Coronavirus

Chaotic Vaccine Rollout Highlights Healthcare Disparities in Miami

A healthcare worker administers the Pfizer vaccine at the Miami Dade College North Campus site.
A healthcare worker administers the Pfizer vaccine at the Miami Dade College North Campus site. Photo by Joe Raedle/Getty
It was the COVID-19 vaccination experience everyone hopes for: walk up, register, and get your shot in a matter of minutes.

No line. No confusion. No clawing for appointments online.

That's how it went on an afternoon late last week at the Overtown vaccine center. Smiling faces and celebratory selfies abounded as vaccine recipients walked out of the gate.

But noticeably absent from the scene were Overtown's own residents. In a neighborhood where three-fourths of residents are African-American, only three of the two dozen people who visited the vaccination site in the late afternoon hours were Black.


Most of the traffic consisted of well-off folks from outside the community. Luxury vehicle after luxury vehicle rolled up in front of a colorfully painted street mural alongside the site: A half-dozen Benzes, three Porsches, and a pair of BMWs pulled in within a 90-minute span.

Yet these vaccine recipients weren't jumping a line or taking the spot of a local resident. In fact, the intake tent was nearly empty around 3 p.m.

The demographic disparities on display have been well-documented throughout the chaotic vaccine rollout.

African-Americans are getting vaccinated at markedly low rates in Miami-Dade and Florida at large, compared to other demographic groups. And in a Pew Research national poll conducted last month, roughly 27 percent of "upper-income adults" versus 14 percent of "lower-income adults" said they'd been vaccinated.

State and federal officials have responded in Miami-Dade by placing more vaccine sites in predominantly Black neighborhoods. The Overtown site and the federally sponsored Miami Dade College location both opened at the beginning of March. Last week, the feds temporarily opened another site in Liberty City's Charles Hadley Park.

Still, the percentage of COVID shots that have gone to Black residents remains strikingly small in the county, according to the latest stats.

To date, 7 percent of the people who've received shots in Miami-Dade — about 47,000 people — are Black. That's despite the fact that the Black population comprises an estimated 16 percent of the county's residents.

The imbalance has persisted since the infancy of the vaccine rollout. And it's becoming evident that dropping vaccination sites in underserved neighborhoods does not necessarily translate into results in evening out those disparities.

Kenneth Goodman, a professor of bioethics at University of Miami, tells New Times that extending site hours and an aggressive campaign of door-to-door vaccinations might help. But demographic gaps in healthcare participation — decades in the making — won't be solved in a matter of weeks.

"The deck was already stacked. The system was broken before this pandemic, and we are stuck with these problems. The disparities are part of our state," he says. "If you're already disconnected from the communities you're supposed to be serving, figuring it out now in the middle of a pandemic is a day late and a dollar short."
click to enlarge Jackson Memorial Hospital's outreach program has turned into a "well-oiled machine." - PHOTO COURTESY OF JACKSON HEALTH SYSTEM
Jackson Memorial Hospital's outreach program has turned into a "well-oiled machine."
Photo courtesy of Jackson Health System
One of the few models that appears to be yielding results for vaccine equity is Jackson Memorial Health System's grassroots outreach program. Soon to enter its 12th week, the program connects Jackson Memorial with local churches and nonprofit organizations, with an eye toward actively recruiting people for vaccination.

Da-Venya Armstrong, an urban marketing consultant for Jackson Memorial, has helped build a deep network of contacts across churches and other cultural hubs. She actively engages with them to book vaccination appointments at three Jackson-run sites.

According to Armstrong, the outreach program has turned into a "well-oiled machine," with partners spanning from Miami Gardens to Overtown to Florida City.

"We are tying in with partners who already have bases of people," Armstrong says. "We are going one organization at a time, one church at a time. It's a hybrid of tie-in marketing and grassroots marketing."

Armstrong says putting a vaccination site in a neighborhood without doing community outreach is akin to releasing a new product with no advertising or promotion.

"I know we can move the needle," the Carol City native says. "People want to be informed. They want to be regarded and engaged."

City of Miami Commissioner Jeffrey Watson says mistrust — brought about by years of marginalization and systemic racism in healthcare — remains an obstacle.

Watson, whose district covers Overtown, Little Haiti, and Liberty City, just recovered from his own bout with the virus, which put him in the hospital for more than a week. In the first few months of the vaccine rollout, he advocated for mobile vaccination units and local TV campaigns to promote the COVID shots.

"It's important for local doctors to get involved in spreading the word as well. Not everybody is comfortable with going out under a big tent and having a stranger stick a needle in their arm," Watson says.

Viral posts on social media, meanwhile, have been breeding fear of vaccination. When 86-year-old baseball legend Hank Aaron died two weeks after receiving a COVID shot, social-media conjecture quickly spread, suggesting without evidence that the vaccine had killed him. Robert F. Kennedy, Jr. — an environmental lawyer and high-profile critic of vaccines — posted on Twitter that Aaron's passing was "part of a wave of suspicious deaths among elderly" people who had been vaccinated.

Armstrong believes the apprehension will slowly subside.

"As more people see someone that they know get vaccinated — and not coming out of it walking backwards or with a third eye — the needle will move," she says. "The internet and social media is what it is. People have to do their own research and come to the space on their own. I'm not here with a hammer telling people, 'You have to get a vaccine.' I want to speak to opportunity."

The February Pew Research poll found that 69 percent of white Americans and 61 percent of Black Americans responded that they have been vaccinated or plan to get vaccinated against COVID. That gap has tightened since late last year, when a Pew poll showed that only 42 percent of Black respondents said they intended to get vaccinated.

As of now, Jackson Memorial Health System has vaccinated nearly 131,000 people, more than 14 percent of whom identify as Black. That ratio closely reflects the demographics in the Miami area.
click to enlarge People without a computer or internet are struggling to learn about vaccine sites and book appointments. - PHOTO BY JOE RAEDLE/GETTY IMAGES
People without a computer or internet are struggling to learn about vaccine sites and book appointments.
Stanley Campbell, a Navy veteran and healthcare IT executive who grew up in Liberty City, doesn't much buy into the theory of "Black reluctance" as the primary explanation for the demographic disparities persisting three months deep into the vaccination effort.

Instead, Campbell sees internet access as a large and lingering barrier to vaccination in Miami. He says that for anyone without a computer or internet, finding out about vaccine sites and booking appointments remains a struggle, particularly for the elderly.

And in South Florida, that's a problem. A 2020 review by Florida International University suggested that Miami-Dade had the third-highest percentage of households without internet among the dozens of counties surveyed.

The City of Miami had the lowest rate of internet access and the lowest median household income among Florida's five most populous cities, according to the FIU review. Roughly 32 percent of Miami households lacked internet — a rate far worse than the comparably sized municipalities of Jacksonville and Tampa. The percentage of homes without internet stood at 36 percent for Black Miami residents.

Campbell, who runs a healthcare tech company called EagleForce, has proposed an initiative to distribute thousands of smartphones to financially struggling Miami residents. The devices would be equipped with EagleForce's healthcare application MyVax, which keeps track of personal health records while helping health officials monitor community vaccination trends.

"We ought to make it as easy as possible for these folks to participate. We need them. What we don't need is people on ventilators at Jackson Memorial just because they don't have access to a computer or smartphone," Campbell says.

Campbell, the brother of 2 Live Crew rapper and New Times columnist Luther Campbell, has also floated the idea of a universal vaccine registry.

Florida has a statewide booking site, MyVaccine.fl.gov, that coordinates with county departments to set vaccine appointments. But according to Campbell, fragmentation of appointment systems across private pharmacies, hospitals, and local health departments remains. That, he says, has created inefficiencies and exacerbated inequities in the last mile of vaccine distribution.

Centralizing the system would also tamp down on booking free-for-alls, wherein hospitals and private pharmacies list vaccine appointments online, only to have them filled in minutes, Campbell says.
click to enlarge All Florida adults will be eligible for a vaccine on April 5. - PHOTO BY JOE RAEDLE/GETTY
All Florida adults will be eligible for a vaccine on April 5.
This week, President Joe Biden's administration announced a $10 billion plan to "better serve communities of color, rural areas, low-income populations and other underserved communities" in the COVID response.

Funded in large part by the American Rescue Plan Act, the initiative includes a nearly $80 million allotment for Miami-area community health centers to expand coronavirus vaccination, treatment, and testing.

In another announcement this week, Florida Gov. Ron DeSantis said the minimum age for vaccination eligibility will drop to 40 on Monday, March 29. He plans to open up vaccination to all Florida adults the following Monday, April 5.

It remains to be seen what impact the shift will have on vaccination rates in Miami's underserved communities.

Goodman, the University of Miami bioethics professor, says it will take a long-term increase in public-health funding and a massive outreach program to iron out the demographic gaps in vaccination.

"It's difficult to rig this after the fact and ask, 'What's a good way to solve the problem that we've allowed to fester for generations?'" he says.
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Izzy Kapnick is a freelance writer for Miami New Times, covering environmental law, white-collar crime, and the healthcare industry. He has worked as a legal news reporter in South Florida since 2008.
Contact: Izzy Kapnick