn't say that we're waiting to have a waitlist, but we want to make sure that we have the best processes in place so we'll continue to consider that."
McDuffie acknowledged that the pandemic has presented an unprecedented series of challenges for local government. He said he was pleased that DC Health responded to complaints about the online portal in less than 48 hours when Councilmembers raised concerns about racial equity. That level of urgency, he said, is vital to the community.
"If we are making mistakes ... if we are not nimble in responding to the data as it is gathered to understand better the populations that we're trying to serve, then it's going to continue to cost people their lives," said McDuffie.
The coronavirus has killed more Black residents than any other racial group in D.C.
Those life-or-death stakes, Curry said, have also driven higher levels of trust in the vaccine among Black D.C. residents despite the U.S.'s centuries-long history of medical racism. Black Americans have been test subjects in numerous unethical and, at times, fatal health studies and have reason to lack trust in health systems.
"We have a pandemic that is disproportionately killing Black and Brown folk, and [the vaccine] will prevent people from dying," said Curry, of Pennsylvania Avenue Baptist Church. "There's more trust that's building out of necessity [to live]."
Still, mistrust in the vaccine persists among some. Nursing home workers in the region, many of whom are Black or Latino, are declining the vaccine at high rates.
Kathy Thompson-Burton, 53, who lives in Temple Hill, Maryland, attends Saint Francis Xavier Catholic Church in Dupont Park. She said her priest put information about the vaccine in the church bulletin "to educate the community on why they need to get the vaccine and how it can be beneficial to us as African Americans," after she asked him to do so.
Thompson-Burton's church is located just one block from Curry's church; the two often collaborate for community initiatives. She hopes that, together, both churches can support the community by "getting the word out about the vaccine."
In Congress Heights, a communications organization is helping residents learn and ask questions about the vaccine. In early January, Dr. Lisa Fitzpatrick, founder of the organization called Grapevine Health, hosted a Facebook Live conversation with Dr. Kizzmekia Corbett, a Black scientist who helped develop Moderna's vaccine, one of two leading vaccines that has shown to be more than 90% effective.
"I wanted [residents] to hear directly from the Black scientists who created the vaccines to help build trust in the process and to understand it so that people would be more accepting of the vaccine," Fitzpatrick said.
Lane, of the Health Alliance Network and Black Coalition Against COVID, said he was looking forward to collaborating with the D.C. government on vaccine outreach—and, hopefully, a broader plan for addressing the health disparities that have been exposed by the pandemic and the vaccine rollout.
"The coronavirus has informed us of the true disparities that exist for communities of color all across the country, but especially here in the District," he said. "I am anxious to hear the vision put forward by elected officials as to what the District is going to look like after the coronavirus is over ... [I]f it's going to be the same where we have high rates of chronic disease, then the District will not have done its job learning from this pandemic."
This story is from DCist.com, the local news website of WAMU.