The Asymmetry of COVID-19 Vaccine Access

Community Organizations, Neighbors Bridge Gaps in DC Information and Registration

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On Jan. 29, Barbara and David Ehrlich parked their cars and headed towards the Howard University clinic. It was a long walk for the couple, both 85 years old, but they didn’t mind. At the end of it, they were getting the COVID-19 vaccine.

But when the Southwest couple arrived at the clinic, they found the front doors locked. A simple sign was affixed. “No Vaccine,” it read.

“We had an appointment, we had the paperwork. But when we got there, there was no vaccine,” Barbara Ehrlich said. “We didn’t feel great. But it happens. We weren’t the only folks that had appointments and then weren’t able to keep them.”

The District began offering vaccine registration to residents 65 and older online and through a telephone hotline starting Jan. 11. It was the first time vaccines were available to members of the public. Demand far outpaced supply. On the first day, 6,700 appointments were available to about 80,000 eligible residents and were signed up for within hours. That window of availability would shrink from hours to minutes over the following weeks, prompting comparisons to a rush to get Beyonce tickets.

The process did not start out smoothly. After the first two days of registration, users complained of technological glitches, frustrating waits on the phone lines, and poor website design. Advisory Neighborhood Commissioner (ANC) Steve Holtzman 6B05 wrote the Mayor’s office to express concern with the process.

DC Health Director LaQuandra Nesbitt visits the PABC clinic. Photo: John Capozzi

“[I]f residents get frustrated and crazy trying to unsuccessfully get what they view as a life-saving vaccine,” he wrote in an email shared with constituents, “the result is going to be some people who give up and don’t check anymore and who, despite being in priority vulnerable groups, do not get (early) vaccinations.”

The challenges faced by seniors trying to get the COVID-19 vaccine in the District illustrate the asymmetry of access to information and resources about registration. The ways in which communities and organizations stepped up to fill these gaps provide lessons in information dissemination and registration strategies.

These lessons are particularly important as the District opens vaccination appointments to more residents in the context of a vaccine supply far too low to meet demand.

Success of Senior Villages
The Ehrlichs could have given up, but instead, they sought assistance and got it. They turned to their village for help. Waterfront Village is one of the District’s 14 senior villages, volunteer-based organizations providing services and resources to help seniors age in place. They are overwhelmingly located west of the Anacostia River.

Waterfront Village Executive Director Len Bechtel worked with the Dupont Circle village to get the Ehrlichs an appointment at Medstar.

“Len called us on a Sunday night at 8 p.m. Feb 7 to say he’d secured an appointment for Monday at 9:20 a.m.,“ Ehrlich said. “He filled our names in, made the appointment –and then he drove us there,” she said.

Senior villages operate independently from the DC government, but network together to share information and resources. When they learned vaccine registration would open to seniors, the 14 senior villages in the District worked together to get information from the city and disseminate it broadly to members and those subscribed to their list.

“We had members that were calling their adult children overseas to help them negotiate the portal, that’s how challenging and overwhelming it was,” said Capitol Hill Village (CHV) Executive Director Judy Berman.

Faced with calls from seniors who were confused and even put off by the District’s registration system, the 14 senior villages stepped up to be advocate and guide. First, they were a trusted source of information. Second, they provided feedback to DC Health about what was going well and where improvements were necessary. Third, they centralized and distributed information, both in terms of the District vaccination procedures as well as the hospital and healthcare systems also offering vaccinations on separate platforms, including George Washington, Georgetown and Howard University Hospitals, Sibley, as well as the Kaiser and Medstar.

Finally, they worked together to get appointments for seniors who reached out to them. For instance, Waterfront Village conducted a survey of membership to see who still needed an appointment and wanted help in making it. They then matched those individuals with members who had successfully registered as well as community members who helped them secure the appointments.

Lopsided Success
Senior villages were overwhelmingly successful in helping those who reached out to them. By Feb 11, all but five of the 150 members of Waterfront village had received their first dose of the vaccine. 90 percent of the 400 or so members of Capitol Hill Village (CHV) had also secured the vaccine.

But the people who reached out to the senior villages were overwhelmingly white and middle class. CHV’s Berman said that the villages had been discussing ways to provide village resources to all seniors. “The village model is not attractive to all people in the same way,” she said. “It’s definitely had more of an appeal, particularly in our area, to a white and middle-class population. In my view what’s happening is that the function of the village is being served by different institutions in the Black community.”

This map, created by DC Health, shows the number of successful registrations for the COVID-19 vaccine per ward on Jan. 11, the first day registration was available to seniors. Image: Coronavirus.dc.gov

Francis Campbell, 69, struggled to make an appointment for a month after they were available. Campbell, who is black, is not a part of a senior village. “I’m still independent,” he explained.

The former Advisory Neighborhood Commissioner (ANC) 6B10 is comfortable with technology but was still overwhelmed with the process. All through January he tried –and failed—to register himself, his sister and his 88-year-old mother.

In the end, Campbell managed to secure a vaccine by word of mouth. A friend called him from a vaccination site to say there were unclaimed doses and Campbell should gather his family and get down there.

“This is a frustration I’ve never had to deal with no matter how bad situations have been in my life, even when I was teaching,” Campbell said. “If a lot of the Black seniors don’t have someone who is going to advocate for them, or make sure this happens, they’re going to get passed over. That’s what’s happening.”

Kathy E. Pointer is Director of Kingdom Care. The Ward 8 senior village is one of the newest and smallest, serving 50 members out of Greater Fellowship Full Gospel Baptist Church (FGBC) (814 Alabama Ave. SE).

Pointer said that, in terms of the vaccine, she sees the role of the village as sharing information, finding out who needs an appointment and helping them to secure one. For instance, when she received an email telling her that the District had made 660 additional appointments available only through the call center, she sent a text message to all members. Instantly, two successfully booked appointments.

Like CHV and Waterfront Village, Kingdom Care is part of the consortium of villages that share trusted information with members. Unlike the two Ward 6 villages, Kingdom Care is based in the church, growing out of the senior ministry. Pointer herself was a very engaged church member long before she became the village director, and she said that it was an ideal space for the village. “There was already engagement, buy-in from leadership and access for the community,” she said. “It was a win-win sort of thing.”

She said that black churches are key to sharing information about the vaccine. Pastors are trusted leaders, advocates and friends, Pointer added, and messaging is better received when communicated by pastors to parishioners. “There’s a trust,” she said. “There are relationships there, there’s already been a demonstration of care and concern, of health and wholeness. You also have the collaboration among churches that helps to strengthen the community.”

Tweaking the System
The inequities were apparent on Jan. 11, the first day vaccines became available to seniors. Residents of the District’s three most affluent wards claimed 70 percent of available appointments. It was clear that while COVID-19 was disproportionately affecting communities of color, more vaccinations were being administered to the white and affluent residents of the District.

A Jan. 13th DC Council conference call became heated when Councilmember Elissa Silverman (At-Large-I) and Ward 5 Councilmember Kenyan McDuffie suggested that vaccines be prioritized for people hardest hit by COVID-19. Silverman commented that some members of low-income communities might not have access to computers or have the technological literacy to book appointments.

DC Health Director LaQuandra Nesbitt initially scoffed at Silverman’s suggestion, calling the statement pejorative. She said vaccine resistance had played a role. Results of a November 2020 DC Health survey appeared to show that about 44 percent of Black District residents would not take the vaccine.

The District moved to even the playing field. Three days after the council call, Nesbitt announced that access to registration would be prioritized by ward and later by zip code. A week after the change, the ratio of appointments claimed by residents of the three affluent wards dropped from 70 percent to 49.5 percent, which Nesbitt said was an indication that the new system reduced disparities.

The District took further steps to address inequity, including the introduction of the Senior Vaccine Buddies program on Feb. 4. Program staff go door-to-door in neighborhoods most impacted by the disease, offering to sign seniors up for a vaccine appointment.

Finally, on Feb. 7, Mayor Muriel Bowser announced that as part of the “Faith in the Vaccine” pilot program, Pennsylvania Avenue Baptist Church (PABC) would host two vaccination clinics to increase confidence in the vaccine and support the vaccination of residents in their communities. During two clinics, hosted Feb. 11 and 13, more than 200 people were vaccinated.

Pastor Rev. Dr. Kendrick E. Curry began advocating for churches to be used as vaccine distribution sites in August, before vaccines had even been approved. He argued that Black churches were centrally located, engaged in service and capable of operating during non-traditional hours –in short, all elements suited to getting the vaccine deeper into their communities.

“We can do what people need,” Curry said. “that’s why people come to us.”

John Capozzi signed up for the PABC Clinic at a virtual Hillcrest Community Civic Association (HCCA) meeting. Administrators not only announced the clinics, they also shared a link to register. Capozzi, who is 65 this year, clicked on the link and signed up during the meeting. A white Ward 7 resident who lives in a priority zip code, Capozzi had previously tried to sign up through the District portal but while he describes himself as an “intermediate [technology] user,” he was unable to get an appointment.

PABC is particularly “outreach oriented,” long the hub of a network that not only includes other churches, but also civic and political organizations. The church drew on all those networks to get word out about the vaccine clinics.

“I started Calling People”
Sometimes the congregants are the network. “After I got [my vaccine], I came home and pulled out my church directory and I started calling people,” said Barbara Savage. Barbara and her husband Paul were expressing frustration with the District vaccine registration portal when a neighbor said they should try calling United Medical Center (UMC) to get an appointment.

Trying to reach the scheduler and getting a busy signal, Paul Savage redialed the number so many times that a UMC operator finally picked up. A few minutes later, a scheduler called back to make appointments for both Savages.

Like the neighbor who had advised them to call UMC, the Savages shared what they had learned with members of their church and neighborhood, starting a sort of telephone chain.

Barbara started calling the other members of East Washington Heights Baptist (2220 Branch Ave., SE) aged 65 and over, asking if they wanted to register for a COVID vaccine, helping to secure appointments and even taking people to appointments.

Then, in an online church service, Senior Pastor Reverend Dr. Kip Bernard Banks Sr. announced that parishioners wanting assistance registering for a vaccine appointment should contact the Savages. Members of the congregation began referring their neighbors, and they referred their friends. In the month since the Savages received their first dose, they have helped more than 20 people secure an appointment.

Paul Savage had tried and failed to register through the District website. The short lead time on many vaccine announcements meant that he and those like him, who are not wedded to instant messaging, don’t get government notices as they come out.

But it isn’t the short lead time that is the real problem, Savage said. It’s the fact that the District uses the same methods to reach the diverse communities of the District. “They still haven’t figured out how to serve African Americans and Latinos in the same manner that they do other people,” he said. “and that’s on them. There’s a history of how you do this, and don’t do this.”

Paul Savage, a former District official, said that the city needs to do a better job of contacting the people who live in and care about the communities they hope to reach. “In the Black community, it’s not the internet –it’s not any of those things,” Savage said. “It’s word of mouth, in the church, or on the telephone. That’s how people disseminate information.”

“What Barbara did, that’s normal. We have a long history in East Washington of community involvement with our neighbors,” Savage said. “People in this city should know that, because it’s been going on for a long time.”