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Brian Lehrer: Brian Lehrer on WNYC. Since the earliest days of the pandemic, as you know, Black and Latino people in New York City have died from COVID-19 at twice the rate of white New Yorkers. Now, as vaccines become available, those communities that have been hit the hardest are not getting prioritized in a rollout system, that seems to be giving an advantage to groups that skew whiter and wealthier.

According to city data released over the weekend, three white residents receive a COVID-19 vaccine for every Black or Latino person in the city. Some more specifics, white people makeup 32% of the city's population, but have received 48% of vaccine doses. While Latino residents make up 29% of New York City residents, they comprise only 15% of vaccine takers. The Black community accounts for a quarter of the city, but their vaccination rate is merely 11%.

The data is incomplete because a large portion of non-city run vaccination sites have failed to report vaccinations by race, but public health experts say that this data that we have shows a definite and concerning trend that is being repeated in much of the country. With me now is City Council Member Mark Levine. He chairs the council's health committee and is calling on the city to make specific changes to its vaccine rollout.

We also have Dr. Uché Blackstock. She, as some of you know, from her appearances on this show and elsewhere, is an emergency medicine physician, founder, and CEO of Advancing Health Equity, and a Yahoo News medical contributor. She has suggestions for the Biden-Harris administration to fix inequities in the distribution system at the national level. Welcome back to WNYC, both of you. Hi, good morning.

Dr. Uché Blackstock: Hi, Brian. Thank you.

City Council Member Mark Levine: Thank you so much, Brian.

Brian: Council Member, for listeners who did not hear the mayor's press conference on this over the weekend, can you further elaborate on the data that was released? I know you and others have been calling for its release for weeks.

Council Member Levine: Well, we have an incomplete picture, Brian. I want to stress that. We only got a piece of the data which illuminates inequality, but it does offer race and ethnicity breakdowns, and you ran through them. White New Yorkers are getting vaccinated at triple the rate of African American and Latino New Yorkers. Really, that's a discrepancy that's even greater than some of the other COVID inequality that we've been seeing in this crisis, but we're still lacking something really fundamental.

We have no ZIP code level data, which could compare the Upper East side to the South Bronx, another critical view of inequality. It's really perplexing that it hasn't been released yet because the data is there. The city collects addresses on everyone it vaccinates. We're still fighting for more transparency, but it's not too soon to get beyond hand-wringing and point to solutions.

We need to fix this. We need a new web registration system that stops blocking out people who don't have tech-savvy or English language skills. We need to stop of crowding out people in vaccination sites in low-income neighborhoods who are competing against people, generally white, middle, and upper-income people, from all over the region. We can do that by having prioritization and scheduling for local neighborhoods at their vaccine site. We need to change eligibility in a way that fixes the error of omitting so many critical groups like people who deliver food, people who work in taxis, in restaurants, nail salons, people who are incarcerated.

Finally, Brian, we have to get out of city facilities and go door to door. We have to be going door to door to vaccinate. We actually can deliver the vaccine door to door for people who are homebound. Other states are doing this, and also simply to make appointments for people who are not able to get onto a home computer. Let's go door to door with iPads and sign people up. This problem can be addressed, and we need to not just talk about it. We need serious action to reboot our equity strategy for vaccination.

Brian: Dr. Blackstock, you recently wrote a piece in the Washington Post about this topic, and you wrote while there is urgency to vaccinate quickly, it cannot and must not be done at a cost to equity. I think that obviously is the guiding tension of this issue. Public officials want to get the vaccine into as many arms as possible and targeting specific demographics, they might see a slowing it down because it would take more time to organize. Can both things be done at the same time, in your opinion?

Dr. Blackstock: Yes, Brian, I feel strongly that both things can be done, and that we should not sacrifice equity for a more speedy rollout. The fact is that, and my sister and I, we wrote the piece together. We mentioned this, that it is almost our moral obligation to ensure that we're addressing these inequities head-on. I think it's interesting just to step back and to see how these inequities were created.

They were created by systemic racism, through practices and policies. We are going to need to be very intentional in the rollout in terms of mitigating these inequities. My sister and I, we laid it out in the piece. We strongly feel that Black Americans, because of the history of systemic racism in this country, we can just talk about redlining alone, the GI bill. There were federal policies that have disadvantaged Black Americans, leading to disinvestment in our communities that has directly impacted health.

When you look at the neighborhoods, current day, here in New York City with the worst health outcomes, those were the redlined areas. It is the city's moral obligation, really to focus on prioritizing Black communities and other communities of color. It's not just about making sure that there are vaccination centers in these neighborhoods. It's ensuring that there is accessibility because everyone, especially our homebound elders cannot get to the vaccination center.

As Mark mentioned, we need to be going door to door. We need to use community health workers who are trained lay professionals, either from the community, or who know the community well, to perform outreach, to go door to door with vaccines, and we need the complete data. We have incomplete data that's already showing a trend. The same thing happened at the beginning of the pandemic when we were asking for the data for cases, hospitalizations, and deaths. We saw the trend at the beginning. We're seeing the trend now and we have time to course-correct.

Brian: Let me give credit by name to your sister and co-author of that Washington Post piece, Dr. Oni Blackstock.

Dr. Blackstock: Thank you.

Brian: You're Dr. Uché Blackstock. She's not been on the show, I guess we'll have to advance a little family equity in the future and have her on, but Dr. Uché Blackstock and Dr. Oni Blackstock, collaborating on this. Calling Dr. Blackstock, calling Dr. Blackstock, how do we know which one's going to answer?

Council Member Levine, it wasn't supposed to be like this. Knowing all these underlying systemic racism factors like housing, redlining, segregating housing, all these things that Dr. Blackstock was just talking about that contributed to the starting point, and so many other things than that. Mayor de Blasio came on this show early on as the vaccine was about to be rolled out, and many other places and said, "We're going to prioritize 27 ZIP codes within New York City. That's how we're going to make sure that the people who've been getting the disease at disproportionate rates are getting the vaccine at those same rates," and yet it didn't happen. What went wrong?

Council Member Levine: Well, Dr. Blackstock, and I wrote an op-ed in Gotham Gazette in early December that warned of exactly this scenario, and it's played out as we feared. I think maybe she would agree, even worse than we feared. I'm not sure what prioritization in those 27 ZIP codes has looked like right now, but certainly, it's not helping people get an appointment. You go to a vaccine site, a city-run vaccine site in the South Bronx, and most of the people there are going to be white, and middle and upper income.

They're coming from, Brian, in some cases, not just all over the city, but all over the region. I don't blame anyone who's trying to get themselves vaccinated, willing to travel a couple of hours, but the fact is, we're crowding out local neighborhoods. The armory, which came in for a lot of criticism in New York in running a large--

Brian: Washington Heights Armory, in 169th Street in Manhattan.

Council Member Levine: Came in for a lot of criticism in its early days because the same thing was happening there. It was basically dominated by people coming from all over the region, the vast majority of which were white. They made a change. They are reserving 60% of their appointment slots for people from the ZIP codes in Washington Heights, Inwood, Harlem, and the South Bronx.

Now, they're getting a much more representative group of people vaccinating, but the city's not doing that. The state sites aren't doing that. I'm not sure what prioritization means as long as you're still crowding out local people, but this is the thing that a hospital's doing now, the city can and should do it as well.

Brian: To that point, another stat that jumped out to people from over the weekend and the mayor's release of these numbers. New York City has vaccinated more non-residents than it has vaccinated Black, Latino and Native American people who live in the five boroughs combined. That's a real statistical eye-popper on people driving in from outside the city or however they get there, getting their shots at city sites.

Council Member Levine: I wanted to say something about that very quick. This is an underappreciated trend. A quarter of the people we're vaccinating in New York city do not live here. Now, some of them are essential workers who work in the city and absolutely we should vaccinate them. A significant number, I think, need to be considered vaccine tourists. They're coming here because they get an appointment slot. That's okay, but we get dosage, we get supplies of dosages from the federal government based on our population and we're getting very little.

We're getting no extra dosage for the huge number of people who were vaccinating, who don't live here. You think of a site like the Aqueduct, which is a mass vaccination site in Queens, on the Long Island border, only accessible by car. Most people who are going there are almost certainly from Long Island, and every one of those doses is coming out of our stockpiles. It really is. It's crowding out people locally. The federal government could fix this by giving us an allocation that accounts for everyone we're vaccinating, who doesn't live here. It's something that I would like to see the Biden administration do.

Brian: Reacting to something that you said before, Dr. Blackstock, let me take a caller. Here's Keith in the Bronx. You're on WNYC. Hi, Keith.

Keith: How you doing? Good morning.

Brian: Good morning.

Keith: I really appreciate, I appreciate the conversations with the doctors to say, I'm a vet. I've served eight years, active and reserve. I live in the community of the Bronx and live in New York City since 1958. My point is, yes, we need to do this in our community. I work in health care. Why don't they use the healthcare workers as the doctor say, to talk to the community, to show them that, "Yes, we'll take the vaccine. You can do that. We can talk to our fellow New Yorkers and we can get this. Talk to the main hospitals like Mount Sinai, Montefiore, Mount Sinai, Northwell to get their members, to ask them to-- not volunteer, but whatever they may do to the federal government or the state to help out on the weekends. We can do this.

Brian: Keith, thank you. Please call us again. Dr. Blackstock?

Dr. Blackstock: I agree with that. I honestly think that the vaccination rollout should be community based. Unfortunately, the way that it started out, and it's not just in New York City or New York State, but the focus had been on hospitals and pharmacies. Pharmacies more addressing the long-term care facilities, and hospitals, first vaccinating healthcare workers. I think that in the process, we have really forgotten the importance of, especially for Black and Latinx communities, having a community-based approach.

Our amazing public health department actually partners with a number of community-based organizations, and we really should be maximizing those connections that they have to community members. Often, we talk about this issue of vaccine hesitancy. I like to frame it more as institutional trustworthiness, but the way that we can gain communities' trust is by putting the resources into the community, by putting resources into community-based organizations, supporting the work of community healthcare workers, who I mentioned before, know the neighborhoods well, know the people, and can interact in a way that others cannot.

I also just wanted to mention about the ZIP codes. I know that Washington, DC saw the same issue with non-residents coming in to be vaccinated. What they have done is actually prioritize a certain allotment for people who live in the ZIP codes with the highest infection and death rates. This is probably, this is a model that I think New York City should consider following, that we should absolutely reserve a certain number for people from the hardest hit areas so that non-residents are not coming in and utilizing the supply.

Brian: Dr. Blackstock, the hesitancy or the institutional trustworthiness, as you very aptly rename it, how much of a factor do you think that is, or--? My tendency right now is to say, we barely should be talking about that. That that's a distraction until we know that the systems are set up for the potential for vaccine equity.

Dr. Blackstock: Absolutely, Brian, I agree with that point, and I think that given how inconsistent that's rollout has been, it's further undermining public trust. Even when the surveys are done, there are a number of people who say, "I want to wait and see what happens." It's not that they don't trust that the vaccine works. They want to see the effect it has on other people. We need to get this right. We need to get the rollout right. We need to get outreach and accessibility right. We need to make sure we're collecting the data and focus on the process before we start talking about the "vaccine hesitancy".

Brian: Let's take another phone call. Maria in Sunset Park, you're on WNYC. Hi, Maria, thanks for calling in today.

Maria: Good morning to all. I have two point. Definitely the doctor's comments about it being a neighborhood approach. People know each other, there are trust factors, everything. I think everyone that is in this call is aware of that and the good that that brings. However, we already have in the City of New York, a trained cadre of people that went door to door, the census enumerators, that are sitting home, either collecting unemployment or were not eligible for unemployment, put them back to work.

These folks have already been in the neighborhoods, put them back to the areas where they work. They're known, their faces are familiar because they knock on the door, because they are known from the neighborhood. Pair them with someone that can give the vaccine and there you got it. It is such low-hanging fruit. You don't have to hire them all back, pick the ones that were the best performers. You pick the best, the people who knew how to get the idea across and let's do it. I submit, take Sunset Park for the first attempt and see how it goes. You don't have to necessarily do everything en masse. Test it and Sunset Park is ready for that test. Let's see if it works or not.

The second thing is that our senior centers are sitting vacant and the taxpayer is paying rent often to private landlords. They're sitting there with full commercial kitchens and nothing is being-- they are working off from the phone, but my goodness, they're accessible. They are ADA accessible. All those seniors for whom that senior centers was a lifeline on so many levels. Put the census back--

Brian: Maria, thank you for two wonderful suggestions, and City Council Member Mark Levine, chair of the Health Committee in city council. How much could you take up, could the city government take up either of those suggestions? Like the first one about using census enumerators, or maybe it's census enumerators who just had recent experience going door to door, as she said, plus some other new workers and send them out with iPads, or whatever, that can connect to the vaccination, particular appointment websites, that they would have control over and make appointments door to door in that way. Is that something that is consistent with what you were calling for before and that's doable?

Council Member Levine: Maria is exactly right. We have to do this. Actually, the census outreach is a successful model. We spent tens of millions of dollars. We contracted with local community organizations, groups that are on the ground, that have cultural competency, that speak the languages of communities. We need a comparable effort, at least as big, at least as well-funded, for outreach around vaccination. We haven't had it yet and we're losing precious time.

It must include door to door, door-to-door scheduling, but also door-to-door delivery of the vaccine, potentially, because we have hundreds of thousands of homebound seniors and people with disabilities who have no way to get to a clinic safely right now, and are left out of the vaccination process. You have the homebound people who have not been able to have family visit for 11 months because of a fear of catching the virus. The implication is real. We are behind on this. It's already February. We need to have people on the ground, elevating local voices in the languages of the city so that no communities are left behind. This is the way to build trust.

Brian: I'm amazed Councilman, that there isn't door-to-door vaccine delivery yet for the homebound, elderly, or anyone else who, for medical reasons, might be homebound. We get meals-on-wheels out there to so many people every single day. I asked Mayor de Blasio about this on the show recently and he was like, "Well, we'd like to do that. What we are offering is providing transportation for people who can't move easily to the sites," but Dr. Blackstock, that's not enough.

Dr. Blackstock: No, no, I agree. I did just want to make a point that I think the city was working out issues around the ultra-cold storage that's required for the Pfizer and Moderna vaccines. Initially, that was an issue. I think that they are figuring ways around that, but I will say that with some of the newer vaccines, like the Johnson & Johnson vaccine, that don't require ultra- cold storage, that it definitely will be proved to be a game-changer, exactly.

Brian: I know you have to go in a minute, Dr. Blackstock, let me read a tweet that came in and get your reaction to it. Brandon writes, "As a white-collar Black man, I can tell you that I don't trust this vaccine yet, and given the history of this country's experiments on its people, especially on Black folks, I can tell you that most Black folks who I've spoken and listen to, aren't big fans yet either." Can you respond to Brandon?

Dr. Blackstock: I would say Brandon, I get it. I totally get it. I know the history as well, but I also know the science that went into making this vaccine. I also know that the studies done on tens of thousands of people were reviewed by independent experts and showed that the vaccine is both safe and effective. I tell people that if there is any hope of seeing your grandmother, hugging a newborn baby, traveling to see relatives again, then our hope is in these vaccines.

I would encourage people to access as much information as they can about the vaccine, talk to their physicians or healthcare professionals, so that they can make an informed decision. I am fully vaccinated now, and I did this for, not only my family, my patients and my community.

Brian: Dr. Uché Blackstock, emergency medicine physician, founder and CEO of Advancing Health Equity, and a Yahoo News medical contributor. Thanks for coming on again today. We always appreciate it.

Dr. Blackstock: Thank you, Brian. It's always a pleasure.

Brian: We'll finish up with City Councilman Mark Levine from Manhattan, who's chair of the City Council Health Committee, and Councilman, how responsive is the de Blasio administration to the things you're calling for right now?

It seems to me like it should be fairly simple to do what they're doing at the Washington Heights Armory, which is reserving 60% of the vaccinations for people in the immediately surrounding ZIP codes, and the rest of the vaccinations only for residents of elsewhere in New York City, and reaching out proactively, to people in the neighboring ZIP codes as they've started to do from New York Presbyterian Hospital. You're saying that the city's health and hospitals corporation sites and other city-run vaccination sites are not doing that. Can't they just start?

Council Member Levine: They have to, the mayor's made some general statements this week in the wake of the release of some of the early data about moving in this direction, but we don't know anything about timing or the extent of that programming. I also want to emphasize that we are still missing a key piece of data, which is ZIP code level reporting on what neighborhoods are getting vaccinated, to what extent. That actually might be a good question for you to ask on Friday, Brian.

Cities all over the country are publicizing it, and it's a key piece of the equity puzzle, and many of our solutions are ZIP code based. It's the idea that people from local ZIP codes would have a preference at their local site. In a way, they don't. We need to push for the policy and we need the data that will track our progress on that.

Brian: Hopefully, it will be a moot question by Friday, which is three days from now, which could be a long time before the mayor comes on, hopefully. Do they have that data by ZIP code and they're just withholding it for some reason?

Council Member Levine: Absolutely. When you get a vaccine, your home address is entered into the database. That's true. Whether it's a flu shot or any other kind of vaccine. It's actually more readily available than race, ethnicity data, which makes it perplexing that we haven't released it yet. It's probably the easiest and cleanest data set we have. We also, by the way, haven't gotten gender data and nothing on profession, and I have legislation that we're drafting now to force that.

We also have legislation that I'm drafting, by the way, to require ZIP code preferences in low-income neighborhoods. We're going to make sure this happens one way or another, be great if the mayor and the administration do it proactively, but I don't think this is something the city council can sit by idle on.

Brian: City Councilman Mark Levine. Thank you very much and you bet, if this isn't resolved by Friday, we'll follow up with the mayor. Yes, go ahead.

Council Member Levine: Brian. 30 seconds left, because this is just an issue that's not getting enough attention, which is the rise of variants in New York City. This just poses a real threat, and government leaders are not talking about it, and frankly, reporters aren't either. This is partly because again, no data is being released, but I have understanding that there's been 13 detected now of the B117 variant in New York City. It's a far more transmissible, and examples from elsewhere around the world, make it pretty clear that we could be headed for a rough few weeks on this.

We're sequencing so few samples, that the presence of 13 detected probably means thousands are here. Every decision that we make about personal behavior, and policy decisions about whether to reopen are made with the awareness that the variants are here and growing rapidly. I've also got legislation to require reporting on that, too, because, I think the public has no eyes into that, and we need them to understand the mounting threat.

Brian: How do you think that should inform people's decision about whether to get a vaccine early?

Council Member Levine: We are essentially in a race between vaccination and the variants, and so the stakes are raised on every front. It makes it more urgent that we accelerate vaccination, that we get vaccination to every community. There's no herd immunity in the city if we leave out whole sectors of the city. In fact, variants develop if there's uncontrolled spread. We have uncontrolled spread in New York City right now. We have over 5,000 cases a day. That's an astounding number, and Brian, we're still seeing over 400 fatalities a week.

Again, in any other context, that is astounding. I know we've become numb to this after just a brutal 11 months, after such loss, and the pain of being locked in, it's tough for everybody, but the fight's not over. We can't let our guard down. This also needs to impact personal decisions. At this point, really, people should be really judicious and non-essential activities outside of home. If you are someone who's high risk, you should really limit travel outside of home. If you live with someone who's high risk, you should really limit travel outside of home. That message isn't being delivered enough to the public, but the rise of variants makes it urgent that people take this seriously.

Brian: Councilman, thanks for your work on this. Thanks for coming on.

Council Member Levine: Thank you, Brian. Thanks so much. Be safe.

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