I tried and tried again, but between dwindling supplies, huge demand, and difficulties with the dating website, each time I failed.
On Tuesday, New York City Health Commissioner Ashwin Vasan said 9,200 vaccination appointments were full in just seven minutes after they went live last week. It is therefore not surprising that the New York City Department of Health decided to switch from its two-dose vaccination strategy to a single-dose strategy. Vasan said the agency hasn’t given up on the second hit but is focusing on the first hits for now.
Demand exceeding supply is a problem we could have avoided; demand was and is largely predictable, as cases in the United States are still mostly limited to men who have sex with men (MSM) – many of whom identify as gay, bisexual or transgender. And studies consistently show that LGBTQ people are far more likely to get vaccinated than our heterosexual peers, including getting vaccinated against Covid-19.
There is no doubt that there is an urgent need to accelerate the delivery and distribution of more vaccines. But, as a gay doctor-in-training who has cared for LGBT people in low-income and immigrant neighborhoods, I’m concerned that our current approach to rationing available vaccine supplies is unfair and disadvantages people who might need it the most.
Above all, we must prioritize the distribution of vaccines in black and brown communities. This is not only about opening sites in predominantly minority neighborhoods, but also about ensuring that the people who live there can to access
their. The latest surveillance data from the New York Department of Health shows that non-white people account for a larger share of known cases of monkeypox than white people. Additionally, 2 in 5 cases are outside of Manhattan and Staten Island, in predominantly non-white boroughs. Other cities, such as Atlanta, appear to have a similar racial/ethnic disparity among known cases, with black people being more affected.
Yet, based on what I have heard from black and brown peers and patients, and corroborated by what is happening reported anecdotally on social media
, people of color seem to have a really hard time getting vaccination appointments. As more doses become available in the future, we need to adjust our distribution strategies so that these people and their communities are not further blocked
. Disseminating anonymized socio-demographic information about who receives vaccines and in which neighborhoods can help ensure that minority neighborhoods are reached.
We also need to complement the current approach in many cities of online-only, first-come, first-served scheduling portals with pre-registration (as Washington, DC does) and walk-in options. As we saw with the rollout of the Covid-19 vaccine, the online first-come, first-served system puts anyone who has a job or other obligations that prevent them from logging on the minute appointments at a disadvantage. -you are freed, as well as people with unstable housing who often do not have access to digital technology.
There are also still a good number of MSM who value anonymity and discretion over health. I’ve seen this not only in my own patient group, but in conversations with people online. Many of these people do not feel comfortable with the digital traceability of online portals. We are doing people a disservice if we don’t employ different and more discreet strategies such as walk-in dates without online registration.
Linguistic equity is also important when disseminating information about vaccine updates, especially in urban centers like New York, which are linguistically diverse. I know several gay men who only speak Mandarin or Portuguese and have had trouble understanding the updates posted on vaccine availability. Although web pages can often be translated, cities should ensure that monkeypox information and vaccine availability updates effectively and accurately reach those who are not native English speakers.
Finally, current eligibility criteria encourage immunocompromised people to seek out vaccines, but they are not prioritized in a first-come, first-served scheduling portal, despite some preliminary data indicating that immunocompromised people – including those from uncontrolled illnesses or poorly controlled HIV – can have more serious consequences from monkeypox. We should prioritize vaccinations for these people.
The monkeypox situation is changing rapidly. In New York, we went from one case in May to over 600 by mid-July. And even though the majority of known cases have been in adult males, New York State Department of Health Commissioner Dr. Mary Bassett mentioned in a recent town hall that health officials are starting to see cases in children. . The renewed emphasis on vaccination as well as primary prevention will be essential to curb the spread of the virus in different groups.
There is no perfect, one-size-fits-all solution to all vaccine delivery challenges that meets everyone’s needs. But it’s especially important to me, as an immigrant and a doctor-in-training, 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 help ensure that access to resources is equitable for all New Yorkers.