I tried and tried again but between dwindling supplies, high demand and difficulties with the appointment website, I failed every time.
On Tuesday, New York City Health Commissioner Ashwin Vasan said 9,200 vaccination appointments were booked up in just seven minutes after going online last week. It should come as no surprise, then, that the New York City Health Department has decided to switch its two-dose vaccination strategy to a one-dose vaccination strategy. Vasan said the agency did not discard the second shot but was concentrating on the first shot for now.
Demand exceeding supply is a problem we could have prevented; Demand was, and is, largely predictable, as cases in the US are still mostly limited to men who have sex with men (MSM) – many of whom self-identify as gay, bisexual or transgender. And studies consistently show that LGBTQ people are much more likely to be vaccinated than our straight peers — including the Covid-19 vaccine.
There is no doubt that the delivery and distribution of more vaccines urgently needs to be accelerated. But as a gay medical student who has cared for LGBT people in low-income and immigrant communities, I am concerned that our current approach to rationing available vaccine supplies is unfair and disadvantages those who may need it most.
First and foremost, we must prioritize vaccine distribution in black and brown communities. This includes not only opening locations in predominantly minority neighborhoods, but also ensuring that the people who live there can do so
Access She. Recent surveillance data from the NYC Department of Health shows that non-white people account for a larger proportion of known monkeypox cases than white people. Additionally, 2 in 5 cases occur outside of Manhattan and Staten Island, in counties that are predominantly non-white. Other cities such as Atlanta appear to have a similar racial/ethnic disparity between known cases, with blacks being more affected.
Yet based on what I’ve heard from black and brown colleagues and patients and corroborated by what is
reported anecdotally on social media, People of Color seem to have a very difficult time getting vaccination appointments. As more doses become available in the future, we need to adjust our distribution strategies to keep these individuals and their communities no further away
with special needs. Publishing anonymized socio-demographic information about who is receiving the vaccines and in which neighborhoods can help reach minority neighborhoods.
We also need to complement the current approach in many cities of first-come, first-served, online-only scheduling portals with pre-registration (like Washington, DC does) and walk-in options. As we saw with the launch of the Covid-19 vaccine, the online first-come, first-served system penalizes those who have work or other commitments that prevent them from getting online once appointments are released, as well as people with unstable housing who do this often do not have access to digital technology.
There are also still a number of MSM who value anonymity and discretion over health. I’ve seen this not only in my own patient pool, but also in conversations with people online. Many of these people are not comfortable with the digital traceability of online portals. We’re doing people a disservice if we don’t use other, more discreet strategies like walk-in appointments without online registration.
Linguistic fairness is also important when disseminating information about vaccine updates, especially in urban centers like New York that are linguistically diverse. I know several gay men who only speak Mandarin or Portuguese and have difficulty understanding published updates on vaccine availability. Although websites can often be translated, cities should ensure that monkeypox information and updates on vaccine availability reach non-native English speakers efficiently and accurately.
Finally, current eligibility criteria encourage people with immunocompromised conditions to seek vaccines, but they’re not given priority in a first-come, first-served planning portal, although some early data suggests those who are immunocompromised — including from uncontrolled or poorly controlled HIV – can have more serious consequences from monkeypox. We should prioritize vaccinations for these people.
The monkeypox situation is developing rapidly. In New York City, we went from one case in May to over 600 in mid-July. And although the majority of known cases have occurred in adult males, Dr. Mary Bassett, Commissioner of the New York State Department of Health, recently at a city hall that health officials are beginning to see cases in children. A renewed emphasis on vaccination as well as primary prevention will be crucial to contain the spread of the virus in different groups.
There is no perfect one-size-fits-all solution to vaccine distribution challenges that meets all needs. But as a migrant and doctor-in-training, it is particularly important to me to be able to speak up on behalf of the disadvantaged groups that I serve. I must vouch for their visibility in the public health system to ensure that all New Yorkers have equitable access to resources.
