Dan Gorenstein: Black and Latino Americans are twice as likely to die from COVID-19 as white Americans. 

And yet, vaccination rates for white people are nearly two times higher than for Black people and three times higher than for Latinos.

Health departments from Washington D.C. to San Francisco are trying to get communities of color to the front of the line. 

But the road to vaccine equity is bumpy. 

Today, when good intentions hit reality in Chicago.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein and this is Tradeoffs.

Almost immediately after vaccines started rolling out, alarm bells began ringing inside the Chicago Public Health Department.

News clip: We begin this Hour 18 with what is being called one of the biggest challenges of ending COVID-19 — getting vaccines into the arms of people who need them most.

Allison Arwady: Right at the beginning, 18% of our vaccine was going to Black and Latinx Chicagoans, even though Chicago is 59% Black and Latinx.

DG: The city’s Health Commissioner Allison Arwady says then something remarkable happened.

AA: These last couple of weeks, more than half of our vaccine has gone to Black and Latinx residents. That was a goal that we set. We’re not done. There’s a long way to go. But I really think covid for the health department has been about putting our money where our mouth is.

DG:To jump from 18% of the vaccine going to Black and brown Chicagoans to 51%, the city had to rely on a recipe — a mix of data, trusted neighborhood groups and a pledge from the city’s most powerful leaders.

To understand how it worked, let’s step back.

The essential ingredients of the recipe came together over the last few years as Allison’s department, the mayor and the city council decided to tackle Chicago’s racial life expectancy gap.

AA: Black Chicagoans live almost nine years less long than other Chicagoans, regardless of where they live in the city.

DG: In response, Chicago decided to invest in underserved, majority-Black and Latino neighborhoods.

AA: It was all about building community capacity and recognizing that there are neighborhoods in Chicago that have been systemically not invested in where we have issues related to housing and neighborhood safety, access to food. These underlying root causes that we have to work on in a very long term way.

DG: So by the time the first COVID outbreaks swept through Chicago last spring, the health department had a grasp on which neighborhoods were the most vulnerable. 

That was Step 1. 

Step 2 — invite leaders from these Black and brown communities to advise city officials on the best way to blunt spiking caseloads. 

James Rudyk with the Northwest Side Housing Center explained that Belmont Cragin’s housing problems were exacerbating their COVID problems.

James Rudyk: The average house is somewhere between like 1,200-2,000 square feet. That is meant to be occupied by a family. That now is being occupied by two families and two families of five to seven individuals.

DG: Working-class families from Mexico, Puerto Rico and Central America make up 80% of the neighborhood. 

80,000 residents squeezed into four square miles — about twice as dense as the city overall — making it that much harder to socially distance.

James also told the city as many as a quarter of residents were undocumented, wary of speaking up even if they were sick.

And that led to Step 3 — deliver resources. 

Belmont Cragin asked for a testing center: They got one.

Belmont Cragin asked for masks: They got 25,000.

JR: We went door to door to every single household and passed out five masks, a bottle of sanitizer and a covid testing flyer to every single household in Spanish.

DG: Meaningful progress and, says James, a harsh reminder of how much work was left.

JR: During the second wave in November of 2020, 24% of people in Belmont Cragin tested positive. That’s one in four community members during the second wave.

DG: Here’s one way Chicago is lucky. 

It’s one of just five cities to get COVID vaccines directly from the federal government. That means the city has more control to distribute its doses where other cities must coordinate and compromise with state officials. 

Like most places Commissioner Allison Arwardy tagged Chicago’s first wave of shots for frontline health workers and nursing home residents.

But who should be next in line?

Allison directed her team to pull together what they call the COVID-19 Community Vulnerability Index.

It drew on neighborhood-level data the department had tracked for years — like population density and access to health care — and then added COVID-specifics like case and death rates.

AA: Put all of that together, this is what we have learned about covid over the last year. Ranked Chicago’s one through seventy seven community areas and use that ranking to say, we can’t do everything at once, we don’t have enough vaccine. So we use this index literally for every decision that we make as we allocate scarce resources. 

DG: The department decided in January to direct enough doses to fully vaccinate 10% of the adult population this spring in the 15 most vulnerable neighborhoods based on their Index score.

And prioritizing these communities meant not prioritizing other groups.

For example, anyone over 18 in a priority neighborhood could get a shot — regardless of health status — while people under 65 in the rest of the city with conditions like cancer or diabetes could not.

AA: I say no 100 times a day right now to a lot of providers, communities, individuals, about all things related to vaccine. I have to say no so that we can say yes to these initiatives.

DG: Little surprise, Belmont Cragin made the health department’s list of 15.

The city offered the neighborhood 16,000 doses.

James Rudyk in late January organized community leaders to come up with a plan.

JR: We said to that group, how do we need to do this? And what we heard was do a weekend site, have it be free, not have to show documentation and have it be at a trusted site that folks know and are willing to go to. That meant our local Chicago Public High School Steinmetz.

DG: There was just one problem.

Vanessa Valentin: We know that the city of Chicago, Chicago Public Schools have a lot of policies, right? They always find a red tape to, like, stop, you can use this facility. You can’t do that.

DG: Vanessa Valentin runs community relations for Alderman Gilbert Villegas. 

It made no sense to her when the Health Department and the Chicago Public Schools (CPS) said Steinmetz would not work.

VV: We said, why wouldn’t it work? Steinmetz is a big building, that’s not being utilized. You’re talking about events Saturdays and Sundays where there’s no students. Why? Why the obstacle, right?

DG: CPS says they wanted to make it happen, but a district policy requiring clinic staff to undergo full background checks was a roadblock. 

The health department suggested a little known banquet hall instead.

The idea angered Vanessa.

She thought about how much her job had changed since COVID, from fielding calls about garbage pickup and fixing busted street lights to something totally different.  

VV: Residents were calling me. They weren’t calling 911. They weren’t calling a doctor. They were calling me to make sure that they will be OK if they go get tested or they will say, “Oh, no, no, I’m not going to go. I’m going to do a tea. I’m going to do what we do back in my country.” And I lost so many people to that mindset because they couldn’t trust the process.

DG: With a vaccine nearly in hand, Vanessa saw a chance to do better this time. 

The school district seemed to be putting its policies in front of 221 Belmont Cragin residents who had died from COVID-19.

Challenging big players like the city’s health department and Chicago Public Schools though was new to her.

Nervous, she summoned strength from the people she’d lost, and she pushed.

VV: I thought about Mr. Sanchez. I thought about Mr. Aguilar, Mr. Ospina. All I kept seeing was we have an opportunity to bounce back and save lives, and we’re going to do it and we’re going to do it right.

DG: And it worked.

CPS and the Health Department said Steinmetz was on — until it was off.

JR: One day we would hear from someone hey OK, we got the approval, you’re good. Then the next day, oh we didn’t loop in the principal, they actually have concerns. The site’s off. Then the next day we talk to the principal. OK, it’s on. Then we hear from someone at the city that we didn’t talk to the legal team, OK, it’s off again. I can’t make this up.

DG: This all forced James to make an executive decision. 

JR: Wednesday morning we started registering for Saturday at Steinmetz, not yet having Steinmetz High School confirmed.

DG: Volunteers leapt into action — texts, door knocking, walking into small businesses. 

Vanessa spent so much time getting folks registered that her teenagers nicknamed her the “vaccine queen.”

VV: Because I don’t get up from this table till everybody’s scheduled. [laughs]

DG: In three days, they got 2,000 people signed up.

48 hours before the clinic opened, CPS finally said the Belmont Cragin team could use the school.

And that first weekend Team Belmont Cragin hit it out of the park.

VV: People that said we weren’t going to get the vaccine, but because it’s being provided in our local high school, we trust it.

DG: Safe space: check.

VV: We think vaccine, long lines, right? People are saying take some food, take some snacks. That’s not happening in Belmont Cragin.

DG: In-and-out in 30 minutes: check.

VV: And for them it’s like, wow.

DG: But CPS had only signed off for that first weekend, Valentine’s Day weekend. 

VV: And that Sunday, my stress level was up here because we didn’t know if we were coming back the second weekend.

DG:: Ultimately, it took Vanessa and Alderman Villegas appealing to the mayor’s office to finally get all this sorted out.

Three weeks in, Belmont Cragin has vaccinated 6,000-plus people, all at Steinmetz.

City officials have good reason to be proud of their vaccine equity work.

They’ve turned their numbers around.

But Vanessa says the mess with Steinmetz illustrates that even with everyone seemingly pushing toward equity, policies and details can threaten to undermine the whole effort.

VV: We have to change business as usual, right? We have to do things right that are going to really make an impact in our communities. So I’m glad that I’m not just saving the light pole right. Now I’m saving lives, and that is more fulfilling than a light. [laughs]

DG: When we come back, how other communities are dealing with vaccine inequities and how the new COVID relief bill could turbo charge those efforts.

BREAK

DG: Welcome back.

Vaccine equity has been a major talking point and priority for President Biden.

The administration is helping cities stand up mass vaccination sites and mobile units, sending extra doses to local pharmacies and community health centers in hard-hit areas.

Biden has also included billions of dollars for vaccines in his $1.9 trillion COVID relief bill — known as the American Rescue Plan — currently working its way through Congress.

Adriane Casalotti: There’s $7.5 billion that’s in there for state and local health department vaccine distribution, including things like community vaccination sites, mobile units, some of the data efforts.

DG: Adrian Casalotti is the chief of government and Public Affairs for the National Association of County and City Health Officials, which represents the nearly 3,000 local health departments across the country.

AC: There is an investment of $7.6 billion that could be used for public health workforce where we can start having the staff to do this work. Public health jobs are not ones that the robots can come take any time soon. So that workforce piece is absolutely critical, especially if we can hire people from the communities to which we want to be partnering.

DG: How should we think about that money, Adriane? How much of an impact should we expect that it’s going to have on the sort of racial disparities that we’re seeing?

AC: So the amount of money that’s in the American Rescue Plan is significant and it is important. And having those resources is critical. That’s how you pay for staff for both outreach, but also for actually doing vaccination. It’s how you can do longer hours, weekend hours. But the way that the bill needs to be written for some Senate procedural reasons, it doesn’t have a lot of meat on the bones. And so there’s not a lot that focuses those dollars specifically on equity. And so that decision making will be made by the CDC as well as, when you get down to the state level, the decisions made there about what’s the prioritization and what are we going to support.

DG: Adrian says for cities that end up getting more resources out of this latest package, Chicago could offer a roadmap for tackling racial disparities in vaccines.

AC: So, one, you know, focus on the data. Have that first. You need to be able to pinpoint the challenges, know the challenges, and then target your efforts better. That’s going to be, I think, one of the biggest hurdles for a lot of local health departments that are not Chicago, because you need to have either the academic partnerships or the internal staff who can run those numbers. But once you have that, and this is where I think all local health departments really can thrive in lots of different public health issues, is working with community based organizations and local leaders. So once you figure out we do have a problem, this is where we could target our efforts to make a difference, who do we have to have at the table to do that? The other piece I think is incredibly important to replicate in something that does take people, but it’s not waiting for people to register. You’re not sitting back behind a web portal or even at a phone bank waiting for people to contact you. In the Chicago example, they reached out directly to the folks they wanted to reach.

DG: So the money hasn’t quite arrived yet, but why in general do you think we’re not seeing more Chicagos right now?

AC: So people are doing things a little bit differently. But that political will that you see in Chicago is absolutely critical to move things on a large scale. So we saw in Dallas County, Texas, that they were looking at their registration data and they realized it was predominantly upper-class white residents who were getting who are registering. They wanted to figure out a way, how do we do this more equitably? And they came up with a plan to prioritize certain areas for vaccines. 

News clip: And an ultimatum from the state quickly followed: Rescind the plan or vaccine doses will be cancelled or limited.

AC: So they had to roll back that effort. So even in some of our largest cities, the political will is necessary at the local level, but also at the state level. And that can be a real challenge depending upon where you are.

DG: One of the lessons coming out of Chicago seems to be that if you really want to do this hard work of prioritizing underserved populations, elected leaders need to work with community groups in new ways. That requires its own kind of trust, a trust that in some instances has never been built before. Is that right?

AC: Yeah. I mean, what we see in communities right now is those that are able to leverage those relationships have built those relationships over time. Money coming in does not mean in 20 minutes trust is built. You can’t hire someone in 20 minutes. You can’t build trust with the community in 20 minutes. And it’s one of the reasons that we’ve really tried to help people understand if you don’t have the time, resources, people doing that in peace times for lack of a better term, it’s really hard to activate them now and build those relationships up. That being said, just because you don’t have them doesn’t mean you shouldn’t focus on it now, because whatever we can build for the coronavirus response can and should be maintained long-term to really help us in all aspects of public health moving forward. Even after the pandemic.

DG: Adriane, thank you very, very much for talking to us. 

AC: You’re welcome.

DG: So far, limited supply has been the biggest barrier to getting people vaccinated regardless of who they are or where they live.

That should change soon with a new vaccine approved and President Biden saying this week that any adult in America who wants a shot should be able to get one by the end of May.

But more doses alone will not fix racial disparities in vaccinations or the rest of our public health system.

I’m Dan Gorenstein, and this is Tradeoffs.