Elected officials and public health officials at the Beach 39th Street Vaccine Hub in Far Rockaway (photo: @JCCofRP)
Despite pouring tens of millions of dollars into "credible messengers," targeted outreach, pop-up and in-home vaccination sites, and door-to-door canvassing, New York City health officials have struggled to boost covid vaccination in some historically underserved and overlooked neighborhoods. Among them is Far Rockaway, Queens, one of the places most severely impacted by the pandemic in terms of infection, death and economic turmoil.
In Far Rockaway and other areas like it, where healthcare disparities have existed for decades, limited access to medical care, misinformation, and reported mistrust in the vaccine and government have depressed vaccination rates for months. Only 35% of residents in the zip code, 11691, a church- and synagogue- studded, semi-suburban section on the eastern end of the Rockaway peninsula, have been fully vaccinated, the lowest of any New York City zip code. The city average is 57%. (Forty-two percent of 11691 residents have received at least one dose of the vaccine, compared to about 64% citywide.)
Mayor Bill de Blasio and top health officials have said the city has deployed all the "tools" at its disposal to overcome those obstacles in the 33 neighborhoods across the city identified as hardest hit by the pandemic. Almost all of them, including Far Rockaway, have suffered from a history of housing segregation, underinvestment, and government neglect. Recent reporting on Far Rockaway and commentary from de Blasio and other politicians have focused on vaccine mistrust in Black communities but testimony from local service providers indicates gaps in the city's approach to encourage vaccination, particularly its effort to engage those providers in grassroots outreach -- a key pillar of New York's pandemic response.
"We know the Black community was hit very, very hard by Covid. There's a lot of pain. There's a lot of distrust. There's a lot of historical distrust. There's a lot of misinformation out there in all communities," de Blasio told reporters at an August 5 news conference in response to a question about the low vaccination rate among Black New Yorkers, which was just 39% citywide as of August 24.
When asked about misinformation around masks and vaccines two weeks earlier, the mayor said the city would be redoubling efforts to inform and encourage vaccination. "We're going to be more and more sharp about that and use more and more tools to get people vaccinated," he said at a July 20 news conference. At the time and in appearances since, de Blasio touted the city's $100 reward for people getting vaccinated at city sites and for organizations that make referrals. The city has also sought to use vaccine-or-testing requirements to pressure municipal employees to get inoculated and has instituted vaccine mandates for patrons of many private businesses. But many of the city's methods have come up short. At the same July 20 briefing, de Blasio got frustrated with reticent communities.
"We will come to your door for free and vaccinate you in your home. I mean what more do we have to do here at this point? This is getting insane," he said.
Far Rockaway, one of the targeted neighborhoods, has the city's fourth highest rate of Covid-related death per capita; one in every 124 residents has died, according to city data. The eastern end of the peninsula is isolated, with a single hospital and high rates of diabetes, heart disease, and obesity. On the western end is Breezy Point, an affluent and almost entirely white neighborhood, with a vaccination rate of 80%.
According to spokespeople for the Department of Health and Mental Hygiene (DOHMH), which leads the citywide vaccination effort, the de Blasio administration has dispatched pop-up sites and mobile vans to public housing, retirement communities, and houses of worship in the 33 hard-hit neighborhoods. DOHMH has enlisted local organizations and an army of door-knockers and phone bankers to conduct outreach. The department has launched media campaigns in multiple languages, and de Blasio and now-former Governor Andrew Cuomo announced a series of mandates and incentive programs to induce residents to get inoculated. In late June, the city expanded it's at-home vaccination service, originally for homebound New Yorkers, to all residents.
The city has also been providing grants to community-based organizations -- the "trusted" or "credible messengers" -- to inform and encourage people to get vaccinated. Spokespeople for lawmakers representing Far Rockaway, including Council Member Selvena Brooks-Powers, Senator James Sanders, Jr., and Assembly Member Khaleel Anderson told Gotham Gazette they were working with city and state health departments and their constituents to boost vaccine rates.
"What we're finding is the best way to close that gap is a lot of education, a lot of information, getting trusted messengers out, talking to people in their own community from their own community, doctors and pediatricians talking to their patients directly," Mayor Bill de Blasio said at a June 1 press conference.
"We can put up advertising all day long, different types of posters, whatever that helps. But getting community-based organizations to make it a priority to go out and reach people, that really, really helps," he told reporters two weeks later in response to a question specifically about Far Rockaway. "It's going to take persistence and just intense, constant effort at the grassroots."
But those methods have yielded meagre results in Far Rockaway. Conversations with public health officials and local organizations raise questions about the efficacy of the city's approach and the extent of its reach on the peninsula.
Local elected officials and community providers have reported failed pop-up sites on NYCHA campuses and frustrated door-knockers across the district. The at-home vaccination program in Far Rockaway is virtually non-existent: by August 11, only 152 residents in the zip code had been vaccinated in their homes, according to DOHMH.
It is also unclear how much funding to-date has gone to covid vaccine outreach because the de Blasio administration has not released all of that information. The city budgeted roughly $30 million for door-to-door canvassing, phone and text banking, and community-based organizations in fiscal year 2021, which ended in June, according to Laura Feyer, a spokesperson for the Mayor's Office of Management and Budget. Feyer said she could not share what funding had been budgeted for vaccine outreach in fiscal year 2022 but did say an additional $73 million had been spent on advertising since January.
The department appears to be scrambling to tap resources on the ground nine months after the vaccine became available in New York.
According to DOHMH spokespeople, in the second week of August alone, Far Rockaway had five mobile vaccination sites deployed. But the department would not share information on where those deployments took place, making it difficult to follow-up on their successes or failures. The department also would not share a list of which NYCHA facilities, retirement communities, or houses of worship had hosted pop-up sites -- or even an example of one -- despite multiple Gotham Gazette inquiries over several weeks. Nor did the department provide a full list of the 15 community-based organizations spokespeople said were operating in the zip code. When pressed, a spokesperson provided the names of only eight groups, noting the list was "in flux" with more grants going out "soon."
Of those eight CBOs, at least one -- Public Health Solutions -- confirmed through a spokesperson that it was not operating in 11691. Another, Maspeth Town Hall, Inc., a community center and service provider in Central Queens, was tapped to do outreach in Far Rockaway this year despite not being based in the community. A spokesperson for the Mayor's Office of Management and Budget could not say how much funding has gone to community-based organizations for outreach in the current fiscal year, which began July 1.
"That's why we weren't [originally] targeted to go there," said Sean Kearney, Maspeth Town Hall's director of operations, in a phone interview last week. "They put us on 16 [zip codes, including in Far Rockaway] because they were very in need. But, no, we don't have any services [in Far Rockaway]."
The organization mainly serves Corona, Ridgewood, Woodside, Glendale, Maspeth, and Middle Village. Since 2020, it has received over $450,000 in city funding to do testing- and vaccine-related outreach, according to Kearney. Under it's latest grant, running from July through December, Maspeth Town Hall was not contracted to work in Far Rockaway, but in recent weeks DOHMH has expanded that mandate to the peninsula, coinciding with increased media attention including Gotham Gazette inquiries about CBO engagement there. "The past two weekends, Test and Trace has emphasized that we can do weekend events. So the past two weekends we've been in Far Rockaway," Kearney said.
"There are community based organizations, subcontractors and individuals doing an enormous amount of work," wrote Patrick Gallahue, a DOHMH spokesperson, in an email to Gotham Gazette. "Organizations did a magnificent job setting up local operations and developing partnerships."
"They deserve a lot of credit for their work," he added.
Some advocates have argued that by partnering with large, but not locally-based, nonprofits, the city may be missing an opportunity to reach residents when they receive other services -- the very crux of the trusted messenger approach. It means the trust in messengers may be only skin-deep, reflected in one-time interactions on a street corner or at an event, without the possibility of follow-up.
Fortune Society, another group receiving city funding, is based out of West Harlem and Long Island City, Queens, but does have some clients on the peninsula and operates some scatter site housing there.
"Our staff...are largely members of the Black and Latino communities and what they found is they tend to engage more with members of the same racial, ethnic group," said Brittany Smith, Senior Director of Education and Training, who heads Fortune Society's vaccine outreach program. "That was one of the key [reasons] why the trusted messenger approach was emphasized."
Far Rockaway has close to 70,000 residents in 21,000 households, according to Census Bureau data. The zip code is home to large Caribbean and Jewish populations, with 30% of residents born overseas. About a fifth of the population are living below the poverty line with an even higher rate among seniors.
Reports of mistrust in the vaccine are common and reflect a long history of government neglect and medical inequity among Black communities, which make up nearly half of the Far Rockaway population. But mistrust only tells part of the story and lends itself conveniently to blaming the very populations who have persistently endured poor medical representation.
"Some of it is lack of access to adequate health care to begin with," Smith told Gotham Gazette. "Individuals are like, 'I have all these health issues and you want me to do something else on top of everything I'm taking and everything that I'm going through.' But they may not even be actively seeing a primary care doctor or have great health resources within the community."
Smith said the grim reality was that trauma was the biggest motivator she's seen. "We've seen the most people engaged from individuals who may have lost someone."
According to DOHMH's 2018 Community Health Profile (the latest available), 11% of adults in the Rockaways (including Far Rockaway and Breezy Point) were uninsured and 10% reported going without needed medical care in the previous year -- both in line with citywide averages. In 10.3% of live births, expectant mothers received late or no prenatal care, compared to 6.7% citywide, according to the report. HPV vaccination in the Rockaways drastically trailed the citywide rate and flu vaccination also lagged.
"Let's meet people where they are so that we can remove the barriers that are preventing people from receiving their vaccine," said Brooklyn Borough President Eric Adams, the Democratic nominee for mayor, at a news conference on August 5 outside the Beach 39th Street Vaccination Hub, one of a handful of permanent vaccine sites in the neighborhood. "Because you have to remove those barriers," he said, lauding the city's pop-up and mobile sites.
The city has done significant door knocking, which some providers and local elected officials have said are largely unsuccessful. At Redfern Houses, a NYCHA complex in the northeast corner of the zip code, canvassers failed to generate buzz for vaccines, even when a mobile site was situated on the premises, according to Queens Borough President Donovan Richards, who until December represented the district in the City Council.
"Redfern Houses-- we put a van right outside and very few people, even with going door to door, actually came downstairs to get the vaccine," said Richards, flanked by other local elected officials and representatives from DOHMH's Task Force on Racial Inclusion and Equity, at the August 5 press conference. "There's still a lot of hesitancy," he said.
"Think about yourself. If somebody rings your bell or knocks on your door you're always suspicious," Kearney, of Maspeth Town Hall, said. "We sometimes can get some people in the street when they're passing by, sometimes we go into stores, so we're being as creative as possible." He noted the events co-sponsored with other community groups generated the greatest enthusiasm among residents, while canvassing was the least effective.
Nevertheless, as of August 11, city vaccine canvassers knocked on over 70,000 doors in the eastern portion of the Rockaway peninsula, from Belle Harbor to Far Rockaway, and the archipelago known as Broad Channel. In roughly the same area, the health department made approximately 100,000 phone call attempts to residents and sent over 30,000 texts with information on getting a vaccine. The department has held close to 100 events in the Rockaways, including "canvassing, tabling, speaking engagements and virtual briefings," according to a DOHMH spokesperson.
DOHMH officials would not provide a breakdown of how many residents had received shots at pop-up or mobile sites.
Communities Driving Recovery, a citywide coalition of community-based organizations doing grassroots work throughout the pandemic, claims the city and state have overlooked its members for outreach, including in Far Rockaway, despite their ability to follow-up with clientele.
“Instead of re-inventing the wheel with large outside organizations who would first have to get up to speed, the city should use the existing infrastructure of community groups working with it on COVID testing and vaccination to now, finally, launch effective interventions to offset the unprecedented health crises spawned by the COVID epidemic,” said Chris Norwood, a leader of the coalition and the executive director of the Bronx-based healthcare agency, Health People, in a statement. The coalition is pushing the city to invest an additional $54 million in CBO outreach.
According to C. Virginia Fields, the former Manhattan borough president and founder of the National Black Leadership Commission on Health, one of the most important trusted messengers in communities of color are houses of worship. "It is important for interventions and programs to be designed with the target community in mind and working with faith-based and other organizations that provide insight into how the needs can be met as well as direct access from a trusted institution in the community," she said in a statement on August 20. The National Black Leadership Commission on Health is one of the eight named organizations operating in 11691, according to DOHMH, and appears to be the only one that works formally with houses of worship, which are plentiful in the heart of Far Rockaway.
Denean Ferguson is the co-chair of the Far Rockaway/Arverne Nonprofit Coalition (FRANC), an association of local provider organizations, and the director of special projects at Arverne Church of God, a congregation of about 60 people in the heart of Far Rockaway. FRANC was tapped by the city to be an "authorized scheduler" in the spring to help residents set-up vaccination appointments, a designation that came with no city funding, Ferguson told Gotham Gazette. But her church, which is attached to a K-12 school, has not gotten city funding to do outreach, nor have most other FRANC members, she said, despite being well-positioned in the community. (FRANC is also a member of the Communities Driving Recovery coalition.)
"My advocating is around...support for the local, indigenous, community organizations that have been there doing the work," she said last week, over the phone, after the Summer Youth Employment Program she helps run with the NYPD's 101st Precinct let out for the evening. "I'm not talking about a free check to sit around and do nothing. I'm talking about groups that are already vested and at the table and giving you input and ideas and suggestions and corrections."
The mayor's office would not provide a breakdown of how much has gone out through the city's CBO grant program run by New York City Health + Hospitals' Test and Trace program. In a July 14 post on Twitter, Health Commissioner Dave Chokshi said the city has provided over $50 million to community- and faith-based groups "throughout the response to support with education, outreach and connection to services." In May, the health department announced $9 million would go directly to CBOs for vaccine outreach. In June, de Blasio announced a $4 million vaccine referral bonus for eligible organizations to receive $100 for every person they refer to get vaccinated at a city-run site, up to $20,000. Feyer did not say whether that $4 million came from the FY21 vaccine outreach budget or another pot.
According to the Health + Hospitals website, 41 CBOs citywide have received funding under the education and outreach grant program.
Ferguson said she wanted her church to participate in the referral program but administrative hurdles and delays in payment prevented it. Even so, the funding would be too little in the face of structural inequities in Far Rockaway, she said.
"You can't come in with your little grants...for one year or two years and think we're going to solve our community's problems that have been created by years of neglect and disservice," she said.