Beatrice Evans knocked on every door in her 100-unit apartment complex on B Street SE. As the president of the Triangle View Apartments tenant association, she is the ideal messenger to share information about the COVID-19 vaccine.
“You got people who want it, and then you got people, those hesitant people,” Evans, 67, says of her neighbors.
Nearly every Triangle View resident is Black. Those who are wary of getting vaccinated understand America’s history of medically mistreating Black people. In the 1930s, federal health officials recruited Black men, many of them poor, to participate in what is now known as the Tuskegee Syphilis Experiment. The men were only treated with placebos despite a treatment being available and many experienced serious health problems or died as a result.
But others have accepted the efficacy of the COVID-19 vaccine, which went through clinical trials and was tested on tens of thousands of people of all different races and ethnicities, including Deputy Mayor for Health and Human Services Wayne Turnage and Ward 3 Councilmember Mary Cheh. They just have trouble accessing it.
Many Triangle View residents became eligible for vaccination on Jan. 11 because of their age. The complex’s residents are between the ages of 57 and 93. A few got their shot through private health care providers, like Kaiser Permanente. The rest of the residents encountered greater difficulty.
At first, they did not know how to book an appointment. Evans received just one robocall in mid-February from Johns Hopkins Medicine; Sibley Memorial Hospital in Palisades, part of the Hopkins Medicine network, is a vaccine provider. She says she’s seen no flyers containing vaccine information. (The D.C. government has created flyers telling residents to visit coronavirus.dc.gov/vaccinatedc to learn if they are eligible, but it’s unclear how widely they were distributed.)
“We are not on Facebook and social media and all of that. We look at the news, but they don’t really educate the people,” Evans says. They eventually learned they could book through the D.C. government website, vaccinate.dc.gov, but most did not have computers. Those who did described the website as difficult to use. (Using the portal has been complicated for plenty of people, including George Washington University students.) Many gave up on the call center because their initial experiences proved discouraging—some waited hours to speak with a representative. Sometimes, the call taker failed to call back.
“After hearing all those complaints from my neighbors, I said ‘No. We got to do this a better way. I know there is a better way to get this done,’” Evans says. “Somebody needs to speak up for my people over here. I still got a little energy, and I make the time.”
In early February, Evans reached out to her ANC commissioner, Ward 7 Councilmember Vince Gray, and a community advocate she believed could help the residents of Triangle View, a senior building owned by DC Housing Authority. “I called everyone I knew and said ‘You all need to do something and get a mobile unit over here,” she says. “The people over here are the most vulnerable and the most needy. And I told them, ‘You should take that extra step. If you really care about the seniors over here, then take that extra step and make sure we get vaccinated too.”
Gray’s office suggested that a vaccine site could be set up if enough residents were eligible and interested and if space allowed for it. On Feb. 19, a Gray staffer picked up a list Evans compiled while door knocking—58 eligible seniors in her community, some of whom have mobility issues, wanted to get vaccinated. Other residents who are under 65 but have a disability and will likely be eligible for vaccination on March 1 are also interested.
“I feel like we always get left out,” Evans says of residents east of the Anacostia River. “You all make us last or just forget about us.”
A neighborhood map of fully vaccinated residents published by DC Health shows Fort Dupont, Evans’ neighborhood, at the bottom. Another map showing residents 65 and older who have gotten vaccinated looks like so many other maps of D.C. that underscore inequity. The map published Feb. 16 shows that 50 percent of eligible residents in majority-White Ward 3 received their first shot, while 21 percent of eligible residents in majority-Black Ward 8 have. The map upset those familiar with the other maps of inequity: More people have died of COVID-19 in Ward 8 than in Ward 3, and more people have access to the internet in Ward 3 than in Ward 8. The median household income in Ward 3 is $128,670, 1.5 times the median household income in D.C. and double the median household income in the U.S. The median household income in Ward 8 is $35,245. Those familiar with existing racial and economic disparities in health care anticipated these disparities in vaccination unless the D.C. government got ahead of it.
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“The department of health didn’t create these disparities, but the disparities already existed and they did not account for them,” says Ambrose Lane Jr., founder of the Health Alliance Network in D.C. and co-founder of the Black Coalition Against COVID-19. “They rolled out the vaccine to all seniors … all that did was show the glaring disparities that already existed.”
DC Health receives all the city’s doses from the federal government, but funnels a lot, if not a majority, of vaccines to hospitals and health centers. Just over a third of the District’s supply in the first week of February, for example, was reserved for those booking appointments at some pharmacies and other sites across the city through the government portal. The rest go to hospitals, health centers, and private providers like Kaiser and One Medical, which have the infrastructure to set up appointments themselves. A couple hundred of the tens of thousands of doses D.C. received so far have been reserved for special initiatives like mobile sites.
More than a dozen seniors, community advocates, and health providers City Paper spoke with appreciate how difficult it is to vaccinate hundreds of thousands of residents. The D.C. government faces unavoidable logistical challenges. The Pfizer vaccine must be stored in an ultra-cold freezer, for example. Balancing efficiency and equity would be the greatest challenge, warned DC Health Director Dr. LaQuandra Nesbitt before opening up eligibility to seniors. Nesbitt told the D.C. Council in a Jan. 6 call that DC Health was trying to identify senior communities for mobile vaccine sites. “If I’m being extremely honest and transparent,” she said, “that model is not portable to every community that has 10, 20 seniors who have mobility limitations.”
Still, there are decisions the D.C. government and vaccine providers made that resulted in the uneven rollout. D.C. initially opened eligibility to residents 65 and older as opposed to those 75 and older to account for inequities; Ward 3 residents have a longer life expectancy than Ward 8 residents. But Lane believes DC Health missed an opportunity by failing to prioritize seniors with chronic diseases that put them at increased risk of severe illness from COVID-19. Had officials done that, more Black and Brown seniors would have been vaccinated, he argues. D.C. also relied on a health care system concentrated in Northwest D.C. Some of the hospitals and health centers that generally serve underserved communities like United Medical Center and Bread for the City did not initially prioritize their own patient populations for doses, leading them to vaccinate wealthier residents instead. Then there was the botched rollout of vaccinate.dc.gov—the first-come first-serve model discourages some from using it, even though the government has since made some improvements to the user experience.
As DC Health opens up eligibility to more people—namely, residents with specific medical conditions on March 1—community advocates emphasize meeting people where they are through mobile vaccine clinics to prevent further widening of disparities. Given that hospitals and health centers are concentrated in Northwest, D.C.’s largest quadrant, mobile sites could solve transportation issues. Some people say they would be more comfortable in a church or community-based setting as opposed to a health care setting, especially if it’s not coming through their primary care provider. Evans, for example, hates going to the doctor, but wants to get vaccinated to be an example for family members who are skeptical. She plans on having her 93-year-old mom, whom she cares for, get vaccinated alongside her. Evans believes her mom would be more accepting of the vaccine if she could get it in Evans’ home.
“When it comes to vaccine acceptance and the notion that African Americans are less accepting of the vaccine than others, that part fundamentally is true, but not to the extent in which it was raised and not to the extent in which it was used as an excuse,” says Lane, whose group has been working to build trust in the vaccine since last year.
Advocates believe DC Health is working to narrow disparities that emerged during the previous six weeks that providers have been vaccinating seniors. The agency set up mobile sites at 11 public housing buildings and one at a Baptist church in Ward 7, and officials set aside 200 doses for appointments made when government employees went door knocking in Ward 8. Most notably, the District now releases appointments via the online portal and call center to underserved zip codes on Thursdays and then to every resident regardless of zip code on Fridays. DC Health also started reserving doses for call center users in mid-February so tech-savvy seniors or those with support don’t reserve all the appointments within minutes. Nesbitt was initially resistant to some of those ideas, in part because they presented new logistical challenges. Nesbitt has repeatedly said that racial equity is at the center of the rollout. But not everything is in DC Health’s direct control.
Hospitals began by just vaccinating health care workers, but a spokesperson for Mayor Muriel Bowser says hospitals are now mostly using their doses for residents 65 and older. A majority of the six hospitals that are vaccine providers, along with Kaiser Permanente, are scheduling appointments exclusively for seniors who’ve been patients with them in the past. Sibley, for example, is contacting patients seen in the last two years by phone, email, and text message to offer them the vaccine. Howard University Hospital is letting any resident 65 and older book an appointment online, while United Medical Center is accepting reservations by phone. The hospitals that have been accepting any senior at one point between mid-January to now, UMC and Howard University Hospital, have the most Medicaid patients, although UMC says it has not used its Medicaid rolls as an outreach tool. Every hospital except UMC is located west of the Anacostia River; four of the five hospitals west of the Anacostia are located in Northwest.
Those just scheduling their patient population say they are keeping equity in mind. Kaiser Permanente uses its electronic medical record system to target eligible patients. “We are prioritizing people who [are] at higher risk for serious illness (due to age and health conditions), and those with higher risk of exposure,” a spokesperson writes via email. Due to limited supply, the spokesperson says Kaiser Permanente is only vaccinating members 75 and older. More than half of the seniors who’ve been vaccinated are people of color. MedStar Health is reserving appointments for patients 65 and older on a weekly basis, and prioritizing form submissions from underserved zip codes, a spokesperson says. But a MedStar Health representative told the Council at a Jan. 29 hearing that 60 percent of people they’ve vaccinated across four sites were White, excluding their workforce. Twenty seven percent were Black and 1 percent were Asian. It’s unclear how many, if any, were Latinx.
Located in Ward 8, UMC, D.C.’s only public hospital, was directed to vaccinate residents 65 and older, regardless of where they lived. The hospital started limiting appointments to Wards 7 and 8 residents sometime in February to address emerging disparities. “We would have been irresponsible if we didn’t do something about that right. So we did what we should have done. We focused our efforts to making sure Wards 7 and 8 had access to the vaccine,” says Dr. William Strudwick, UMC’s chief medical officer.
When UMC started vaccinating seniors in mid-January, a lot of Ward 2 and 3 residents, first-time patients, would book appointments. Strudwick believes the disparities reflect the wait-and-see attitude of residents east of the Anacostia River, and the eager, if not aggressive, attitude residents west of the river had. But as more Black leaders got vaccinated at UMC, including Vice President Kamala Harris, residents of the neighborhood became interested in getting their shot at the hospital. The day after Harris got her vaccine at UMC, on Dec. 29, the phone was blowing up, Strudwick says.
“We have more Wards 7 and 8 people that want the vaccine now than we have vaccines to give,” says Strudwick.
The current system is poised to change. “Hospitals that have been providing vaccinations outside of their patient populations will move to be integrated in the District’s vaccinate.dc.gov portal,” says a District of Columbia Hospital Association spokesperson. It’s unclear when hospitals will begin vaccinating residents who book through the portal. Further questions were deferred to DC Health, who did not immediately respond.
This week, Gray’s office says they worked with DC Health to ease restrictions on hospitals who just vaccinate their patient population. The idea is for Gray’s office to partner with, say, MedStar Health so they can vaccinate communities like Triangle View. The hospitals would still vaccinate their patient population but make exceptions for underserved communities. “There is less access to hospitals, clinics, pharmacies and grocery stores used to distribute the vaccine and buses to transport people in the East End,” Gray says. “To overcome these barriers, we need to engage directly with residents in these large buildings who may not be connected to social media or who may have mobility difficulties.”
DC Health strategically picked federally qualified health centers to be vaccine providers because most of their patients are lower income and uninsured or on Medicaid. Their patient population is also more diverse. La Clinica del Pueblo and Mary’s Center see the greatest portion of Latinx patients, while most of the others predominately serve Black residents.
“In terms of equity, the people that need shots are actually coming in, who we see on a regular basis,” says Dr. Tollie Elliott, Mary’s Center’s chief medical officer.
Mary’s Center, whose patient population is 67 percent Hispanic, has so far vaccinated 950 people, a combination of staff, frontline workers, and seniors. There’s been no vaccine wastage. Mary’s Center calls patients 65 and older, focusing on seniors with medical conditions that put them at risk of serious illness, and offers them the vaccine. Two to one, patients say yes. “It’s not an aggressive sales pitch,” Elliott says. “We’re there to offer help, and we’re there to show grace.”
Bread for the City, meanwhile, used to almost exclusively vaccinate seniors who booked through vaccinate.dc.gov, and split its supply between seniors and frontline workers. The provider wasn’t necessarily vaccinating its own patient population, even though it was partly selected for its diverse cliente. Their patients didn’t use the portal—they either couldn’t manage it or called their provider when they learned they were eligible. Some patients who are non-English speakers didn’t even know it was their turn until Bread for the City called.
“The city realized they had made a mistake,” says Bread for the City Chief Medical Officer Dr. Randi Abramson. “And they quickly said, ‘OK, you are not getting any more people through the portal right now and you can go ahead and use all your vaccines to vaccinate your patients.’”
While Bread for the City changed its policy, it still had to give people who booked through the portal their second shots. The week of Feb. 8, the provider vaccinated roughly 360 people, 245 of which were receiving second shots. Of those getting their second doses, 67 percent were White and 18 were Black. And of those getting their first doses, 55 percent were Black and 17 percent were White, which is more reflective of their patient population.
“I think one of the lessons we learned is the portal and having one central call center is not the best way to make sure people can get access to the vaccine,” Abramson says. “And I think getting it more in the community, in the community clinics where people are getting their private care, makes the most sense.”
“What’s really making this such a difficult time is everybody’s fighting over scraps,” says Elliot. “I have full faith [that] in a matter of a couple of weeks, we’re going to look at a totally different landscape.”