Urban areas throughout the United States have been hardest hit by the COVID-19 pandemic, contributing to a major focus on increasing vaccine uptake. Despite ongoing discourse about vaccine hesitancy, vaccine access among underserved populations is underexplored. As of March 10, 2021, the New York City (NYC) Department of Health and Mental Hygiene reported that 1 250 370 residents had received at least 1 dose of a COVID-19 vaccine, including 19% of the non-Hispanic White population compared with a rate of only 9% among those who identified as African American/Black and Hispanic/Latinx.1 In this analysis, we review access to COVID-19 vaccination sites in Brooklyn, the most populated borough in NYC, to better understand disparities in vaccination.
Vaccination sites across Brooklyn were evaluated relative to population demographic characteristics and the NYC Government Poverty Measure for this cross-sectional study (Table 1). Demographic and financial data were based on the 2014 to 2018 American Community Survey. Race and ethnicity were self-reported. Vaccination site locations were extrapolated from the NYC Vaccine Finder website, and testing and vaccination data were retrieved from the NYC Health COVID-19: Data website. Descriptive statistics on vaccination rates and distance to sites (measured from the center of each zip code) were averaged (for a mean) for each zip code and included in 18 community districts in Brooklyn. All other tabulations, including demographic characteristics, poverty rates, and total number of vaccination sites, were calculated at the district level. To adjust for differences in population and size of the community districts, population density within each community district was divided by the total number of vaccination sites.
This study was conducted using publicly available data and, as such, did not require institutional review board approval or informed patient consent, in accordance with 45 CFR §46. This study has been compiled using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Data analysis was performed using R statistical software version 3.6.3 (R Project for Statistical Computing) from February to March 2021.
This study was implemented in Brooklyn, New York; among 2 604 747 residents, 1 346 395 (51.7%) identified as Latinx or Black and 1 368 835 (52.6%) were female;2 the median age was 35.1 years. At the time of data extraction, we identified 87 COVID-19 vaccination sites operating throughout Brooklyn.3
The median (range) number of vaccination sites (4 [0-5]) among districts with less than 40% White (non-Hispanic) race/ethnicity was less than the number of vaccination sites (6 [3-8]) among districts with greater than or equal to 40% White (non-Hispanic) race/ethnicity (Table 2). The median population density per site among districts with lower poverty was 6793.6 persons per square mile per site, compared with a ratio nearly double of 11 263.4 persons per square mile per site among districts with higher poverty. The higher vs lower poverty definition was a median cutoff: the 9 community districts with the highest poverty rates vs the 9 community districts with the lowest poverty rates (as defined by the NYC Government Poverty Measure). Of note, district 16 had the highest percentage of the population below the poverty threshold (29.4%) and has 0 vaccination sites.
The findings of this study suggest that there are substantial vaccination access deserts (areas without ample vaccination resources relative to surrounding areas).4 With many preliminary barriers to vaccination uptake, including supply issues, scheduling multiple doses, and a delay for scheduling appointments,5 vaccine rollout has been slow. Furthermore, early COVID-19 vaccination efforts in NYC have been focused primarily in White, middle-to-upper class neighborhoods, with the greatest access occurring in these areas.
The analysis presented is generally suggestive of disparities in vaccination site access. This study also had some limitations. The data on race/ethnicity and poverty were dichotomized and analyzed at the community level, and thus do not fully capture socioeconomic status.
Despite the limitations, this study makes a substantial contribution to the literature on vaccine uptake and underserved populations. Patterns of access and inequities, driven by structural determinants, have long existed in Black and Latinx and low-income communities. Without concrete, multilevel solutions, disparities in hospitalizations and deaths due to COVID-196 are likely to continue even while COVID-19 positivity rates continue to trend downward.1
Accepted for Publication: April 13, 2021.
Published: June 18, 2021. doi:10.1001/jamanetworkopen.2021.13937
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Williams N et al. JAMA Network Open.
Corresponding Author: Natasha Williams, EdD, MPH, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 7th Flr, New York, NY 10016 (natasha.williams2@nyulangone.org).
Author Contributions: Dr Williams had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Williams, Tutrow, Pina, Belli, Schoenthaler.
Acquisition, analysis, or interpretation of data: Williams, Tutrow, Ogedegbe, Schoenthaler.
Drafting of the manuscript: Williams, Tutrow.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Tutrow, Belli.
Obtained funding: Williams, Belli, Ogedegbe, Schoenthaler.
Administrative, technical, or material support: Williams, Tutrow, Belli, Schoenthaler.
Supervision: Williams, Belli, Ogedegbe, Schoenthaler.
Conflict of Interest Disclosures: None reported.
Funding/Support: Funding for this study was provided by a grant from the National Institutes of Health (NIH) RADx-UP R01MD013769S (Drs Williams, Schoenthaler, Belli). Dr Williams is also supported by NIH K23HL125939.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Samantha Fagan, BS, NYU Grossman School of Medicine Department of Population Health, for contributing to reviewing an earlier draft and literature search. No direct compensation was received for contribution to this manuscript.