Last month, the Supreme Court struck down the Biden administration’s vaccine-or-test mandate for large employers while upholding a vaccine mandate for health care workers at facilities that receive Medicaid and Medicare funds.
Shortly before that, the NYCLU joined a legal brief arguing that New York State’s vaccine mandate for health care workers does not need to include a religious exemption. Our rationale is straightforward: in the Supreme Court’s words, “The right to practice religion freely does not include liberty to expose the community . . . to communicable disease.” The Supreme Court allowed that mandate to go into effect with no religious exemption.
The legal debate over vaccine mandates requires a careful look at the magnitude of the risk to the public, the efficacy and safety of the vaccines, and the efficacy and safety of other methods of lowering the risk to the public.
But amid the legal controversy, we must not lose sight of the very real public health policy issues that the pandemic has brought into stark relief. Issues like access to care, the need for trusted and culturally competent providers, confidentiality, the history and impact of racism in health care, and income inequality are impossible to ignore.
Strong Progress and Persistent Problems
To New York City and New York State’s credit, they have been reporting publicly on vaccination rates by a number of different categories. Both break down the data by race, ethnicity, gender, and age. The State also reports cases by region while the City does so by zip code and borough. Although the data demonstrate that both the City and State have made strides toward increasing vaccination across all demographics and narrowing the gap between Black and white vaccination rates, there are still persistent disparities.
For example, only 55 percent of Black New York City residents are fully vaccinated, lagging behind every other racial demographic. The statewide data reveal similar disparities. And, while 69 percent of youth ages 5 – 17 are fully vaccinated in Manhattan, vaccination rates for young people lag by more than 20 percentage points in all of the outer boroughs except Queens.
A Long History of Racism
Racial disparities are not unique to COVID vaccines – or to New York. They are instead a microcosm of a nationwide health care system imbued with longstanding structural racism.
The Black maternal mortality rate is nearly four times higher than the white maternal mortality rate. Black patients suffering from appendicitis, broken bones, and other serious conditions are less likely to be offered painkillers than white patients.
As recently as 2016, researchers found that half of white medical students surveyed “were willing to entertain one or more false statements about biological differences based on race, such as the notion that African Americans have less-sensitive nerve endings than whites.”
It is worth keeping this disturbing and lengthy history of indifference, cruelty, and deception in mind when governments look at ways to increase vaccination rates. And yet, research has demonstrated that Black people who were vaccine-hesitant overcame that hesitance more quickly than white people.
The game-changers here were culturally competent messages from community members and leaders coupled with policy measures that make it easier and safer for people to access vaccines. These measures include paid time off and child care, not only to receive the vaccine – for which New York requires four hours of paid-leave – but also to recover from side effects the next day.
The Importance of Privacy and Access
Protecting people’s privacy and the personal information they share to receive vaccines is also vital. There is a bill pending in the State Legislature that would ensure that personal information people share to receive a vaccine is protected and cannot be used to deport or criminalize anyone – and you should urge your legislators to make sure it becomes law.
This is important because some New Yorkers are still wary of sharing personal information with the government or private companies to receive a vaccine. Even now, for example, many people worry that there will be negative immigration consequences associated with getting vaccinated.
New York City deserves credit for undertaking a public education campaign in English and Spanish to let residents know they do not have to share their Social Security Numbers or prove their immigration status to receive a vaccine. But the State has done little to implement legally-binding privacy protections. In the absence of these safeguards, some COVID testing sites were still asking for citizenship status as recently as December.
There is also more the State and City can do to provide language assistance and interpretation. Although we can now walk into vaccine sites, too many of those sites still lack reliable interpretation.
And while there’s been great progress made increasing the number of vaccination sites across the State, there’s still room for improvement. The initial vaccine roll-out strategy focused on mass vaccination sites and the pharmacy network for vaccine delivery. This sidelined community-based organizations, safety-net providers, senior centers, and others who are trusted providers for our Black, Latinx, Brown, immigrant, disabled, and low-income communities. As a result – and though there has been progress on this front – vaccination sites are still disproportionately located in whiter, wealthier areas.
For example, until recently, District 16 in Brooklyn – which is home to the highest percentage of New York City’s population living below the poverty line – had no vaccination sites. It now has one thanks to the intrepid work of a community-based organization and a community health center.
Lessons Learned and Examples to Follow
As New York looks for ways to further increase vaccination rates, our State has the opportunity to learn from its experience and from community-based organizations that are deeply rooted in and know how to reach their communities.
The pandemic has also helped emphasize the value of data. Granular information helps governments and community organizations deploy public health strategies to get people access to care they need. The State and City should continue to make comprehensive data available. They should also cross-tabulate that data so that we can compare vaccination rates by race, ethnicity, and gender across neighborhoods. That will allow governments to develop tailored strategies to reach those with the most need.
Finally, New York can also learn from other jurisdictions that have done better at ensuring vaccines reach everyone. Philadelphia provides one example. The City has one of the highest Black vaccination rates in a major U.S. city. This is in large part because Black health care providers set up testing sites in Philly’s hardest-hit neighborhoods even before the arrival of vaccines.
While there, these providers built trust by also conducting check-ups and treating any ailments they could. When vaccines arrived, they kept their sites open late to accommodate those who worked late or nontraditional hours. To New York’s credit, it absorbed this lesson and keeps many vaccine sites open late.
When it became clear that some people were afraid to provide personal information to receive a vaccine, the Philadelphia health care providers streamlined their intake process to require minimal information.
Meanwhile, Philadelphia repurposed its census outreach teams to go door-to-door to answer people’s questions and address their concerns about vaccination. Advocates in New York have called for a similar approach.
Pushing past the pandemic means going beyond vaccine mandates and constantly improving on the progress New York has made. A pandemic recovery that includes all of our communities depends on it.