Given the opportunity to register for a COVID-19 vaccination from his front porch, Jeff Harris, 65, didn’t hesitate.
“If you don’t get it, you die,” he said.
Harris, who lives with his 90-year-old mother, is eager to be vaccinated. He’s mostly stayed home during the pandemic, he said, and even tries to avoid going to the grocery store.
But until Monday, when community activists came to his door, he didn’t know how to sign up.
“Most people don’t have no internet,” Harris said of his Hunting Park neighbors. “They just don’t have a way to get through to schedule no appointment, man.”
Harris’ neighborhood and others that are home largely to lower-income Philadelphians of color have some of the lowest vaccination rates in the city, according to an Inquirer analysis of city-provided zip-code-level data. The 16 zip codes with the lowest vaccination rates in the city are dominated by residents of color. Those least-vaccinated zip codes also tend to be among those that have suffered higher case rates, hospitalizations, and deaths.
Meanwhile, the Inquirer analysis shows residents of the highest-income zip codes have been vaccinated at twice the rate of the lowest-income zip codes.
Public health experts say Philadelphia’s vaccination data reflect systemic disparities that have existed for decades and been made more stark by the pandemic. Lifetimes marked by poverty and racism, plus poor access to health care, set the stage for greater vulnerability to COVID-19. Then, without internet access — about half of Black households in the city didn’t have internet before the pandemic, Census data show — residents often had no way to schedule a vaccine appointment.
“At the root of what we’re seeing is really a manifestation of structural racism at this moment,” said Sharrelle Barber, a Drexel University professor of epidemiology and biostatistics.
City officials say the initial vaccine shortages made it hard to reach out to people in need, but as eligibility expanded so did their outreach effort. Now they are quickly adapting based on what worked, and didn’t, in the early stages.
“All of the planning in the world inevitably changes once you get into a response situation based on the particulars of the situation,” said James Garrow, a spokesperson for the Philadelphia Department of Public Health. “Every decision made by the city and health department in this pandemic has been made with the information available at that time, and in the interest of saving lives and protecting people.”
The city has begun allowing vaccinations without appointments, or through registration by phone, and now is assembling a team led by the woman who helped improve Philadelphia’s participation rates in 2020′s U.S. census. This week, the city announced a second clinic run by the Federal Emergency Management Agency at Esperanza’s offices in North Philadelphia, expected to give 1,500 to 2,000 shots a day. Another city-run clinic opened Monday on Ogontz Avenue in Northwest Philadelphia, close to undervaccinated areas, and “information desks” are in the works for neighborhoods in need.
Just 14% of Philadelphia’s Hispanic residents and 16% of its non-Hispanic Black population have been vaccinated. About 30% of white Philadelphians are fully vaccinated.
“I’ve felt frustration right from the very beginning,” said Quetcy Lozada, of the North Philadelphia community organization Esperanza, which runs the charter school, who has gone door-to-door registering residents including Harris. “Whenever we’re talking about access, we should make sure that it’s reachable, that it’s attainable, not just by some of the population but by all.”
A predictable inequity
While vaccine hesitancy is real, its effect on vaccination rates in Black and brown communities has been overstated, advocates say. In fact, polls show significant narrowing in racial gaps in vaccine hesitancy.
The bigger issue is access — to reliable information about the vaccines and how to get them.
The FEMA-run mass vaccination site at the Convention Center illustrates the point. After seeing that doses overwhelmingly went to white recipients who used the online appointment system, the city allowed people in undervaccinated zip codes to just walk in for shots. In days, the rate of vaccination among people of color sharply increased.
By fall 2020, public health officials knew vaccine candidates were promising, but critical questions remained unanswered: Who would be eligible? How much vaccine would be available? How might distribution work? By December, Garrow said, when it was clear that the few thousand doses supplied each week were only for health-care workers, the city feared a robust outreach effort could backfire.
“We were worried that by strongly encouraging people to be vaccinated, and not having any way for them to be vaccinated, they would ultimately be frustrated and turned off to the idea,” he said.
Public health experts and community advocates say that was a miscalculation. By not conducting a direct outreach campaign in person and by phone well in advance of the vaccine becoming available, inequities that have long divided the population also harmed the vaccination process.
“It was super predictable,” said Barber, the Drexel professor. “We’ve known that there’s going to be a vaccine at some point. This should have been priority planning.”
Philadelphia isn’t alone in struggling with disparities in vaccination. Nationwide, communities of color have been vaccinated at significantly lower rates than white Americans, a New York Times analysis in March showed.
As doses became more widely available in late January, Philadelphia introduced a digital registry so people could sign up and be contacted as doses became available — but to use it, people needed internet access.
“When we saw the disparity, we implemented the phone method, which helped somewhat,” Garrow said. “Our efforts since then have only continued to ramp up and now includes working with community partners and on-the-ground canvassing.”
On Monday, Lozada used voter rolls to target people 65 and older living off Hunting Park Avenue, rowhouse communities with large Black and Latino populations. Some, like Harris, were eager to register, while others were more wary, concerned about which brand of vaccine they should get or just nervous about needles.
Lozada answered questions, gave out information sheets, and told people about the Esperanza-hosted vaccination site opening as soon as April 9. She never argued or corrected people.
“I don’t think it’s my place to try to convince them,” she said. “Our goal here is to make sure that they know that there’s access, and there’s access right in walking distance from their home.”
By day’s end, she had registered 60 people at homes and businesses in the area.
State Rep. Elizabeth Fiedler has also helped organize door-to-door vaccine registration for seniors in her South Philadelphia district.
“We’re hearing from a lot of people — older people, people who don’t have computer access — who did not know whether they qualified and or they did not know how to sign up,” she said.
The health department has held town halls for community leaders beginning in January, and dozens of community meetings, and more recently the city has ramped up community partnerships and street-level canvassing, Garrow said.
‘We should already be out there’
The Philly Counts team is approved to receive $2.1 million through June 2022 to work with the health department and other city offices on targeted outreach to boost vaccinations, much as it approached participation in the 2020 census and presidential election, said Stephanie Reid, the executive director.
“We should already be out there, right?” Reid said. “I want to be out in the neighborhood and hearing from people and starting to listen.”
Reid is adding 21 people to her staff, she said. Her personnel have already begun making calls to help register residents. They will eventually canvass to register people in the targeted neighborhoods, as well as coordinate with community groups.
There are key differences between census participation and vaccine registration, though, she said. Census enumerators could help people fill out forms on the spot, essentially resolving that person’s interaction with the census, while filling out a vaccine registration is just a first step. Philly Counts will initially focus on a narrow set of neighborhoods, Reid said, and will likely visit them repeatedly with the goal of helping those communities reach a 70% immunity rate, and then evaluate which approaches are most effective.
She acknowledged the benefits of vaccination without appointments or registration as another way to improve access, but said continuing to maintain a registry also has worth.
“I think the key is providing the right combination of it,” Reid said. “Some people are going to want an appointment, and some people are going to want to walk up.”
Lozada hopes that as more doses become available and internet-savvy young people are eligible for vaccination in Philadelphia, some of the need for door-to-door outreach will ebb. But Barber warned an abundance of vaccine won’t make equity issues go away.
Philadelphia will begin making some people in the 1c category eligible for vaccination Monday, and she fears that without a concerted effort, underserved people who have suffered from lack of information and access could be forgotten once again in the flood of newly eligible vaccination candidates.
“There has to be a plan in place about how to make sure these inequities don’t widen as the vaccine becomes more available to larger parts of the population,” Barber said. “There’s still such a large part of the population that hasn’t gotten vaccinated, once you open that up they’re even further in the back of the line.”