Our vaccine work in an undervaccinated neighborhood in New York City helped an effort that “closed a dramatic disparity in vaccination rates,” according to the authors of a paper in the New England Journal of Medicine about the program.
ClearHealthCosts partnered with Epicenter-NYC, a Queens-based hyperlocal news startup, and TBN24, a television network for Bangladeshi emigres, in the Vaccine Equity Partner Engagement outreach project, under the management of the Department of Health and Mental Hygiene of New York City, with Fund for Public Health of New York City and Centers for Disease Control funding, from summer of 2021 through the end of 2022.
Our three-way partnership in the VEPE program focused on vaccine distribution in Queens Village, one of the Taskforce for Racial Inclusion and Equity neighborhoods that suffered the worst from the Covid pandemic.
The paper on the effort, “Embedding Health Equity in a Public Health Emergency Response: New York City’s Covid-19 Vaccination Experience” was written by Olosimbu Ige, then assistant commissioner, Bureau of Health Equity Capacity, Department of Health and Mental Hygiene of New York City; Dr. Julian Watkins, acting assistant commissioner, Bureau of Health Equity Capacity, New York City Department of Health and Mental Hygiene; and others.
Our vaccine effort primarily consisted of outreach in the neighborhood to make vaccines more available. We partnered with New York Health + Hospitals and its Test + Trace (later Test + Treat) unit to park a van with vaccine and testing capabilities on a street corner near the Ss. Joachim and Anne Roman Catholic Church in Queens Village.
The first grant was issued in July 2021; it was renewed in January 2022, and renewed again in June 2022. Our staff members on the ground supported the team of health care providers in the van, by assisting with directing traffic, informing and registering members of the public, and giving out information. Our team also did outreach, distributing home test kits, masks, hand sanitizer, gloves and so on to people coming to get tested and vaccinated, as well as to the parishioners at the church, its parochial school, the nearby public school, neighborhood businesses and other members of the community.
‘Dramatically increased’ vaccine rates
Our efforts and those of others in the program “dramatically increased the percentage of adults vaccinated for Covid-19 in the targeted TRIE zip codes and all but closed the vaccination rate gap between marginalized and non-marginalized neighborhoods,” the authors wrote.
“Racial, social, and economic injustices drive health inequities,” wrote the authors, Dr. Ige; Dr. Watkins; Hang Pham-Singer, PharmD; Michelle Dresser, MPH; Duncan Maru, MD, PHD, and Michelle Morse, MD, MPH. “These same drivers of inequities are amplified in public health emergencies. As effective Covid-19 vaccines began to be available to the general public, the New York City Department of Health and Mental Hygiene (health department) recognized that there would be substantial inequities in access to and receipt of vaccination across the city.
“Building off the existing citywide Taskforce on Racial Inclusion & Equity (TRIE) framework, created in response to the Covid-19 pandemic to identify and make recommendations to address pandemic-related disparities, the health department developed a Provider and Community Engagement unit (PACE) to (1) invest in marginalized neighborhoods and communities; (2) deliver tailored engagement to community groups and providers; and (3) take a collective impact approach to tracking and responding to inequities by age, race, and place.”
Uncharted territory
We knew at the time that the health department was venturing into uncharted territory — some of the early organization was challenging. But ultimately the partnership became more organized, with clear lines of communication, regular meetings and clear expectations.
Early on, the overall narrative had been that there was vaccine hesitancy or vaccine resistance in undervaccinated neighborhoods. Instead, we found that the problem to a great degree was availability.
The neighborhood we were assigned to had only two vaccination points, both in chain drugstores, which many people found undesirable — they required online registration, which many found cumbersome; they had pre-set appointments, which were inflexible; a lot of documentation was required in a neighborhood and a city where many people are undocumented; and other downsides.
In response to our queries, the organizers of the program urged us to find our own solutions, which ultimately included the partnership with Health + Hospitals and the church, which we invented on our own. The van parked on a street corner on Wednesdays and Sundays for a year and a half, allowing residents to walk up without appointments and receive service on the spot. We ultimately vaccinated more than 6,000 people and tested many thousands more.
As it turned out the vaccine hesitancy narrative was less important than the idea that people wanted to get vaccinated, but it wasn’t their first priority.
The testing surge was one that proved how important our van was for the community, even if you didn’t want to get vaccinated; getting a free test with a short turnaround from a reputable provider was crucial for many people
‘Community engagement and trust’
In conclusion, the authors wrote: “Advancing health equity is a shared responsibility that requires all of government and all of society for lasting change. Efforts to achieve health equity must be guided through relationships with community partners to build trust and counter misinformation.
“Success resulted from funding trusted partners to lead community engagement, improved coordination of public health activities with health care delivery systems, organizational acknowledgement of the structural barriers that limit access to resources and services, and organizational commitment to prioritizing resources for marginalized and underserved communities.
“PACE also demonstrated a proof of concept. Even in an emergency, a local health department can set up a system of equitable community engagement that centers community needs and still satisfies health department needs. We successfully worked in partnership with communities around issues of equity and community care. We also created systems for bidirectional information and knowledge exchange that built capacity for the health department to foster community engagement and trust.”
