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Brian Lehrer: Brian Lehrer on WNYC. Now Caroline Chen from the nonprofit news organization ProPublica who continues to do great reporting on vaccines. Her latest article coauthored with Maryam Jameel is called How Inequity Gets Built into America's Vaccination System. Thanks for coming on again, Caroline, welcome to WNYC. Welcome back to WNYC.

Caroline Chen: Hi.

Brian Lehrer: Hi. Your article gets specific, and we'll go down your list of major reasons, which I think will be very illuminating to a lot of people who haven't thought this through all the way, but as a starting premise, maybe we should establish that we can't start and end these conversations with there is more vaccine hesitancy among people of color like it's all about individual choice, would you say?

Caroline Chen: Yes, that's definitely true. I think that there's this broad narrative out there that there's just super-high rates of vaccine hesitancy. I think oftentimes, it's just conflated with difficulties and access. I think also, sometimes there are folks who have questions about the vaccine, which does not mean that they're not going to get the vaccine, and I think that also all gets just lumped together in this big category of vaccine hesitancy. Just because someone has questions that they want answered about the vaccine does not mean that they're not going to get it at all.

Brian Lehrer: Vaccine hesitancy is a thing and it is not apparently equal across all demographics, though it's also high among Republicans compared to Democrats, and they tend to be white. There are various categories of vaccine hesitancy that are real, but let's get into these categories where, structurally, inequity is built into America's vaccination system. One big group you discuss is people who don't use the internet, and that's about 10% of Americans, according to the Pew Research Center, which you cite, and that 10% very much overlaps with groups at most risk of getting COVID and getting it bad, right?

Caroline Chen: Yes, so what Maryam and I were looking at were places where systematic barriers are actually designed into vaccination sites, whether it's the signup process or the actual physical site, we can talk about those in a bit, and whether intentionally or not these barriers are created oftentimes disadvantaging people who are really vulnerable. I think people don't think about, how are these systems even designed in the first place? So yes, the internet and access to the internet is one of the issues that has turned up early on which disadvantages, obviously, a lot of the elderly.

I'm sure there's so many of your callers who either have struggled themselves or who have been children or grandchildren who have spent a lot of time on the computer trying to get their parents' or our grandparents' vaccination appointments, and people who don't have people who can help them get these appointments are at a disadvantage. We've talked to people whose only option is the phone. In New York, if you call the phone line, they can only get you appointments at state-run site, so your options suddenly get filtered down. For example, we talked to one woman who the options for her, the closest one, the closest state-run site to her was more than an hour and a half away. You might not just think about that, if you have internet access, you're super internet savvy, you have way more options because you're not only limited to state-run sites.

Brian Lehrer: People who are older and people who have less education and people who have less income and people who are non-white all tend, disproportionately, to be non-internet users according to the Pew survey, so there are several categories of structural inequality right there in vaccine access. Who is addressing this well, and how, if anyone?

Caroline Chen: I think there are so many ways that these systems can be very easily tweaked if you just think about it. For example, one of ProPublica's partners, Wendi Thomas, at MLK50 wrote a story about in Tennessee, in Shelby County, for example, they had vaccine appointments that went up, and what they did was they allowed internet appointments to start on a Saturday and then they opened their phone lines on Monday, so I think you can guess what happened here. All the slots were immediately taken up on the weekend, they never even got to their phone lines.

It would be so easy for them to just either reserve a bunch of phone line appointment sites or start the phones on the same day as the internet. This would not be difficult to do if you just thought about it without majorly changing your system. A lot of the tweaks to the system design often involve just thinking about, is there anything in the design of your vaccine system that might create a barrier for a certain group of people? Is there any way in your design that you want to make sure you're not excluding a group of people?

Brian Lehrer: Listeners, we can take a few phone calls for Caroline Chen from ProPublica. We welcome your calls about ways that inequality is baked into America's vaccination system, the title of her latest article, and how to bake it out, 646-435-7280. How do you believe you or anyone you know has experienced the barrier that exacerbates unequal access to vaccines? We know it hasn't been easy for anyone more or less, but what are you seeing locally or anywhere or in your own life that seems to expose an unequal barrier to getting a vaccine appointment? What are you seeing locally or anywhere else that seems to help level the access playing field solutions as well as problems?

646-435-7280, 646-435-7280. Or any question you have for Caroline Chen from ProPublica. Your article mentions language as another barrier, meaning non-English speaking people in this country, for the most part, also associated with high risk because newer immigrants tend to live in denser housing conditions and have more essential worker service jobs. What's working? Let me keep focusing on solutions to the extent that we can. What's working to reach non-English speakers, and where's that being done well? Because you do have some examples in your piece.

Caroline Chen: Yes, so, of course, languages can be a big barrier. I really am impressed by there's so many community advocacy groups that have been really working really hard to make sure that information gets out, and this is a lot of local door-to-door labor happening here. There have been, for example, in Baltimore, a local nonprofit group called CASA de Maryland is literally hiring people to knock on doors to share vaccine information. They're also hoping that they can have their Baltimore office become a vaccination site. One of the things that we noted as another barrier is accessibility.

Speaking of what CASA de Maryland is doing here, one thing that I had not even thought about until we started recording this, for example, is that Chinatown in Los Angeles is right next to Dodger Stadium, which is obviously one of the biggest vaccine sites in the country, but it's only drive-through. Because it's only drive-through, there are a lot of residents in Chinatown who don't have cars, so they can't get a vaccine at Dodger Stadium, but similarly, again, there's a very active advocacy group, the Southeast Asian Community Alliance, which has been advocating for these residents.

I think partly because of the advocacy of these groups, they've started to slowly get the attention of the city and to be able to get mobile clinics that hopefully will come at some

point this month towards these neighborhoods. I really admire how much these local groups are doing to bring attention to these communities.

Brian Lehrer: I want to ask you about a structural barrier, really a solution to structural barriers that's been proposed that I think wasn't in your article, but to see if you have a take on it. Gothamist has an article that says if vaccines do indeed reduce transmission as preliminary study suggests, then there's a strong argument to shift vaccinations to younger populations who play a larger role in spreading the virus. One source in the Gothamist piece sites how that would help vaccinate essential workers who tend to be younger people of color. Another advocates for eliminating age considerations for Black Americans who want to get the vaccine.

Dr. Uché Blackstock, a frequent guest here, says, "If you give priority over a certain age, you're actually prioritizing white lives and ignoring the historical and current structural inequities that shorten Black lives," Dr. Blackstock's quote. To that point, I asked the mayor on Friday, and we're going to play a clip by Mayor de Blasio here about that concept of basically allowing everyone in low access communities to get vaccinated, not just priority groups like older and sicker people or by job description. Here's a clip, as he says, he has thought about and rejected that approach because he sees the central issue as less supply than demand.

Mayor de Blasio: It's going to be quite a while before we can meet that demand. What we're seeing in African American and Latino communities, in particular, is demand is steadily increasing. We've got lots and lots of people who want the vaccination, especially among the seniors. I think it's a better approach to address that demand, that will also create momentum, that will also create word of mouth, and then as we've made more success there, start to open it up to more and more communities.

Brian Lehrer: That's the choice that Mayor de Blasio is making. Do you know, from your reporting, if any state or locality or policymaker is acting on anything like Dr. Blackstock suggests?

Caroline Chen: I do know that there's at least one small, very small, though, in Arizona County, I think it's called Gila, Arizona, G-I-L-A, that has just opened up to its entire county. I think it has something in the under 50,000 residents or something like that. It's not going to happen in New York City. I think we've talked about this before, Brian, that state by state, every state can do whatever it wants, and county by county even. We don't have a uniform policy across the US. Ultimately, different policies can be tried, and what you're proposing here, which is to lower the age limit to give different priorities in different ways can eventually be tried out in different states as we go and as supply increases.

I think everybody has agreed that initially when supply was extremely, extremely limited that it made the most sense to give the vaccine supply to the most vulnerable, so the elderly because those are the people who are most at risk of dying if they get sick. I think as the vaccine supply increases, we do start to come into these questions you're asking us, which is how do we reduce spread overall? Are there other ways that might be more successful? Because you're right, the great news is that the data is starting to show that, in fact, the vaccines will reduce transmission at least to some extent.

It's kind of funny because the more supply we have, the more we can have those discussions, but then we have more supply, so then we're already going to be starting to expand down those tiers.

Brian Lehrer: In two months, you're going to come back on the show and we're going to talk about all these excess doses that nobody's signing up for, but we'll have that problem when we have that problem. In the meantime, we have this problem.

Caroline Chen: I would love to have that problem, Brian. I waiting for that day, but I do think we're not yet at that point.

Brian Lehrer: No.

Caroline Chen: For sure, and I think one of the main things that I am concerned about right now in New York is that, as we've expanded into the category of people with pre-existing conditions, that I'm worried about, particularly speaking of language barriers, for New Yorkers who maybe don't have the ability to read the fine print that they might think, "Oh, I need a doctor's note," or, "I need a lot of documentation." We know that non-white Americans tend to have less access to doctors. You don't need to have documentation or "proof" of your medical condition to get the vaccine. It's a personal attestation.

That's the way that New York has managed to lower the barrier here, not asking for onerous documentation, which I think is great. I hope that that does not become a barrier, thinking that you need to book a doctor's appointment and get documentation.

Brian Lehrer: I'll add that I didn't realize until I saw it in your piece that even under the Trump administration, the federal government has encouraged undocumented immigrants to get vaccinated, no questions asked. Let's take a few phone calls while we have a few minutes left with Caroline Chen from ProPublica. Her latest article coauthored with Maryam Jameel from ProPublica is called How Inequity Gets Built into America's Vaccination System. Nicola Mamaroneck has an experience. Hi, Nicole, you're on WNYC.

Nicola Mamaroneck: Hi, Brian, thank you for taking my call. I'm an educator and an I have two master's degrees, and I have found this process really difficult to try to get a vaccine. I became eligible as an educator within COVID morbidity, and I made a spreadsheet with all the possible ways to get an appointment. I made lots of phone calls and I walked to Wilkes to Walgreens to hospitals and using the New York State site. It really took me forever to get an appointment, and that's why I think I can share from my own experience. There are times of the day when appointments seem to have [inaudible 00:15:35] and be available.

Sometimes there's tons of day [inaudible 00:15:40] for people who work and you have to call and maybe get into a queue, and they're going to call you back 50 or 75 minutes from when you call. I think I've also figured out that if you have challenges with language barrier, it's very difficult to get through the system because there was a day when I was seeking an appointment time and I put in all my information and I got to the last thing, the whole thing glitched, and then I lost the appointment and there were no more appointments.

Caroline Chen: Oh, no.

Nicola Mamaroneck: I did finally get an appointment around noon on Easter Sunday, I think probably because of I guess a weekend by calling and calling every day around 7:30 in the morning.

Brian Lehrer: Nicole, I'm going to leave it there partly because our connection is really bad, and I think a lot of listeners are probably having trouble understanding you, but Caroline, in that one really excellent call, Nicole laid out so many of the barriers that would afflict people who aren't as privileged as some other people like these time of day requirements. I can't tell you how many people I know personally who've gotten appointments by being available for a last-minute call back when somebody cancels an appointment, and that requires a lot of flexibility in your schedule, which a lot of lower-income essential workers don't have.

Or to be up at 7:30 in the morning and be the first one to check that day, as Nicole was describing, for something that might be opening that day and being able to jump on a moment's notice, and other things that she brought up there. Really excellent examples, right?

Caroline Chen: Yes, I think Nicole's description of her persistence just shows what it's needed right now to be able to get a vaccine. If your priority is taking care of your kids or having to be able to be at your job and not be constantly refreshing a site. I don't think that it's easy to get a vaccine right now.

Brian Lehrer: Let's take another call. Let's see. I apologize. Yes, Steven in Brooklyn I think is working on this with some people. Steven, you're on WNYC. Hi, there.

Steven: Hi, good morning. Thanks for taking my call. I just want to talk about the experiences I've had as a board member for an app for profit, which successfully vaccinated over 500 people on a weekend, and my personal experience trying to get my family members vaccinated. I'm on the board of the Flatbush Y and the state set up a walk-in no appointments or phone only. We were able to vaccinate, I had nothing to do with it personally, only on the board, but the state and its healthcare partners were able to vaccinate 500 people in a weekend, all because a whiteboard was set up on the street outside of the Y, so the community could see that and walk-in, and then they'll make appointments on the phone. No internet and people who called who were not eligible were turned away.

As opposed to the work I did for my in-laws, 85 and 91, which literally took all the tech-savvy of me, my son who was a programmer, and my wife to be refreshing, knowing when sites updated, knowing when certain places put the vaccine out on the street and others. It was very trying, but we succeeded for my in-laws, but it was not an easy process at all. I have the time and we have the tech-savvy to do it, so it's really a crazy system.

Brian Lehrer: I'm really glad you called with this story. Let me ask you a question. Mayor de Blasio has said no to walk-up sites as opposed to drive-through sites because it tends to cause crowds to form if people can just walk up, which is seen as a COVID risk in and of itself. How did you manage that?

Steven: I just want to say I was not on site, the executive director there ran the show with the state and the health care partners, but from the call where we debriefed, the first day was very slow. People didn't know, there was no notice in the community. Very little notice because it was only done via a flyer that was made available the day before, but a whiteboard went out in front, and it said, "Come in, vaccine available here." People came in, they were screened, they have to be eligible. Apparently, on Sunday's Valentine's Day, a lot more people found out. There were lines for those with appointments and those for walk-ins.

My understanding was that most of the people on the line were able to be accommodated. There was social distancing. It was a freezing cold day, so that may have kept the numbers down. I think it was Valentine's Day. My understanding was that it was managed very well, and we were able to process everyone at the Y by opening more rooms and distancing more inside, and accommodating everyone who we could.

Brian Lehrer: Thank you for that story. That's really great. By the way, I see from one of our producers that Dr. Burkhardt from the Morris Heights Health Center in the Bronx was one of the people who spearheaded that effort in Flatbush. Caroline Chen from ProPublica, as we run out of time in our last 30 seconds, is that model spreading? We've heard some good examples of a number of things on the show today from you and from some callers, where's the hope for reducing the vaccine inequity?

Caroline Chen: I love that story, I love the low-tech nature of it. I just add that putting a sign outside and having social distancing outside, we know that being outside is good for lowering COVID risk, and so I don't see if you're able to line up outside or have an open space, an outdoor basketball court or something like that for people to line up and wait. It's getting warmer now, I feel like this is definitely possible. I would encourage seeing a lot more of that type of model and I hope that other places can follow suit.

Brian Lehrer: Caroline Chen from ProPublica, co-author of How Inequity Gets Built into America's Vaccination System on ProPublica site. Caroline, thanks as always.

Caroline Chen: Thanks so much.

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