During the 2009 swine flu pandemic, Columbia placed and received an order of 1,200 H1N1 vaccines before December 10 to distribute to students on campus. Initial vaccine shipments began in early October to medical facilities and uniformed personnel, but Barnard began administering vaccines as early as November 16. These colleges, particularly Columbia, had ample supply before the middle of December—when local pharmacies and residential facilities received their vaccines.

Source: Columbia Spectator Archive

Source: Columbia Spectator Archive

Source: Columbia Spectator Archive

Additionally, several schools around Columbia were forced to close due to the swine flu pandemic, but the University continued schooling operations as normal throughout the pandemic season. Columbia’s Pandemic Preparedness Working Group ensured that the campus was routinely disinfected and safe for students in order to prevent transmission of the virus. Most of Columbia’s neighbors had no such privileges.

Eleven years later, the worldwide hunt for a COVID-19 vaccine continues with a goal to mass-produce one by 2021. COVID-19 vaccines are already in phase testing, with one vaccine from the Chinese company CanSino Biologics Inc. approved for limited release; clinical trials are underway for 26 vaccines. According to experts, the timeframes of approval are uncertain.

Experts say that when a vaccine is approved, its high demand and expected short supply upon release will raise questions of accessibility—an issue that low-income communities faced during the swine flu pandemic.

Manufacturers may actively seek out affluent communities for trial runs of new vaccines, placing lower-income groups at a disadvantage, according to Merlin Chowkwanyun, a professor at the Mailman School of Public Health.

“The normal situation is that if you have a lot of money and if you have excellent healthcare, you usually get [a vaccine] first,” Chowkwanyun said.

Low-income residents in Manhattanville and Hamilton Heights have significantly less access to healthcare facilities with proper insurance coverage compared to their counterparts in Morningside Heights. Furthermore, the income disparity between these two areas is almost 50 percent.

Influenza vaccines in Manhattan typically cost upward of $25. Some drug stores, including CVS, Rite Aid, and Walgreens charge up to $40.

Disadvantaged communities—who also face higher risks of contracting the virus and less access to emergency medical attention—are more likely to face the brunt of imbalanced vaccine distribution. Maritta Dunn, a member of Community Board 9, an advisory board that represents Morningside Heights and surrounding areas, saw this firsthand during the swine flu pandemic. Finances played a major role in determining who had access to the vaccination.

“Money talks. [Those] who had the most money received the most attention,” Dunn said. “So, even if you were a middle-income family, you still would not have been in an area to compete with Columbia or Barnard. You just couldn’t.”

The price of immunity

While Pfizer has stated that the price of its COVID-19 vaccine will likely be around $40, the price, insurance coverage, and overall financial accessibility of the vaccine is still not fully known. According to Shawn Brown, the director of the Pittsburgh Supercomputing Center, who co-authored a paper explaining the consequences of inequitable vaccine distribution, “Rich people get vaccines first because they’re the ones that are giving [pharmaceutical companies] the money. And they’re willing to pay for it.”

“In a shortage, that could be a problem because … [lower-income areas are] more connected [so] disease spreads faster through there,” he said.

During the swine flu pandemic, each state distributed a limited supply of vaccines to initial target groups on a per capita basis. About 159 million of the most vulnerable to the virus and essential workers were prioritized.

However, due to inadequate infrastructure, geographical or socioeconomic barriers, and cultural differences, racial and ethnic minorities—as well as uninsured and low-income residents—were vaccinated comparatively less than other groups nationwide.

For instance, south Los Angeles County, with a median income similar to that of West Harlem, received one dose for every five people, while west Los Angeles County, with a median income similar to that of Morningside Heights, received one dose for every two people. In New York City, residents in high-poverty areas fared worse during the H1N1 pandemic than those living outside them. They comprised approximately half of the hospitalized H1N1 patients in the city.

Projected H1N1 vaccination allocations based on median income level

Based on the statistical similarities between the median incomes of the Los Angeles counties

cited to Morningside Heights and West Harlem. Proportionality of vaccine distribution and

population size is assumed.

In Morningside Heights,

with a median income of

$81,890,

In West Harlem,

with a median income of

$42,563,

one dose per five residents

one dose per two residents

Projected H1N1 vaccination allocations

based on median income level

In West Harlem,

with a median income of

$42,563,

In Morningside Heights,

with a median income of

$81,890,

one dose per two residents

one dose per five residents

Based on the statistical similarities between the median incomes of the Los Angeles counties

cited to Morningside Heights and West Harlem. Proportionality of vaccine distribution and

population size is assumed.

Projected H1N1 vaccination

allocations based on median

income level

In Morningside Heights,

with a median income of

$81,890,

one dose per two residents

In West Harlem,

with a median income of

$42,563,

one dose per five residents

Based on the statistical similarities between the

median incomes of the Los Angeles counties cited

to Morningside Heights and West Harlem.

Proportionality of vaccine distribution and

population size is assumed.

Experts say that to quickly and effectively reach coronavirus immunity for a large portion of the United States, at least 7,300 community clinics should be established nationwide to vaccinate 70 percent of the population. If the United States and New York, in particular, do not open more clinics in underserved communities, low-income residents like those of West Harlem may have fewer opportunities to be vaccinated.

Even if low-income people are able to afford the vaccine, they are still at a disadvantage when it comes to getting vaccinated. The number of uninsured residents in West Harlem is more than double that of Morningside Heights.

Health insurance coverage of

CD9 residents

Health insurance coverage of

Morningside Heights residents

Health insurance coverage of

West Harlem residents

ce: American Community Survey

Health insurance coverage of

ce: American Community Survey

Despite there being 13 existing vaccination locations across Community District 9, only one—in the wealthier Morningside Heights—accepts patients without insurance.

represents one

health clinic servicing

flu vaccinations

Vaccination locations by

neighborhood populations

1 clinic per 10,619 residents

1 clinic per 9,547 residents

8 locations

Population: 76,373

5 locations

Population: 53,094

Although West Harlem has

more uninsured residents

than Morningside Heights,

there are no vaccination

locations that accept

uninsured patients.

San Juan Pharmacy

of Morningside

Heights, is the only

location within CD9

that accepts

uninsured patients.

Barnard College

Primary Care

Columbia University

Medical Services

Source: NYC Open Data, NYC Health Map, NYC Population FactFinder

Due to inconsistencies in city databases, only data points from all sources with locations < 1.0 mi from Neighborhood Tabulation Area (NTA) boundaries are included.

Vaccination locations by

neighborhood populations

represents one health clinic

servicing flu vaccinations

West Harlem

8 locations

Population: 76,373

1 clinic per 9,547 residents

Although West Harlem has

more uninsured residents

than Morningside Heights,

there are no vaccination

locations that accept

uninsured patients.

Barnard College

Primary Care

Columbia University

Medical Services

San Juan Pharmacy of Morningside Heights,

is the only location within CD9 that accepts

uninsured patients.

Morningside Heights

5 locations

Population: 53,094

1 clinic per 10,619 residents

Sources: NYC Open Data, NYC Health Map,

NYC Population FactFinder

Note: Due to inconsistencies in city databases, only data points from all

sources with locations < 1.0 mi from Neighborhood Tabulation Area (NTA)

boundaries are included.

Vaccination locations by

neighborhood populations

Note: Due to inconsistencies in city databases, only

data points from all sources with locations < 1.0 mi

from Neighborhood Tabulation Area (NTA)

boundaries are included.

represents one health clinic

servicing flu vaccinations

West Harlem

8 locations

Population: 76,373

1 clinic per 9,547 residents

Although West Harlem has

more uninsured residents

there are no vaccination

locations that accept

uninsured patients.

Barnard College

Primary Care

Columbia University

Medical Services

Morningside Heights

5 locations

Population: 53,094

1 clinic per 10,619 residents

San Juan Pharmacy of

Morningside Heights, is the only

location within CD9 that accepts

uninsured patients.

Sources: NYC Open Data,

NYC Health Map,

NYC Population FactFinder

Within New York, a quarter of Hispanic people are uninsured; the majority of CD9 residents are Hispanic, according to census data. Moreover, a fifth of New York residents fall below the government poverty threshold, and an average 21.5 percent of New Yorkers who fall below 200 percent of the federal poverty level are uninsured.

Manhattan Community District 9 racial breakdowns

Morningside

Heights

residents

Manhattan Community District 9

residents under poverty threshold

Residents below

poverty threshold

Residents above

poverty threshold

Within CD9, 17.5 percent of

residents that fall below

the poverty threshold are

from West Harlem.

ce: American Community Survey

Manhattan Community

District 9 racial breakdowns

Morningside

Heights

residents

Manhattan Community District 9

residents under poverty threshold

Residents above

poverty threshold

Within CD9,

20,936

West Harlem

residents fall

below the poverty

threshold.

ce: American Community Survey

Access to health care facilities also contributes to the accessibility of vaccines. Some insurance policies restrict where holders can receive preventative care, which could further exacerbate inaccessibility to health care facilities.

According to Chowkwanyun, it is likely that the COVID-19 vaccine will be covered by Medicaid, a federal and state health program that allows low-income residents to afford vaccines and other health services. But facilities that serve Medicaid recipients are often under-resourced and overcrowded.

“The problem is that if you have Medicaid, you’re often going to facilities where you might have to wait for a very long time because the facilities that tend to accept Medicaid tend to have really long queues, be under-resourced, and understaffed,” he explained. “So you might be eligible for the vaccine on paper, but it might actually take you a lot longer to get to it compared to someone with a fancy health insurance plan that allows them to go to a private practice where they can get it immediately,” he added.

[Related: Segregation exposes Black residents to health risks. Hospitals are disincentivized from treating them.]

What does all of this mean for COVID-19?

In response to the COVID-19 pandemic, the federal government established Operation Warp Speed with a mission to deliver 300 million efficient COVID-19 vaccines to the U.S. by January 2021.

According to Chowkwanyun, there are many debates centering around who should get the vaccine first. Several groups considered for priority among others include older people, essential workers, and people in demographic groups that have higher rates of contracting the virus, such as Black and Hispanic people. However, the plan does not explicitly state whether or not low-income communities would be prioritized.

Brown noted that the projected use of pandemic flu planning procedures to distribute the vaccines will likely mimic the swine flu pandemic. “My guess is that [the federal government] is planning on giving the [vaccine] to the states, and the states are then left in charge of distributing them [to the people],” he said.

Priority of H1N1 vaccine distribution

– Ages 6 months to 24 years

– Healthcare and emergency medical personnel

– Those in close contact with infants

– Pregnant women

– Ages 25-64 with health conditions

– Those caring for groups above

Source: Centers for Disease Control and Prevention

Priority of H1N1 vaccine distribution

– Ages 6 months to 24 years

– Healthcare and emergency

– Those in close contact with infants

– Pregnant women

– Ages 25-64 with health conditions

– Those caring for groups above

Source: Centers for Disease Control and Prevention

Priority of H1N1 vaccine distribution

– Ages 6 months

– Healthcare and

Source: Centers for Disease Control and Prevention

During the swine flu pandemic, Brown worked on an intensive model designed to observe the outcomes of different scenarios of the vaccine distribution in a shortage. His research concluded that it was critical for low-income communities to be considered as essential priorities in vaccination.

When only the wealthiest counties received vaccinations, the total rate of infection was higher throughout the pandemic, with a larger quantity infected during the H1N1 virus’s peak.

Although this was a simulated model, it spelled out a quintessential message for public health experts: Delaying low-income communities’ access to vaccinations can prolong a pandemic, increasing rates of infection and, potentially, the number of deaths.

“If you want to stop the spread of the disease, the best thing for everybody is to stop it in the most vulnerable populations as quickly as possible,” Brown added.

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