I tried and tried again, but between dwindling supplies, overwhelming demand, and difficulties with the dating website, I failed every time.
On Tuesday, New York City Health Commissioner Ashwin Vasan said 9,200 vaccination hours were fully booked in just seven minutes after they went online last week. It should come as no surprise, then, that the New York City Health Department decided to switch its two-dose vaccination strategy to a one-dose strategy. Vasan said the agency has not rejected the second photo, but is focusing on the first photos for now. Demand outstripping 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 have consistently shown that LGBTQ individuals are far more likely to get vaccinated than our heterosexual peers—including getting the Covid-19 vaccine.
There is no doubt that there is an urgent need to speed up the delivery and distribution of more vaccines. But as a gay physician-in-training who has cared for LGBT people in low-income and immigrant neighborhoods, I worry that our current approach to allocating available vaccine supplies is unfair and disadvantages people who might need it the most.
First and foremost, we must prioritize the distribution of vaccines in black and brown communities. This includes not only opening sites in predominantly minority neighborhoods, but also making sure that the people who live there have access to them. Recent New York City Department of Health surveillance data show that non-white individuals make up a greater proportion of known cases of monkeypox than white individuals. Additionally, 2 out of every 5 cases are outside of Manhattan and Staten Island, in areas that are predominantly non-white. Other cities, such as Atlanta, appear to have a similar racial/ethnic disparity among known cases, with black individuals more affected. Yet, based on what I heard from black and brown peers and patients, and confirmed by anecdotal reporting on social media, people of color seem to have a lot of difficulty securing vaccination appointments. As more doses become available in the future, we must adjust our distribution strategies so that these individuals and their communities are not further disadvantaged. Releasing anonymized sociodemographic information about who is getting the vaccines and in which neighborhoods can help ensure that minority neighborhoods are reached. We also need to supplement the current multi-city portal approach of first-come, first-served, online-only schedules with pre-registration (as Washington does) and walk-in options. As we have seen with the spread of the Covid-19 vaccine, the first-come, first-served online system disadvantages anyone who has work or other commitments that prevent them from going online when classes are available, as well as people with unstable housing who often do not have access to digital technologies.
There are still plenty of MSM who prioritize anonymity and discretion over health. I have seen this not only in my own pool of patients, but also in conversations with people online. Many of these people are not comfortable with the digital tracking of online portals. We’re doing people a disservice if we don’t use different, more discreet strategies, like making appointments without online registration.
Language equity 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 who struggle to understand the published updates on vaccine availability. Although web pages can often be translated, cities must 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 are not prioritized in a scheduling portal on a first-come, first-served basis, despite the fact that some early evidence suggests that those who are immunocompromised – including from uncontrolled or poorly controlled HIV – can have more serious outcomes than monkeypox. We need to prioritize vaccinations for these individuals. The monkeypox situation is evolving rapidly. In New York, we went from one case in May to over 600 in mid-July. And although the majority of known cases have been in adult men, Dr. Mary Bassett, commissioner of the New York State Department of Health, mentioned in a recent town hall that health officials are starting to see cases in children. A renewed emphasis on vaccination, as well as primary prevention, will be critical to limiting the spread of the virus in various populations.
There is no perfect, one-size-fits-all solution to vaccine distribution challenges that will meet everyone’s needs. But for me, as an immigrant and physician-in-training, it is especially important to be able to advocate for the needs of the disadvantaged groups I serve. I must ensure their visibility in the public health system to ensure that access to resources is equitable for all New Yorkers.
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